Earlier this month, the Office of the Chief Coroner for Ont…

Earlier this month, the Office of the Chief Coroner for Ontario released new reports highlighting some of the reasons some Canadians have chosen medical assistance in dying (MAiD, which in Canada involves euthanasia — meaning medically-administered injection rather than self-administered — over 99.9 per cent of the time).
The reports have received international attention for what they highlight, including patients being euthanized despite untreated mental illness and addictions, unclear medical diagnoses and suffering fuelled by housing insecurity, poverty and social marginalization.
Some are shocked by what these reports reveal, but none should be surprised. This is what happens when you let the foxes run the henhouse, as Canada has arguably done by allowing right-to-die advocacy to shape policy and replace evidence.
Canada’s medical assistance in dying (MAiD) laws, introduced for those in terminal situations, were expanded by the Trudeau government in 2021 to allow death by MAiD via “Track 2” to Canadians struggling with disabilities who were not dying. In 2023, Track 2 represented 2.6 per cent of the 4,644 MAiD deaths in Ontario, or 116 people.
I am not a conscientious objector. I am a psychiatrist and previously chaired my former hospital’s MAiD team. However, I believe we’ve experienced a bait and switch: laws initially intended to compassionately help Canadians avoid suffering a painful death have metastasized into policies facilitating suicides of other Canadians seeking death to escape a painful life.
The coroner’s reports show how far over the cliff we’ve fallen with Track 2 MAiD.
Marginalization and MAiD
Many have warned for years that when facilitated suicide is expanded to those with disabilities who have decades left to live, it is impossible to filter out suffering due to poverty, loneliness and other marginalization fueling MAiD requests. The medical disability becomes the foot in the door to open eligibility for MAiD, but social suffering pushes the marginalized through that door to seek state-sponsored death for their life struggles.
The coroner’s report uses a marginalization index based on area of residence (similar to the way impacts on marginalized populations were identified during COVID-19) to divide the population into five levels, each representing 20 per cent of the population. The data shows a much higher proportion of Track 2 MAiD recipients come from highly marginalized categories than Track 1 MAiD recipients, or the general population.
People in the lowest “material resource” category (i.e. poverty) represent 20 per cent of the general population, but they make up 28.4 per cent of Track 2 MAiD recipients, compared to 21.5 per cent of Track 1 recipients.
People in the lowest 20 per cent of the population with the worst housing instability made up 48.3 per cent of Track 2 MAiD recipients, compared to 34.3 per cent of Track 1 recipients. Track 2 recipients were also far more likely to come from the most vulnerable 20 per cent of the population in terms of age and labour force participation, with 56.9 per cent of Track 2 MAiD recipients coming from this category compared to 41.8 per cent of Track 1 MAiD recipients.
Gender gaps of more women than men receiving Track 2 MAiD are also emerging.
Additionally the report shed light on specific cases of concern, including people receiving Track 2 MAiD for social and housing vulnerability, and for unclear reasons while still suffering from inadequately treated mental illness and addictions.
This includes a man with a history of suicidal ideation and untreated addictions whose psychiatrist asked during a session whether he was aware of MAiD. After being approved, he was “personally transported (by the MAiD provider) in their vehicle to an external location for the provision of MAiD”.
Denialism
Policy mistakes can occur, but these marginalized deaths result from wilful avoidance and denial of evidence-based cautions. I have previously written of the lack of safeguards and absence of evidence informing MAiD expansion.
Beyond the evidence in the coroner’s report, there are clear signs of this denial:
Leaders of the Canadian Psychiatric Association (CPA) supported euthanasia for depression and addictions without once mentioning suicide risks of mental illness or the need for suicide prevention in any of their consultations and testimony that led to Bill C-7’s “sunset clause” for introducing MAiD for mental illness, literally not once mentioning the words suicide, suicidal or any variant in these consultations on death and mental illness (in disclosure, I am a past president and distinguished fellow, but no longer a member, of the CPA);
The federally appointed chair of the MAiD expansion panel charged with recommending safeguards for psychiatric euthanasia recommended no additional legislative safeguards and said the gender gap of twice as many women as men being euthanized for mental illness in Europe “doesn’t concern” her, testifying:
“It does…