What can we learn from Canada about Medical Aid in Dying?

Medical Aid in Dying (MAiD) laws are intended to save people from prolonged suffering at the end of their lives. Where MAiD is legal, a terminally ill person can ask a doctor to prescribe lethal drugs so that they can control the time and manner of their impending death. Ten states and DC allow MAiD. Many fear that MAiD is a slippery slope and could be used by healthy but suicidal people or by greedy heirs to coerce elders into killing themselves. Is MAiD too dangerous? Canada’s experience is cautionary.

Canada legalized MAiD in 2016. That year, 1,018 people in Canada used MAiD; last year, 10,064 people used it. Canada currently leads the world in MAiD and the numbers suggest that MAiD is easily accessible. Nevertheless, in response to court challenges, legislators expanded MAiD eligibility in 2021. Under the expanded law, someone who is not terminally ill but who suffers from a “grievous and irremediable medical condition” may choose MAiD. And, in a very controversial expansion, starting in 2023 a person who does not have a medical illness but who suffers from mental illness, including depression and personality disorders, can elect to die with medical aid.

Canada's expansion of MAiD criteria — to include people who are seriously but not terminally ill — goes well beyond the law's original intent. Problems with this expansion have been widely reported. For example, an Ontario man who is not terminally ill applied for MAiD because he lost his lease and couldn’t find affordable housing. Another Ontario man with a degenerative neurological disorder claims that nurses at his government healthcare facility pressured him to end his life because of the high cost of his care.

We can learn from Canada's experience with MAiD without repeating its mistakes. The American and Canadian legal systems, and moral and religious norms, are different. It is already established law in the United States that patients have the right to refuse medical treatment, including life-sustaining medical treatment. Is having the option to decline life-sustaining treatment substantially different from having the option to choose life-ending treatment?

MAiD laws can be narrowly crafted to provide a compassionate option for the terminally ill. Let’s talk about dying.