Canada’s medical assistance in dying (MAID) program is the fastest-growing in the world, according to a new report from Canadian think tank Cardus.
This is despite earlier claims from politicians and lawyers that the program would only be used in exceptional circumstances.
“Medical assistance in dying can pose real risks and… we do not wish to promote premature death as a solution to all medical suffering,” then-minister of justice Jody-Wilson Raybould told the House of Commons as MAID approached legalization in 2016.
Six years later, Canada’s rate of assisted dying nevertheless rapidly surpassed peer countries.
In 2016, when Canadian medical assistance in dying became legal, 1,018 Canadians chose to end their lives using the new voluntary euthanasia program. By 2022, in just one year, it would end the lives of 13,241 Canadians. Thus, Canadian deaths from euthanasia as a percent of all deaths rose from 2016’s 0.38 to 2022’s 4.18 percent.
That thirteenfold increase in deaths is the most dramatic six-year increase for euthanasia programs across all peer countries that have legalized the option.
For comparison, in the six years following euthanasia legalization in peer countries (2003-2009), deaths in peer countries only increased by 3.4 times (Belgium), 1.5 times (Switzerland) and 1.4 times (Netherlands).
In 2009, euthanasia comprised 1.96 (Netherlands), 0.79 (Belgium) and 0.48 (Switzerland) percent of those country’s total deaths, respectively.
In 2022 in Canada, only six years after legalization, euthanasia deaths represented 3 percent of total deaths.
In the Netherlands meanwhile, it took double the time for euthanasia to reach 3 percent of total deaths, 11 years after legalization. Belgium, which legalized euthanasia two months after the Netherlands, has never passed the 3 percent threshold.
In May 2022, Health Canada predicted it would take until 2033 for euthanasia deaths to reach 4 percent of Canada’s total deaths, before stabilizing, according to the government of Canada. However, Canada exceeded 4 percent MAID deaths more than a decade earlier than predicted, in 2022, after seven years of legalization.
“Assisted dying was clearly not meant by the courts to become a normal way of dying…Despite judges’ and policymakers’ claims or expectations, MAID is no longer an option of last resort,’” said the Cardus MAID report.
Still, others are more satisfied with the direction MAID has taken.
“The individuals requesting MAID are among the country’s most physically compromised and vulnerable patients,” said Shanaaz Gokool, CEO of MAID advocacy group Dying With Dignity Canada, in a press release following Ontario’s 2018 decision requiring doctors to connect eligible patients with MAID upon request. “Patients not only have a legal right to a peaceful death in Canada, but they have the right to trust that their physician will help them navigate an already confusing system.”
In March 2023 amid MAID’s rising use, Health Canada released their “Model Practice Standard for Medical Assistance in Dying” — requirements health care providers must meet regarding MAID.
Under the standard, providers “[M]ust take reasonable steps to ensure persons are informed of the full range of treatment options available to relieve suffering,” and “must not disclose that a person has requested a MAID assessment or provision without the consent to do so from the person.” Physicians or nurses unwilling to participate in MAID are required to transfer patients seeking MAID.
Between the provinces, Quebec shows Canada’s sharpest increase in euthanasia-caused deaths, followed by British Columbia.
Between 2016 and 2022, Quebec’s assisted deaths rose from 494 to 4,801. In B.C., it rose from 194 to 2,515.
In 2022, those provinces’ respective euthanasia deaths as a percent of total deaths were 6.5 and 5.5 percent–both above that of the Netherlands, the country with the highest total percent of euthanasia deaths across all deaths.
Unlike total mortality rates, euthanasia rates differ greatly across Canada. According to the report, this may be due to the province's varying euthanasia safeguards, with healthcare being a provincial responsibility. In Newfoundland and Labrador, for instance, nurses are instructed to not begin conversations with patients about MAID. In Alberta, MAID intake is centralized, which may reduce “doctor shopping” for lenient MAID provision, explains Cardus.
Provincial collection of euthanasia death data also varies. Some government agencies record MAID deaths but specify them as “natural deaths” resulting from an underlying condition. Others omit the use of MAID entirely. Still, others describe MAID deaths as “unnatural deaths.”
In 2022, MAID virtually tied for Canada’s fifth leading cause of death, alongside stroke-related deaths (cerebrovascular diseases). MAID deaths surpassed lung (lower respiratory) disease, and was itself surpassed only by accidents, COVID-19, heart diseases, and cancer.
Editors Note: A previous version of this article did not include Health Canada’s latest guidelines around delivering MAID. The Hub has now updated this article to include them.
