In years following legalization, Canada had world's fastest-growing rate of MAID deaths, says report

Canada logged the fastest-growing rate of medical assistance in dying (MAID) deaths in the world, according to a new report from an Ontario-based think tank.

Research from Cardus looked at global data from countries with physician-assisted death laws.

Canada legalized the practice in June 2016. The number of Canadians opting for MAID increased roughly 4.5 fold from 2017 to 2022.

In its first full year in practice, 2,838 patients died by MAID. The most recent government data shows 13,241 Canadians died by MAID in 2022, accounting for 4.1 per cent of all deaths in the country that year. 

“With any new medical practice we will see an increase and the reason for that is many, many fold,” said Dr. Konia Trouton, president of the Canadian Association of MAID Assessors and Providers (CAMAP).

Canada’s MAID rate is nearing that of the Netherlands, which has a global high of 5.1 per cent, according to Cardus. The Netherlands legalized the practice in 2002.

“I don't think that the data necessarily tells us exactly why, but I think it highlights that we need to take a good, hard look at what is happening,” said Cardus health program director Rebecca Vachon.

“We want to make sure there aren't wrongful deaths happening. We want to make sure that people aren't choosing MAID because they feel like they have no other choice, or they don't have adequate aid in living.”

In 2022, the average age of Canadians undergoing MAID was 77 years. Cancer was the most cited underlying medical condition at 63 per cent, followed by cardiovascular conditions at roughly 19 per cent.

Dr. Lilian Thorpe, a MAID assessor and provider in Saskatchewan, agrees the increase in MAID deaths is not surprising.

“We all know that the rates are increasing. I think the issue is how you interpret that,” Thorpe said.

The geriatric psychiatrist believes the main drivers are likely a rise in education and a strong desire for patients to control their end of life process. Additionally, more clinicians are trained in MAID, making the process more accessible.

When MAID was first legalized, Thorpe said people with a “high education and high socio-economic status” were more likely to apply for MAID. As awareness increased, she has seen patients from all backgrounds request the medical process.

“Our patients are telling us they want to have access under their control to a peaceful death. They are day in and day out suffering, knowing that things are not getting better, so people are making this wish,” she said.

Patients must meet the federal criteria and undergo a thorough assessment before receiving MAID.

CAMAP recently helped develop a seven-part standardized training course to teach clinicians how to assess MAID applicants. The modules rolled out last fall.

“It was very thorough already, and it's becoming even more standardized and clarified,” Trouton said.

Before considering MAID, Thorpe said healthcare providers need to re-think the treatments that are no longer working for patients.

“We do want to make sure that as the law becomes more widely known to patients … we don't end up using MAID instead of supplying appropriate care,” Thorpe said.

Earlier this year, the federal government announced plans to delay the expansion of MAID to people whose sole underlying medical condition is a mental illness. The expansion was supposed to take effect March 2024, but eligibility will not expand to that group until Mar. 17, 2027.