Myths and Facts

Medical assistance in dying (MAID) in Canada

Home / Advocacy / Myths and Facts – Medical assistance in dying (MAID) in Canada  

Canada’s assisted dying law is currently under review by the Parliament of Canada’s Special Joint Committee on Medical Assistance in Dying (MAID). The Committee is considering five issues, including advance requests, MAID for mature minors and those whose sole condition is a mental illness, the state of palliative care, and the protection of people with disabilities. Dying With Dignity Canada (DWDC) would like to clear up some misinformation surrounding MAID, the criteria and safeguards, and its application that we have been reading in recent media.

Fact: Dying With Dignity Canada has never advocated for medical assistance in dying for infants, with or without a disability. We believe mature minors (individuals at least 12 years of age and capable of making decisions with respect to their health) should be allowed the right to choose MAID with special eligibility criteria in place. In many jurisdictions across Canada, mature minors already have the right to make important decisions regarding their care. This includes the right to consent to or refuse lifesaving medical treatment. We recommend that the informed consent of a competent parent or guardian be required for eligible minors 12-15 years of age inclusive, and that MAID assessors be required to consult a competent parent or guardian for eligible minors aged 16-17. The most important criteria in Canada’s assisted dying law is the ability to provide informed consent to the procedure. We do not advocate for MAID for infants as they cannot provide consent.

Fact: This is not true. Access to MAID by mature minors is an issue being studied as part of the Parliamentary Review of MAID legislation, together with advance requests, MAID for individuals with mental disorders, the protection of people living with disabilities, and the state of palliative care. The Parliamentary Review was mandated through Bill C-7 and the Special Joint Committee on Medical Assistance in Dying is expected to table its final report, covering all aspects of the Parliamentary Review, by February 17, 2023.  

Fact: This is not true. Bill C-14, Canada’s original assisted dying law, did not exclude people living with a disability from accessing MAID. The law stated that, in order to be approved for MAID, one must have a serious and incurable illness, disease or disability; be in an advanced state of irreversible decline in capability; that illness, disease, disability, or state of decline causes them enduring physical or psychological suffering that is intolerable to them and cannot be relieved under conditions they find acceptable; AND their natural death has become reasonably foreseeable (without a prognosis as to the specific length of time they have remaining). Bill C-7 removed the last requirement, that natural death has become reasonably foreseeable, after a Canadian Charter of Rights challenge (launched by two Canadians living with disabilities), determined that it was discriminatory and a violation of the constitutional right to the security of person.  

Fact: The root of the term euthanasia comes from the Greek – eu, meaning good, and thanatos, meaning death. A simple definition of euthanasia is “the practice of intentionally ending life to relieve pain and suffering.” The term itself is not inherently wrong or bad; in fact, some jurisdictions around the world still use the term euthanasia in their assisted dying legislation. The reason Dying With Dignity Canada avoids this term is because it has been commandeered by the anti-choice movement in Canada. 

Fact: Under Bill C-7, the eligibility of individuals whose sole underlying medical condition is a mental illness applies only to adults 18 years of age or older, and have decision-making capacity. Access to MAID by mature minors (under the age of 18 but capable of making decisions related to their health) is a separate issue that is being studied by a Parliamentary Committee and has no connection to the legalization of MAID for mental disorders. There is currently no legislation proposed that addresses the eligibility of mature minors for medical assistance in dying.  

Fact: The provision of medical assistance in dying (MAID) in most of Canada is by intravenous administration of a series of medications – most typically midazolam, propofol, and rocuronium. The first medication is used as a sedative, the second puts the individual into a deep coma, and the third ultimately stops the person’s heart. Lidocaine is sometimes used to numb the vein and further ensure that there is no stinging or burning from the propofol. The injecting of medications, and death, typically occur within five to eight minutes. 

These medications have been used in emergency departments and operating rooms long before they were used for medical assistance in dying. If you have ever been sedated before an operation or procedure, you were likely given midazolam, followed by propofol, and will know that there is no memory, pain, or suffering during the procedure. The dosages provided during a MAID provision are much higher. The medical assistance in dying procedure is a peaceful one. 

Fact: Suffering from a lack of social supports alone does not qualify a person for MAID. No one can receive MAID on the basis of inadequate housing, disability supports, or home care. 

To be eligible for an assisted death, a patient must have a serious illness, disease or disability, be in an advanced state of decline that cannot be reversed, and experience unbearable physical or mental suffering from an illness, disease, disability or state of decline that cannot be relieved under conditions that person considers acceptable. A person must be approved by two independent assessors, each of whom work within the parameters of the law; they are careful and thoughtful in their work.

Fact: This is not true. The most important criteria in Bill C-7 is that an individual must have made a voluntary request for MAID that was not a result of external pressure and must give informed consent to receive MAID after having received all information needed to make this decision, including a medical diagnosis, available forms of treatment, and options to relieve suffering (including palliative care). 

Fact: Palliative care and MAID both provide quality options for care at the end of life. According to Health Canada, 80% of Canadians that seek an assisted death have also accessed palliative care. In the situations where palliative care was not accessed prior to MAID, it was available to the patient 88.5% of the time. 

Fact: This is not true. All MAID assessments are done on a case-by-case basis, and individuals must meet the rigorous criteria to be eligible for an assisted death; the same rigour would be applied to those whose sole condition is a mental illness. We anticipate that a very small number of individuals will be eligible under this criterion – individuals who have endured many years of persistent unbearable suffering that has not been improved by many attempts at different interventions.In the Netherlands, where assisted dying for mental illness has been available for 20 years, only 1% of assisted deaths have been approved for those suffering from mental illness. 

Fact: MAID is not about cost savings; it is about compassion and choice to end suffering that is intolerable to the individual. A 2020 report by the Parliamentary Budget Office (PBO), created as part of its mandated independent economic and financial analysis to Parliament, has stated that the “net reduction in health care costs for the provincial governments only “represent[s] a negligible portion (0.08%) of the health care budgets of provinces.

Fact: The criteria for eligibility for MAID are clear: a person must have a serious and incurable illness, disease or disability, be in an advanced state of irreversible decline in capability, and they must be experiencing intolerable suffering caused by the illness, disease or disability or state of decline. 

Poverty, short intervals of depression, or feelings of being a burden do not qualify a person for MAID. 

No one can be forced into accessing MAID. It is a decision made by free and informed individuals after having been offered alternative means to relieve their suffering. Suffering caused by social or financial factors may contribute to someone applying for medical assistance in dying, but that application would not be approved based on those factors. MAID assessors carefully assess a person’s reasons for applying for MAID to ensure there are no signs of coercion. 

“Neither the national data in Canada or Quebec nor the foreign data indicate any abuse, slippery slope or even heightened risks for vulnerable people when imminent end of life is not an eligibility criterion for medical assistance in dying,” as concluded by Madam Justice Christine Baudouin in Truchon v. Quebec.

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