MAiD in Canada
Medical assistance in dying in Canada — known variously as MAID and MAiD — was essentially enacted by the Trudeau government under a false pretence, as it was sold to the public on the basis that it was to be used in rare circumstances, carefully monitored and only available to people with terminal illness at the end of their lives. However, MAID has become the fifth-leading cause of death in the country. Moreover, eligibility for MAID was subsequently expanded to include people with non-terminal conditions: “Track 2”.
Under the Carney government, lethal injections are scheduled to be available for some people with mental illness in several months. “The eligibility date for persons suffering solely from a mental illness is now March 17, 2027“(Government of Canada).
Investigative journalist Sam Cooper at The Bureau has identified a number of existing concerns with the application of MAID in Canada — including evidence suggesting that socio-economic factors are driving its use by some vulnerable people — and he recently advocated for an external review of the program (From Exception to Routine. Why Canada’s State-Assisted Suicide Regime Demands a Human-Rights Review), which I fully support.
For transparency, I support MAID for people with terminal illnesses. However, I fundamentally object to MAID for mental illness for several reasons, as documented in my former submission to the Special Joint Committee on Medical Assistance on Dying (November 11, 2023).
It is simply not possible to accurately predict a person’s future mental health and quality of life. A fact eloquently addressed by Dr. K. Sonu Gaind, a professor in the Temerity Faculty of Medicine at the University of Toronto, former chief of psychiatry at Sunnybrook Health Sciences Centre and a past president of the Canadian Psychiatric Association, who stated: “The evidence shows that we are right less than half the time … That means that at least half the people who assessors say, ‘You’re not going to get better from mental illness, and you can get MAID,’ at least half of those people would have gotten better. Meaning we would have provided death under a false pretence” (National Post, November 6, 2023).
At a time when Canada’s deficit and debt are massive, and access to proper health care is increasingly difficult to find, the number of people opting for MAID is growing exponentially. According to health care scholar Sally Pipes: “Caring for patients with complex, chronic or terminal conditions is among the most expensive obligations in any health system. That creates an inherent tension in systems where the government both finances care—and decides what care is worth covering” (Forbes, April 6, 2o26).
The death of 26-year old Kiano Vafaeian on December 30, 2025, serves to raise a number of serious questions about the application of MAID in Canada: (Global Television, January 29, 2026): (National Post, January 30, 2026): (People, February 2, 2026): and (Newsweek, February 18, 2026). An article published in 2022 identifies that Mr. Vafaeian was originally approved for death by MAID at the age of 23 (The Free Press, October 11, 2022). The doctor who reportedly ended Mr. Vafaeian’s life by MAID has provided the same service to over 400 people and was formerly interviewed by Liz Carr for her BBC documentary (YouTube).
Following are published papers, statements and information about MAID, mental illness, stigma and mental health recovery provided by researchers, psychiatrists and other stakeholders — in reverse chronological order by year.
NOTE: I’ve included some of my own content for context, as there was a time when a lethal injection would have been a far more comfortable option that what I planned for myself. As addressed in a report by Australia’s House of Representatives Standing Committee on Education and Employment, I have personally been close to suicide (Work Wanted, June 28, 2012, p.19).
Ironically, I was on the brink of suicide while originally campaigning for an investigation into the File 1000-121 Affair, after the stigma of mental illness had been weaponized against me in the media, which was only made possible by cabinet ministers and then prime minister Jean Chrétien ignoring existing evidence of systemic corruption at the Canadian Radio-television and Telecommunications Commission (House of Commons, March 30, 1995).
Dying With Dignity. Get the Facts: Canada’s Medical Assistance in Dying (MAID) Law. Retrieved on June 5, 2026.
“Both nurse practitioners and physicians can provide MAID. Other health providers who assist with the process of assessing eligibility or administering MAID are also protected from liability. These practitioners include, but are not limited to, pharmacists, social workers, psychologists, therapists, hospital lawyers, and nurses. … Unlike assisted dying laws in some other jurisdictions, you do not need to have a fatal or terminal condition to be eligible for medical assistance in dying in Canada.”
“A London, Ont., doctor who assessed a patient with inflammatory bowel disease and a history of mental health issues for MAID outside a Tim Hortons location and later personally drove the man to the place his life was ended has agreed to a minimum six months’ supervision.”
“In another case, Dr. James MacLean failed to administer one of three drugs used in assisted deaths — one that paralyzes the body’s muscles, including the muscles involved in breathing. The patient resumed spontaneously breathing again after initially being pronounced dead, and after MacLean had already left the home.”
“[T]he doctor’s case is raising new concerns about MAID’s oversight and accountability.“What is striking is not only the seriousness of the concerns identified in these cases, but the limited regulatory response,” said Dr. Ramona Coelho, a family physician and former member of the Office of the Chief Coroner of Ontario’s MAID death review committee.”
Statement — Latest Data Confirm MAiD Has Gone from Exceptional to Routine (2025, December 2) Cardus.
“The data also point to dramatic growth in reports of social suffering. Almost 58 percent of Track 1 MAiD recipients and more than 63 percent of Track 2 recipients reported ‘emotional distress/anxiety/fear/existential suffering’ in 2024, a significant jump from around 39 percent and 35 percent respectively in 2023. Meanwhile, almost of half of those who died by MAiD in 2024 reported feeling like a burden on family, friends, or caregivers, maintaining the alarmingly high levels of previous years.”
Health Canada (2025) Sixth Annual Report on Medical Assistance in Dying in Canada
“MAID was administered by a practitioner in all cases that occurred in 2024. While self-administration of MAID is permitted in all provinces and territories in Canada (except for Quebec), very few people have chosen this option since 2016.”
“[A] critical weakness in Canada’s MAID framework—and, more broadly, in its healthcare system—must be addressed to prevent harm to eligible patients and safeguard their autonomy. This weakness lies in the provision and awareness of palliative care. … In jurisdictions where MAID is legal, it is crucial to ensure patients make informed, autonomous decisions regarding MAID rather than choosing it due to fear or desperation because of unbearable suffering. Therefore, ensuring equitable access to palliative care is not just a medical necessity but a moral and policy imperative to prevent vulnerable individuals from feeling that death is their only viable option. … The relationship between the availability of palliative care and MAID is complex. A study two years after the Death with Dignity Act (DWDA) was passed in Oregon, in the United States, found that 46% of patients who had requested a lethal prescription changed their mind when offered a ‘substantive palliative intervention’ (Ganzini et al., 2000). … In 2018, a federal framework on palliative care outlining guiding principles and goals for expanding palliative care was published. While seen as a positive development, the Canadian Institute for Health Information states that, while the situation is improving, the provision of palliative care across Canada still varies significantly. Their 2023 report states that ‘there are still signs of poor-quality palliative care, including people not getting palliative care until just before they die’.”
“Canada’s recent history involves unprosecuted admissions of illegal assisted suicide or homicide by clinicians who deemed the law unfair. Now legally protected under MAID, clinicians may sequentially take many lives by euthanasia, committing serial non-culpable homicide. It is reasonable to consider that without adequate oversight, some medical practitioners may be drawn to commit MAiD homicides for personal benefit and rationales that diverge from MAiD’s legal, bioethical, and medical justifications (Muldoon et al., 1982), with some suggestion that this could be occurring (Lyon, 2024).”
Calabro, E.P. (2025, August 11). Canada Is Killing Itself. The Atlantic.
“When Canada’s Parliament in 2016 legalized the practice of euthanasia—Medical Assistance in Dying, or MAID, as it’s formally called—it launched an open-ended medical experiment. One day, administering a lethal injection to a patient was against the law; the next, it was as legitimate as a tonsillectomy, but often with less of a wait. MAID now accounts for about one in 20 deaths in Canada—more than Alzheimer’s and diabetes combined—surpassing countries where assisted dying has been legal for far longer.”
“This study explores the potential economic savings from expanding medical assistance in dying (MAiD) in Canada, where it is currently a leading cause of death, to include vulnerable groups that cost the government more than they contribute in taxes. These groups include individuals with severe mental health issues, the homeless, drug users, retired elderly, and indigenous communities. Both voluntary and non-voluntary scenarios were analyzed, projecting total savings of up to CAD $1.273 trillion by 2047. With an estimated 2.6 million deaths in the voluntary scenario, mostly among mentally ill and elderly populations, this cost-saving measure raises significant ethical concerns.Financially incentivizing MAiD could shift healthcare priorities away from providing necessary support, potentially devaluing vulnerable lives and fostering a troubling reliance on assisted death as an economic solution. The findings highlight a need for ethical scrutiny of MAiD policy expansion.”
“Our results suggest monitoring should be aligned with its intended purposes, and the system should account for the fact that monitoring places burdens on practitioners. Monitoring provides important insights into practice, but its function is distinct from oversight. Jurisdictions that are considering, implementing, and/or evaluating their AD laws should develop systems to maintain the goals of monitoring while minimizing burdens on practitioners, where possible.”
“[T]he dual continuum model (Figure 2) proposes that mental wellbeing and mental ill-health are different though related experiences and people can simultaneously experience a level of mental wellbeing (low, moderate, high) and a level of mental ill-health (absent, mild, moderate, severe). Importantly, the model suggests that even if a person has some ongoing symptoms of a mental health condition, they can still experience a high level of mental wellbeing – a view that aligns well with the concept of recovery. The dual continuum model is backed by a large volume of research evidence.”
“Canada is one of several jurisdictions in the world that permit MAID, for persons meeting certain criteria. Unlike other jurisdictions allowing MAID such as the Netherlands, Canada does not explicitly require that MAID be a last resort, meaning that persons can be eligible for MAID even if there are reasonable, standard treatments or resources that would make their suffering tolerable but are inaccessible due to lack of availability, extended wait times, financial insecurity, or other reasons.”
Raikin, A. (2024) From Exceptional to Routine: The Rise of Euthanasia in Canada. Cardus.
“The number of Canadians dying prematurely by “medical assistance in dying” (MAiD) has risen thirteenfold since legalization. In 2016, the number of people dying in this way was 1,018. In 2022, the last year for which data are available, the number was 13,241.”
“MAiD in Canada is the world’s fastest-growing assisted-dying program.”
“MAiD is now tied with cerebrovascular diseases as the fifth leading cause of death in Canada. Only deaths from cancer, heart disease, COVID-19, and accidents exceed the number of deaths from MAiD.”
“Assisted dying was not meant to become a routine way of dying. Court rulings stressed that it be a “stringently limited, carefully monitored system of exceptions.” Then Minister of Justice and Attorney General Jody Wilson-Raybould agreed: “We do not wish to promote premature death as a solution to all medical suffering.” The Canadian Medical Association likewise stated that MAiD was intended for rare situations.”
“MAiD assessors and providers do not treat it as a last resort. The percentage of MAiD requests that are denied continues to decline (currently it is 3.5 percent). MAiD requests can be assessed and provided in a single day.”
“Government departments and agencies continue to state that Canada’s MAiD experience is similar to that of other jurisdictions, that the rate of increase is expected, and that the growth is gradual. The data contradict these statements.”
British Columbia Ministry of Health (2024, August 10). Medical Assistance in Dying.
“Medical assistance in dying occurs when an authorized doctor or nurse practitioner provides or administers medication that intentionally brings about a person’s death, at that person’s request. This procedure is only available to eligible individuals.”
“For the purposes of eligibility for medical assistance in dying, a mental illness is not considered to be an “illness, disease, or disability” under the current legislation. This restriction is expected to be repealed in the future.”
Bill C-62, An Act to Amend the Criminal Code (Medical Assistance in Dying). 1st Session, 44th Parliament (February 29, 2024).
The legislation was enacted to exclude eligibility for MAID to people whose sole underlying medical condition is mental illness until March 17, 2027.
“[It] is important to re-emphasize what was mentioned at the beginning – mental illness can be severe and cause suffering that can be comparable to physical illness. But the health care available formental illness is not comparable to the health care available for physical illnesses.”
“Mental health care has been significantly underfunded compared to physical health care. There are also inconsistencies in treatments covered by different provincial health plans. This means that many people across Canada do not have ready access to the full range of evidence-informed treatments that can assist in their recovery.”
“It is immoral for doctors to administer lethal injections to individuals whose sole medical condition is mental illness for several reasons, including the fact that mental health experts cannot accurately predict a person’s future trajectory and quality of life. As a result, one psychiatrist describes MAID as “death under a false pretence.” … At the same time that it is necessary to acknowledge that assessments respecting a person’s future mental health are highly unreliable, it is also important to stress that all doctors are not created equal. For example, the psychiatrist in Toronto who initially diagnosed me with bipolar disorder did not convey to me that it was possible for me to recover and lead a satisfying and productive life. Under his care, I felt a profound sense of hopelessness and my mental health significantly deteriorated. However, my subsequent psychiatrist in the same city was strengths-based, stressed my prior accomplishments in life, and expressed her confidence that I had the ability to learn how to effectively manage the severe mental illness. I am convinced that these two psychiatrists would not predict exactly the same future outcomes for individuals seeking eligibility for lethal injections under MAID.”
“The evidence shows that that we are right less than half the time,” said Dr. Sonu Gaind, chief of psychiatry at Sunnybrook Health Sciences Centre in Toronto.
“That means that at least half the people who assessors say, ‘You’re not going to get better from your mental illness, and you can get MAID,’ at least half of those people would have gotten better. Meaning, we would have provided death under a false pretence.”
“Several scientific studies and reviews, provincial and correctional system authorities have identified issues with MAiD practice. As well, there is a growing accumulation of narrative accounts detailing people getting MAiD due to suffering associated with a lack of access to medical, disability, and social support.”
“The Canadian MAiD regime is lacking the safeguards, data collection, and oversight necessary to protect Canadians against premature death. The authors have identified these policy gaps and used MAiD cases to illustrate these findings.”
“Criticism is growing as an increasing number of media reports regarding worrisome MAiD stories are emerging in the Canadian press. Yet, those who support the expansion of MAiD tend to reject the claim that social service failures can create and sustain the predicaments that can make death an attractive choice [and] wrongly suggests MAiD is supporting the autonomy of marginalized people who are rather being driven to death by poverty and lack of care, despite knowing how to address poverty and improve care.”
“Evidence-based reviews, including the Expert Advisory Group in 2020 and a recent publication by Nicolini et al, conclude that predictions of irremediability for mental illnesses are at best, no better than chance (EAG 2020; Nicolini et al. 2022). The Council of Canadian Academies reported on MAiD for mental illness and highlighted the known risk of providing psychiatric MAiD to suicidal individuals who would otherwise recover with suicide prevention strategies (Council of Canadian Academies 2018). Yet these evidence-based cautions are dismissed by some MAiD expansionists at times with outright “alternate facts” (Gaind 2023). Therefore, patients with mental illness, a population known for a high prevalence of psychosocial suffering, will be wrongly informed, during periods of despair and hopelessness, that their conditions are “irremediable” and will not improve, despite this being impossible to predict.”
Canadian Institute for Health Information. 2023. Access to Palliative Care in Canada.
“Some people experience greater barriers to accessing palliative care because of their age, where they live or their disease diagnosis.”
“Things have improved in the last 5 years but there are still signs of poor quality palliative care, including people not getting palliative care until just before they die, and people dying in hospital even when they have community supports such as long-term care or home care.”
“Changes are needed to better assess Canadians’ access to quality palliative care. These changes include better understanding who is receiving what care, better identifying those who face barriers to access, and tracking data that will tell us more about how we’re doing, including how well patients’ symptoms are controlled, the level of stress patients and caregivers feel, and how satisfied they are with palliative care.”
Expert Advisory Group (2023, May 20) Brief to Parliamentary Committee.
“The EAG recognizes MAiD is a complex topic spanning a range of opinions and belief systems. We hope the parliamentary committee honours its mandate to review the issues honestly and with integrity, to be guided by evidence and to avoid partisanship or personal bias from influencing its deliberations.”
“The 2020 EAG report found no standards exist for determining irremediability of mental illnesses, and evidence shows irremediability cannot be prospectively predicted in individual mental illnesses. No evidence has emerged to change these conclusions, but rather to reinforce them.”
“This means providing MAiD for sole mental illness defies the safeguard that MAiD be for a predictably irremediable medical condition. In making such determinations of “irremediability”, individual assessors would be making value-based, unscientific and arbitrary decisions falsely predicting irremediability and exposing non-dying patients to death by MAiD.”
“Indeed, many people describe stigma as being worse than the condition itself” (Thornicroft et al., 2022, p.1438).
The legislation delayed the eligibility of MAID for mental illness until March 17, 2024 to provide time to develop clinical guidelines, training for assessors/providers and consistent application across the provinces and territories.
“The topic discussed focuses on recovery from severe mental illness, a process based less on relief from symptoms than on the possibility of overcoming the trauma of the illness and its consequences, and the loss of abilities and opportunities providing access to social life.”
“Leamy et al. [74] developed a conceptual framework for personal recovery through a systematic review and a narrative synthesis. The resulting conceptual framework consists in a series of characteristics of the recovery journey (e.g., recovery as an active process, a unique process, a nonlinear process, a journey), five recovery processes comprising connectedness, hope and optimism about the future, identity, meaning in life and empowerment.”
Eligibility for MAID expanded beyond cases where natural death is “reasonably foreseeable.” It removed that requirement for a broader group of people but included a temporary exclusion for mental illness as a sole condition for a period of two years, the exclusion scheduled to end on March 17, 2023. This eligibility is known as Track 2.
Health Canada (2020) First Annual Report of Medical Assistance in Dying, 2019 (published July 2020).
“Practitioners reported that suffering among MAID recipients was closely tied to a loss of autonomy. … Loss of ability to engage in meaningful life activities (82.1%) followed closely by loss of ability to perform activities of daily living (78.1%), and inadequate control of symptoms other than pain, or concern about it (56.4%) were the most frequently reported descriptions of the patient’s intolerable suffering.”
“MAiD policies in Canada have developed on the premise of having an irremediable medical condition with irreversible decline and unresolvable suffering, with MAiD being provided to relieve otherwise inevitable suffering. This naturally requires a condition that can be deemed to be irremediable. Unlike other medical conditions with a known, predictable course, evidence shows that mental illnesses can never be predicted to be irremediable. As the Centre for Addiction and Mental Health has pointed out, “At any point in time it may appear that an individual is not responding to any interventions – that their illness is currently irremediable – but it is not possible to determine with any certainty the course of this individual’s illness.”
“Despite the scientific evidence showing that irremediability of mental illnesses cannot be predicted, some health professionals would nonetheless claim they could assess a person with mental illness as being irremediable, leading to people receiving MAiD without ever knowing they would have gotten better.”
“Some argue that if MAiD is available to those with predictably declining medical illnesses, it must be made available to those with mental disorders or we risk discrimination. In fact, allowing MAiD for mental disorders that cannot actually be determined to be irremediable, while claiming it is being provided for an irremediable condition, would be the ultimate form of discrimination.”
“An example of how vulnerability manifests in this patient population is that patients with mental illnesses may change their minds more often. Some Belgian data show that patients who request MAiD based solely on mental illnesses are more likely to rescind their requests than patients who file based on “physical” illnesses (Thienpont et al. 2015). If patients with mental illnesses tend to withdraw their requests more often, the universal exclusion of this population may be warranted to protect those who may change their minds. Other countries do not appear to have solved this problem. In jurisdictions where MAiD is permitted for mental illnesses, no explicit safeguards are added for this population.
“A panel of provincial/territorial experts on MAID, tasked with exploring options for a legislative response to the Carter decision, released its final report on November 30, 2015. Recommendation 17 stated that access to PAS should not be ‘impeded by the imposition of arbitrary age limits’ and that relevant changes to the Criminal Code should be based on ‘competence rather than age’. This wording raised the issue of access to MAID for youth who met ‘mature minor’ doctrine requirements.”
“For all young patients facing life-limiting illness or an illness associated with prolonged suffering, having access to quality, evidence-based, compassionate paediatric palliative care is paramount. Health systems must provide and fund hospital, community and home-based palliative care services, and guarantee universal access to essential care. Current evidence suggests that many patients who could benefit from specialized paediatric palliative care do not receive it. To meet this critical need, paediatric palliative care specialists need more support, and community-based physicians, nurses and home care providers need enhanced education and skills development.
“There is no country, society or culture where people with mental illness have the same societal value as people without a mental illness.
Corrigan, P.W. (2016, February 22) Regarding: An Open Letter to Address the Opportunity to Challenge the Stigma of Mental Illness, Raise Awareness of Recovery and Inspire Hope [Unpublished Open Letter to Prime Minister Justin Trudeau].
“If you choose to initiate an investigation in the company subsidy scheme as requested by Mr. Mahar, there will inevitably be media coverage of his public interest campaign to address this issue, including his personal experience of severe mental illness and recovery. Knowledge of Mr. Mahar’s story will serve to challenge the stigma of mental illness, raise awareness of recovery, and inspire hope for people with mental health problems and their families.”
“There were a number of obstacles that had to be overcome for me to rebuild my life, but stigma was by far the biggest one that I faced. To be more precise, internalized stigma was the most damaging. I was effectively paralyzed by shame. Furthermore, I was totally demoralized and felt hopeless because I accepted the false stereotype that people with severe mental illness cannot recover.”
“People with mental ill health may internalise the stigma that is circulating throughout the community and workplace that can be reinforced by families and clinicians, forming a negative perception of themselves, with associated low expectations. This is called self-stigma. Mr Keith Mahar, Ambassador, Disability Employment Australia, reported that self-stigma had brought him close to suicide.”
“Recovery from mental illness involves much more than recovery from the illness itself. People with mental illness may have to recover from the stigma they have incorporated into their very being; from the iatrogenic effects of treatment settings; from a lack of recent opportunities for self-determination; from the negative side effects of unemployment; and from crushed dreams. Recovery is often a complex, time consuming process.”