Critics of medical assistance in dying (MAID) in Canada have raised concerns that marginalized people might access MAID because of housing insecurity, or due to social distress or untreated mental illness – particularly those seeking MAID under Track 2. Citing stories of individuals who were allegedly pushed to choose MAID by inadequate social supports, they claim that these cases indicate problems with how MAID is assessed and provided in Canada. The data*, however, tells another story. 

People who seek and receive MAID under Track 2 are those whose natural death is not reasonably foreseeable. In 2023, this accounted for just 4.1% of all MAID recipients in Canada. Despite the wave of media reporting, the truth is that Track 2 MAID recipients, when compared to others receiving palliative care or living with neurodegenerative diseases, tend to have higher incomes and be less socially marginalized overall. In this post, we will explore myths and facts when it comes to MAID and marginalization. 

Myths and facts about Track 2 marginalization 

Myth: Track 2 MAID deaths are skyrocketing.

Fact: MAID cases for people whose natural deaths are not reasonably foreseeable (Track 2) fell in 2023, and they remain rare (accounting for just 0.09% of all deaths in Canada). 

Myth: People seek MAID because they don’t have access to social supports. 

Fact: 95% of those in Track 2 with a self-reported disability received supportive services. No one can receive MAID on the basis of a lack of social supports, including housing, disability, or mental health.  

Myth: People who are in mental distress can rush into accessing MAID through Track 2. 

Fact: In addition to the safeguards in place for all MAID requests, Track 2 requests are also subject to a 90-day assessment period. The individual seeking MAID must be informed of all other available and appropriate means to relieve their suffering, and the individual and clinicians must all agree that consideration was given. One of the two clinicians assessing eligibility must also have experience in the condition causing suffering, otherwise they must consult with such expertise.  

This is a rigorous and thorough process carried out by clinicians with care and thoughtfulness.  Individuals who are in an acute mental health crisis are not able to access MAID.  

Myth: People who seek Track 2 “doctor shop” by going from provider to provider until they are approved. 

Fact: Only 3% of Track 2 recipients (four people in total) had previously been found ineligible for MAID, and there is no evidence that “doctor shopping” happened. Instead, changes in their medical conditions likely led them to be approved for MAID after being denied previously. 

Myth: People seek MAID because they are isolated. 

Fact: People who seek MAID are statistically no more likely to feel isolated or perceive themselves as burdens than terminally ill people who do not seek MAID. 

Myth: Housing insecurity drives people to seek MAID. 

Fact: MAID recipients are much more likely to live in private residences, and less likely to be in residential care/long-term care than those who die naturally. Many older MAID recipients live alone, but at rates that are typical for people of their age. 

Myth: Track 2 targets women. 

Fact: Women tend to live longer than men, leading them to represent a greater percentage of the elderly population. They are also more likely to experience long-term chronic conditions, such as osteoporosis, dementia, and rheumatoid arthritis. While such conditions can cause enduring suffering, they would not typically make a person’s death reasonably foreseeable. Women, therefore, are more likely than men to be assessed as Track 2. In contrast, men experience higher rates of heart disease and the most severe forms of cancer, making them more likely to seek MAID under Track 1. 

Myth: Track 2 targets racialized people and newcomers to Canada. 

Fact: Racialized and newcomer populations are much less likely than the general population to seek or access MAID, regardless of track. 

Myth: Track 2 targets poor people. 

Fact: Health Canada conducted analyses to better understand the characteristics of the communities that MAID recipients lived in. These analyses suggest, at a high level, that people who receive MAID do not disproportionately come from lower-income or disadvantaged communities. Findings indicate that MAID recipients live in neighbourhoods across the income and marginalization spectrum as well as in urban, rural, and remote communities. 

Reports that Track 2 MAID recipients specifically are poorer/more marginalized than average are misleading. People who die without MAID, or people living with chronic illness, show the same degree of marginalization as those who are assessed on Track 2. Tools used to measure marginalization look at circumstances that are more likely to affect seniors in general, including factors like living alone, not being employed, and being single, divorced, or widowed. These factors relate more to disease and age than they do to MAID. 

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Social isolation, marginalization, and financial insecurity are real issues that can have significant impacts on quality of life. People who are struggling deserve adequate government supports, and no one should suffer from lack of housing or medical care. There is no good evidence, however, that these factors are driving people to choose MAID. In fact, as the data shows, MAID recipients are less likely to be marginalized — socially or financially — than those who do not seek MAID. 

Sources: 

Myths and Facts: Medical assistance in dying (MAID) in Canada 

The Ontario Chief Coroner’s reports are clear — alarm about MAID in Canada isn’t warranted 

Recent Reports on MAiD Contradict Claims that Marginalization Drives Assisted Dying in Canada 

MAiD Death Review Committee (MDRC) Report 2024 

MAiD Death Review Committee (MDRC) Report 2024 – 2 

MAiD Death Review Committee (MDRC) Report 2024 – 3Myths & Facts: Setting the record straight on MAID 

Myths & Facts: MAID and Marginalization in Canada