MAiD — PART 4: When Care Collapses
How System Failure Becomes “Eligibility”
Canada’s assisted death system was built on a promise. MAiD would never replace treatment. It would never appear where care exists. It would never be the “solution” to systemic shortages.
Part 4 shows what happens now that those promises have broken.
Across the country, patients who should be receiving standard medical care are being pushed toward MAiD because the health care system cannot or will not treat them. The result is a quiet redefinition of “irremediable illness.” The illness is not always incurable. The system is.
This section examines three major failures that converged to create this new reality.
1. Hospice as a MAiD Funnel
A recent account described patients who needed basic rehabilitative services being moved into hospice because there was “no room” for care like physio. Once inside hospice, the environment shifts. Hospice is legally required in many provinces to allow MAiD on site. Staff are trained to discuss it. The cultural message changes.
Hospice is no longer only for the dying. It is becoming the holding space for those the system cannot accommodate.
The workflow looks like this:
Lack of beds or rehabilitation services in hospitals.
Patients transferred to hospice, despite not being terminal.
Hospice staff obligated to allow and discuss MAiD.
Patient is reframed as “end of life” because the system has nowhere else to place them.
MAiD becomes a rational option inside a structure that has been built around death, not recovery.
This is not patient choice. It is system drift.
And it is happening quietly, with no public debate.
2. Capacity Failure Treated as Irremediability
The case of Jolene Van Alstine makes the problem impossible to deny.
She suffers from a rare parathyroid condition that is treatable with surgery. Saskatchewan could not provide access. Surgeons were not available. The wait times were too long. The system failed her, but MAiD assessors approved her anyway on the basis that her condition caused ongoing suffering.
Her illness was not irremediable. The health care infrastructure was.
The fact that an American commentator, Glenn Beck, stepped in to pay for surgery in the United States exposes the reality. Jolene did not need to die. She needed treatment. When a foreign media host can secure care that a G7 health system cannot, the ethical foundation of MAiD collapses.
This single case reveals the core flaw in Canada’s MAiD expansion.
The law says MAiD requires an irremediable condition.
In practice, we are substituting system failure for medical inevitability.
That is a catastrophic shift.
3. Federally Funded Normalization: How CAMAP Shapes the Culture
The Canadian Association of MAiD Assessors and Providers (CAMAP) is funded by Health Canada. Its training programs and conferences do more than teach procedure. They shape mentality. They encourage interpretations of eligibility that broaden MAiD access. They promote “barrier reduction” and teach assessors to focus on suffering rather than structural pressures.
While palliative care and disability supports face chronic underfunding, MAiD provider education is robust and publicly subsidized. This creates a two track system:
Track One: Underfunded care, long waits, limited access, repeated shortages.
Track Two: Fully trained, well organized, nationally standardized assisted death services.
The incentives are now tilted. Systems follow incentives.
The cultural meaning of MAiD is no longer exceptional relief. It is becoming an integrated pathway inside a strained health system.
4. Infrastructure Tells the Story: What Health Authorities Are Building
Island Health in British Columbia recently laid out infrastructure priorities for new properties. They include long term care, hospice, assisted living, respite care, and a medical clinic. What is missing are facilities for rehabilitation, recovery or mobility support.
When a province builds more space for people to decline, but not for people to improve, the trajectory becomes clear. If the only fully funded route is decline management, the health system will generate more “decline”.
Capacity shortages are not accidents. They are reflections of planning. And Canada is planning for more people to exit the system early.
5. Structural Coercion Without a Single Coercive Word
None of this requires anyone to pressure a patient directly. Structural coercion operates through conditions, not conversations.
If your choices are:
Option A. Live in pain with no treatment
Option B. Choose MAiD
Then Option B is not true autonomy. It is resignation shaped by collapse.
A system that cannot provide care cannot provide consent either.
Conclusion: This Is the Point Where MAiD Stops Being a Medical Procedure
Part 4 shows the transition point.
Canada is no longer distinguishing between conditions that cannot be treated and conditions that are not being treated. Patients are being approved for MAiD because the health care system has broken down around them. Hospice is absorbing people who should be in rehabilitation. Training and funding are prioritizing death over recovery. Infrastructure decisions signal resignation. And real patients, like Jolene Van Alstine, are being pushed to the edge because they cannot access surgery that would cure them.
This is not the future scenario ethicists warned about. It is the present.
The slope is not slippery. The slope is built.