A decade after Canada amended its Criminal Code to permit medical assistance in dying (MAID), the procedure has evolved from a controversial exception to a relatively common medical act. The latest figures reveal that 76,475 Canadians have ended their lives with medical assistance, a number that continues to fuel a profound national debate about ethics, autonomy, and the limits of healthcare.
From Exceptional Act to Common Practice
Initially presented as an exceptional option for those nearing a natural death, MAID now accounts for approximately one in every 20 deaths nationwide. In 2024 alone, a record 16,499 people received a doctor-administered lethal injection, representing the highest annual total to date. While the year-over-year growth rate is showing signs of flattening, the absolute numbers underscore a significant shift in end-of-life practices.
Proponents of the law argue these figures reflect a long-suppressed demand for a compassionate end-of-life option that has consistently garnered broad public support. They view the growing acceptance of MAID as a sign of societal maturity in respecting individual autonomy over unbearable suffering.
Critics Sound Alarm Over Safeguards and "Death Therapy"
Conversely, critics express deep concern that the practice has moved far beyond its original intent. Health law expert Trudo Lemmens, a professor at the University of Toronto, states that Canada has gone "way beyond an exceptional practice that is a last resort measure." Some opponents fear MAID is being marketed as a simple medical treatment or a "death therapy," potentially overshadowing discussions about palliative care and social supports.
These concerns are amplified by findings from retrospective reviews. In Ontario, a special MAID death review committee, which includes Lemmens, examines select cases to improve practices. While the Office of the Chief Coroner found that 88% of the 4,356 MAID deaths in Ontario in 2024 met all legislative requirements, the review committee has flagged several troubling issues:
- Lax interpretations of legal safeguards.
- Minimal or inadequately documented assessments of a person's capacity to consent.
- Insufficient exploration of alternatives to alleviate suffering.
- Potential risks of coercion from family members or exhausted caregivers.
- Instances where doctors accepted nods or hand squeezes as final consent immediately before the procedure.
Lemmens has pointedly noted in the Canadian Journal of Bioethics that "documented problematic applications of MAID have not yet resulted in either criminal or professional regulatory intervention," a situation he finds deeply troubling.
The Unanswerable Question and the Path Forward
The central, perhaps unanswerable, question persists: How many assisted deaths are too many? Some analysts suggest that as Canada's population ages, the absolute number of MAID deaths will naturally rise, and there is no objectively "correct" number. Others are calling for a systemic overhaul, arguing that the review findings point to a need for stricter oversight and clearer guidelines.
Ten years on, the journey of MAID in Canada reflects a society grappling with the profound implications of its own laws. The debate is no longer about whether assisted dying should exist, but about how it is implemented, monitored, and integrated into a holistic framework of end-of-life care that truly honors both choice and dignity.
