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Canada’s MAID law, which expanded the right to die to people without a terminal illness, raises ethical and medical dilemmas.
In 2023, one out of 20 Canadians who died received a physician-assisted death, making Canada the No. 1 provider of medical assistance in dying (MAID) in the world, when measured in total figures. In one province, Quebec, there were more MAID deaths per capita than anywhere else. Canadians, by and large, have been supportive of this trend. A 2022 poll showed that a stunning 86 percent of Canadians supported MAID’s legalization.
But in some corners, MAID has been the subject of a growing unease. While MAID in Canada was initially restricted to patients with terminal conditions — people whose natural deaths were “reasonably foreseeable” — the law was controversially amended in 2021 to include people who were suffering but who weren’t actually dying: patients who might have many years or even decades of life ahead of them. This new category includes people with chronic pain and physical disabilities.
For The New York Times Magazine, I interviewed dozens of clinicians, ethicists, lawyers, advocates and patients about how MAID in Canada works. Here is what I learned:
The criteria for MAID in Canada is among the broadest in the world
When Canada’s first MAID law, Bill C-14, passed in 2016, it had strict eligibility criteria: Patients needed to be over 18, eligible for Canadian health care and mentally competent to consent to death. They needed to have a “serious and incurable illness, disease or disability”; be in an “advanced state of irreversible decline in capability”; and have “enduring physical or psychological suffering” that was “intolerable.” Their natural deaths also had to be “reasonably foreseeable.” In other words, they had to be dying. Early MAID patients were often people in their 70s or 80s with terminal cancer.
In 2021, the Canadian government passed Bill C-7, which removed the criteria that a patient’s death be “reasonably foreseeable.” Now Canadians who are chronically sick or disabled — with conditions ranging from quadriplegia to multiple sclerosis to blindness to early-stage Parkinson’s to chronic back pain — can receive assisted deaths from doctors or nurse practitioners. Within Canada, this newer kind of MAID is known as Track 2.
Track 2 is controversial, even among MAID supporters
Some clinicians who are involved with MAID objected to the legal expansion. They argue that it isn’t really “assistance in dying” if the patient isn’t dying.