MAiD Part 2 | The Erosion of Safeguards
— When “Choice” Becomes Expectation
Part 2: The Erosion of Safeguards — When ‘Choice’ Becomes Expectation
Introduction: The Quiet Collapse of Oversight
Canada’s MAiD framework has evolved faster than the ethical, legal, or clinical systems built to govern it. What began as a strictly terminal option has become an open-ended policy domain—one where vulnerability itself now qualifies as suffering.
A recent federal consultation confirms how far the practice has outpaced its guardrails:
“The principle of advance requests was generally supported. Concern about how advance requests could be implemented safely in practice.”
— Health Canada, “What We Heard: National Conversation on Advance Requests for MAiD” (Oct 29 2025)
That single sentence encapsulates the contradiction at the heart of MAiD: policymakers acknowledge the danger yet continue to expand eligibility before resolving it.
1. From Safeguard to Shortcut
In Carter v. Canada (2015), the Supreme Court ruled that strict oversight and rigorous capacity assessment would protect vulnerable Canadians. A decade later, those assurances have eroded.
Provincial review boards now report cases where patients have been approved for MAiD after refusing treatment, or where assessors failed to confirm access to disability supports. The Ontario MAiD Death Review Committee warned:
“The report raises concerns that people are being approved even when it is unclear why they refused all treatments. … ‘MAID legislation requires more than a respect for autonomy, it also mandates the application of clinical expertise to ensure that reasonable care options are considered.’”
— Ontario MAiD Death Review Committee, via Canadian Affairs (Aug 27 2025)
This represents a quiet but profound shift—from MAiD as a last resort to MAiD as an administratively efficient default.
2. The Numbers No One Can Ignore
Data Box | By the Numbers (2023 – 2025)
42 % of MAiD deaths involved people requiring disability supports (Cardus 2025).
10 % rise in patients who said they felt like a burden on others (Health Canada 2023).
22 % cited isolation and loneliness as key suffering factors.
78 % of all requests for MAiD ended in death by 2023 — up from 59 % in 2019 (Cardus 2025).
13 days — average time from request to death (Health Canada 2024).
“Requests are decreasingly likely to be challenged by clinicians. … Based on the figures … for every 100 MAiD deaths in 2023 there were 28 or fewer requests that did not result in a MAiD death.”
— Cardus, In Contrast to Carter (Sept 16 2025)
In any other medical context, an 80 percent completion rate would signal a process lacking critical review. Yet MAiD’s rising approval rate is framed as efficiency rather than failure.
3. The Human Cost of Systemic Speed
The system’s acceleration has moral consequences. According to the Macdonald-Laurier Institute’s 2025 MAiD Death Review, the average review period between initial request and final procedure was under two weeks, and same-day approvals still occur in some regions.
This speed undermines the principle of reflection that Carter promised would separate autonomy from desperation. It also correlates with inadequate screening for depression and untreated social distress—the very vulnerabilities that judicial rulings claimed would be protected.
The same report noted that many assessors recorded “unknown” for whether applicants had access to disability or home-care supports, confirming that capacity decisions are often made in informational voids.
4. When Autonomy Masks Abandonment
The expansion of Track 2 MAiD (for non-terminal conditions) has blurred the line between voluntary choice and institutional neglect. Academic and provincial data reveal that many applicants cite reasons unrelated to pain or terminal prognosis—poverty, social isolation, or caregiver fatigue.
Dr. Ramona Coelho, testifying to Parliament, called it “a cliff, not a slope.” Her warning now reads as understatement. In practice, Canada’s MAiD regime no longer distinguishes clearly between personal choice and systemic failure—it increasingly functions as a release valve for an overburdened healthcare system.
5. The Moral Ledger
The defenders of MAiD argue that expansion empowers the suffering. Yet the evidence now shows that the suffering are disproportionately those whom the state failed to support.
When autonomy is exercised in a vacuum of care, it ceases to be true freedom. The result is a kind of ethical outsourcing: the state avoids the cost of compassion by underwriting clinical convenience.
Conclusion: A System Losing Its Soul
The Canadian experiment in assisted dying has reached a point where law and morality are diverging. Every safeguard that justified legalization—terminal illness, informed consent, rigorous review—has been diluted or ignored.
If the expansion to mental illness proceeds in 2027 without a complete overhaul of oversight, Canada will cross a threshold no other democracy has crossed deliberately: turning suffering itself into sufficient cause for state-assisted death.
Before that line hardens into law, the country must ask not whether MAiD is legal, but whether it remains moral.
Editor’s Note
This draft integrates findings from:
Cardus, “In Contrast to Carter” (Sept 2025)
Ontario MAiD Death Review Committee Reports (2024–25)
Health Canada, “What We Heard: Advance Requests” (Oct 2025)
Macdonald-Laurier Institute, MDRC Series (2025)
Further statistical verification pending the 2025 Health Canada Annual MAiD Report release (expected Dec 2025).
Part 3 exposes the machinery running behind it — the networks, incentives, and quiet coordination that keep MAiD expanding while oversight collapses.
Proceed to Part 3.
