Euthanasia Recipients Often Reside in Poorer Neighbourhoods: Ontario Reports

The entrance sign to a hospital in Toronto in a file photo. The Canadian Press/Evan Buhler

Lower-income Canadians struggling with housing are more likely to access medical assistance in dying (MAID), according to a series of reports published by the Ontario government.

Since Canada expanded MAID to those without terminal illness, concerns have been raised over people turning to assisted death when they cannot access social supports. The new reports give examples of cases where social conditions, such as isolation, were factors in opting for MAID.

In September, several disability rights organizations launched a Charter challenge to MAID, saying it was an “abandonment” of those with disabilities. The groups said some Canadians with disabilities are accessing MAID when social supports are not available.

The reports, which The Epoch Times has viewed, came out of the work of a MAID Death Review Committee (MDRC) made up of 16 professionals from different backgrounds, including law, medicine, social work, nursing, mental health, and disabilities.

Canada has two tracks for MAID, one for those whose death is reasonalby foreseeable, considered track 1 applications, and track 2, for those whose death is not foreseeable.

The committee said it found geographical differences among applications for MAID when death was not foreseeable.

“Track 2 recipients are more likely to reside in areas of the province with high levels of marginalization (28.4 percent) than Track 1 recipients (21.5 percent),” the committee said.

Ottawa calls MAID a complex and “deeply personal” issue and said it’s committed to ensuring laws reflect Canadians’ needs, protect those who are vulnerable, and support freedom of choice.

In its work, the committee looked at several cases that highlighted concerns over potential misuse of the procedure. Among those who were approved for assisted death was a man in his 40s who suffered from inflammatory bowel disease. It noted the man, called Mr. A, had alcohol and opioid-use problems as well.

During an assessment, a psychiatrist asked Mr. A if he was aware of MAID but did not offer addiction treatment. The MAID provider drove Mr. A to a facility where MAID was provided.

MDRC members were divided over the professional’s actions, with some saying they pressured the patient to receive MAID while others thought they were “helpful and compassionate.”

Another case the committee reviewed was a woman in her 50s who was struggling to find suitable housing due to a medical condition—multiple chemical sensitivity syndrome—that made her sensitive to chemical use. It had been recommended that she live in a hypoallergenic space, such as a bubble. As a result, she suffered from social isolation, according to the committee.

The committee said the cases were not representative of most MAID deaths but were examined to identify issues arising from MAID assessments and to suggest improvements to the process.

“The deaths selected are chosen for the ability to generate discussion, thought, and considerations for practice improvement,” the authors wrote.

Another case of concern involved a man in his 40s who was quadriplegic following a car accident. Due to his condition and complex medical needs, he was not able to return home to live with his family. The committee noted that one MAID assessor indicated the 90-day assessment period could be shortened if his condition deteriorated.

While track 2 applicants are required to go through a 90-day process, 13 percent of cases were approved before the 90-day mark, the committee found. Forty-five percent were approved between 90 and 120 days.

Reasons for Non-Terminal Patient Requests

In 2021, 53 MAID deaths were approved for track 2 applicants. That number jumped to 121 in 2022 and dropped slightly to 116 in 2023. In comparison, there were 2,547 track 1 MAID deaths in 2021, 3,813 in 2022, and 4,528 in 2023.

“Chronic pain was the reported condition for nearly 40 percent of Track 2 recipients, followed by neurological conditions (37.9 percent), which included Parkinson’s disease, multiple sclerosis, amyotrophic lateral sclerosis, and neurocognitive disorders,” the report authors wrote.

Over 30 percent of those making track 2 MAID applications (34.5 percent) had a condition that was not on the list.

“Conditions included in this category are diabetes, spinal stenosis, end stage renal disease, and – for less than one percent of recipients – a mental health condition,” the authors said. However, the mental health issue was secondary to the reason the applicant was seeking assisted death.

Mental Health Issues, Complex Cases

In 2027, Canada may open MAID to those whose only condition is a mental illness. This controversial move has already been postponed twice. Currently, MAID patients may have a mental illness, but that cannot be the sole reason for requesting MAID.

One of the cases reviewed by in the reports was that of a man in his late 40s with a history of depression and trauma experiences, along with possible psychotic symptoms. The MAID assessors opined that the reason for his rapid decline was “post COVID-19 vaccination somatic symptom disorder.” He suffered a “functional decline following three vaccinations,” the report stated.

His case was considered a “complex medical condition,” and the report notes that diagnostic uncertainty makes it difficult for MAID providers to determine if the condition meets legislative requirements. It’s difficult to determine if the condition is “grievous and irremediable.”

“Many complex chronic conditions are a combination of biological, psychological, and social factors,” the report authors said, adding that it is important to provide psychiatric interventions that may help and also psychiatric evaluations to determine the reasons for the MAID request.

In the case of the man who suffered a decline after COVID-19 vaccinations, the report authors said “the role of psychiatry was potentially underutilized for the purposes of MAiD eligibility determinations.”

The reports also found that some applicants applied more than once, with a previous application being denied. Nearly half of the track 2 individuals who had a previous MAiD request had been assessed and found ineligible, and 44 percent of track 2 applicants had previously been denied MAID.

More women than men requested MAID under track 2: 61 percent of applicants were women, and 17 percent of those were between 18 and 59 years of age. That number was slightly higher for men in the same age group, representing 18 percent of track 2 MAID applicants.

The published reports were developed by Ontario’s Ministry of the Solicitor General and Office of the Chief Coroner.

Assisted death became legal in Canada in 2016 after Parliament passed legislation allowing the procedure for the terminally ill. It was expanded in 2021 with Bill C-7, allowing Canadians whose death is not foreseeable to apply for MAID. Canada is considered to have one of the most permissive eligibility criterion in the world.

The Canadian Press contributed to this report.