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Ethical Problems and Inequities Remain in Canada's MAiD Regime

Discussion paper challenges leaders to deal with unresolved issues in euthanasia and assisted suicide


September 14, 2023 

OTTAWA, ON – Political and healthcare leaders need to wrestle through unsettled ethical questions before further expanding euthanasia and assisted suicide, referred to as “medical assistance in dying” (MAiD) in Canadian law, according to a new discussion paper by think tank Cardus.

Ethical Issues in Euthanasia and Assisted Suicide in Canada challenges leaders to deal head-on with the significant ethical problems flowing from the implementation and evolution of MAiD from its inception until now.

“These ethical problems consist of gaps in equity and care, rapid and unnecessary expansion, a misconstrued sense of what suffering is and how it may be addressed, and a shift in understanding what Canadian healthcare is and how it ought to be delivered,” according to the discussion paper.

The discussion paper raises multiple ethical issues, including those that flow from the 2021 expansion of euthanasia and assisted suicide to patients whose death is not foreseeable. This change rebalances the patient-provider relationship by allowing patients to request MAID when they no longer believe their lives are worth living.

“As such, the decision to end a patient’s life is not based on the healthcare professional’s expertise but instead on the patient’s ability to articulate that they are suffering in such a way that death is warranted,” according to the discussion paper. “Given the increasing lack of safeguards, little is needed to substantiate such a claim.”

Likewise, the push for more liberal rules for advance MAiD requests raises ethical questions. Through these requests, patients who later lose decision-making capacity will have automatically assented to the possibility of having their life actively ended by a MAiD provider. This places caregivers or substitute decision-makers in the position of determining when someone else’s life is no longer worth living.

“Unlike other decisions that a caregiver with power of attorney for healthcare must make on behalf of the patient, this is a decision to actively end life through the administration of lethal drugs,” according to the paper.

Canada’s delayed expansion of access to euthanasia and assisted suicide in the place of treatment or mental illness also raises ethical issues leaders need to consider.

“Unless the new guidelines are more restrictive than the current ones (which do not require the patient to receive treatment before receiving euthanasia or assisted suicide), it is possible that those with a mental illness may be able to request death on demand for this reason alone,” according to the paper. “In this case, healthcare in Canada is no longer a service to support the mentally ill but one solely operating on consumer demand.”

Ethical Issues in Euthanasia and Assisted Suicide similarly looks at the idea of allowing children considered mature enough to make their own health decisions to request MAiD.

“It is not clear how euthanasia or assisted suicide could be conceived of as a need for mature minors, when, to date, there is not enough pediatric palliative or specialized pediatric palliative care to serve the children in Canada who would benefit from accessing it,” according to the paper. “Canada lacks the most basic infrastructure to support mature minors’ end-of-life care in the first place.”

The discussion paper concludes with a call for a different approach.

“Given that MAiD offers death as the solution rather than addressing the challenges that suffering brings to those who are ill, Canada needs a radical pivot from autonomy-forward approaches to those that value dependency within healthcare access and delivery,” according to the paper. “At a time when Canadians are facing crises in healthcare, it is vital that we do not lose a sense of our humanity by qualifying those who are suffering as having a less-meaningful existence. Instead, we need to start providing life-giving alternatives to alleviating suffering, oriented to helping Canadians receive supports they need to live well and flourish.”

Cardus published this discussion paper to alert Canadians to ethical issues that exist in relation to MAiD and the care disparities that exist for suffering and dying Canadians. Cardus hopes that the paper generates public discussion, which will lead to better legislation, improved practice guidelines, and modified policies to address these ethical issues and care disparities.

Ethical Issues in Euthanasia and Assisted Suicide in Canada is freely available online.

Daniel Proussalidis
Cardus – Director of Communications

Cardus – Imagination toward a thriving society

Cardus is a non-partisan think tank dedicated to clarifying and strengthening, through research and dialogue, the ways in which society’s institutions can work together for the common good.