One Hundred Thousand Deaths Later

Ten years after Parliament promised MAiD would never replace care, the government’s own data tells a different story

THE OLD GUARDIAN

www.theoldguardian.ca | Independent Investigative Journalism

By Chris Allen | The Old Guardian | June 17, 2026

Ten years ago today, Parliament passed Bill C-14 and Canada became one of the first countries in the world to legalize medical assistance in dying. The assurances that made it possible were precise: MAiD would be a last resort, available only to those in irremediable suffering for whom no other option remained. Consent would be meaningful, not inferred. Vulnerability would be protected, not eligible.

Today, on the tenth anniversary of that legislation, a parliamentary committee has recommended that the federal government indefinitely exclude people with mental illness from MAiD eligibility — a recommendation that is itself an acknowledgment of how far the program has drifted from what it promised to be.

But here is what the committee report does not address, and what this investigation has spent months building from primary government sources: the accountability failures it identified in psychiatric MAiD are already present — documented, measured, and in some cases prosecuted — in the system currently serving 100,000 Canadians who have already died.

A pause on expansion answers a different question than the one the evidence raises. The question the evidence raises is this: does Canada have a MAiD system that can be trusted with the authority it already has?

The answer, built from Health Canada’s own annual reports, parliamentary testimony, regulatory findings, and six documented case files, is no.

I. The Scale No One Is Stating Plainly

In 2024, 16,499 Canadians died by MAiD. That represents 5.1 percent of all deaths in the country — one in twenty. By raw numbers, MAiD is now the fourth most common way Canadians die, behind cancer, heart disease, and accidents. The government does not state it this way, because the World Health Organization classifies MAiD as a health service rather than a cause of death. That classification is itself part of the story: the agency responsible for counting how Canadians die has formally decided not to count this one.

Cumulative provisions surpassed 100,000 in April 2026 — nine years after legalization. Quebec’s MAiD rate has reached 7.9 percent of all provincial deaths, the highest rate in the world. In the same decade, Canada’s palliative care coverage has declined, its hospice bed capacity sits at 57 percent of the recommended standard, and its average healthcare wait time has reached 30 weeks — while the average time from MAiD request to death is 13 days.

These numbers are not from critics of the program. They are from Health Canada’s own annual reports. The government collected them, published them, and released them under a ministerial message emphasizing compassion and patient-centered care. The numbers tell a different story than the message does.

II. What the Promises Actually Were

The legal foundation of Canada’s MAiD framework is Carter v. Canada, the 2015 Supreme Court decision that struck down the criminal prohibition on assisted dying. Carter was explicit about the conditions under which the right existed: competent adults in grievous and irremediable suffering, for whom no other means of relieving suffering remained acceptable. The safeguards — two assessors, reflection periods, mandatory consideration of alternatives — were not bureaucratic decoration. They were the conditions under which the court found the right existed at all.

The first legislative expansion came in 2021 with Bill C-7, which created Track 2 MAiD for people whose death is not reasonably foreseeable — people who are not terminally ill. The psychiatric expansion — MAiD for those whose sole underlying condition is mental illness — was added by Senate amendment and has been delayed three times, most recently to March 2027, which is where the AMAD committee has now recommended it stay, indefinitely.

What has not been delayed is the erosion of the conditions that made the original framework defensible. Four words have been quietly redefined in the decade since Carter, without legislation, without parliamentary debate, and without public announcement.

Irremediable once meant that medicine had exhausted its options. It now means that the patient finds available options unacceptable — and Canada is the only jurisdiction in the world that does not require proof that treatment was tried before approving MAiD. Suffering has expanded from clinical symptoms to life circumstances: poverty, isolation, loneliness. Compassion has been reframed from accompanying a person through their pain to removing the person experiencing it. And safeguard now describes a documentation process that records compliance without verifying it.

None of those redefinitions passed through Parliament. They accumulated through training programs, clinical guidelines, and the institutional culture of a provider community funded and organized around access rather than gatekeeping.

III. The Data the Minister’s Message Does Not Mention

The government publishes detailed annual data on MAiD. What follows is drawn entirely from Health Canada’s own Fifth and Sixth Annual Reports.

The approval rate

In 2019, 59 percent of MAiD requests ended in death. By 2023 that figure was 78 percent, and rising. In any other medical context, an approval rate approaching 80 percent for an irreversible procedure would prompt scrutiny of whether the gatekeeping function was operating. In the MAiD context, it is presented as evidence of appropriate access.

The Track 2 profile

Track 2 MAiD — for people who are not terminally ill — grew 34 percent between 2022 and 2023, and a further 17 percent between 2023 and 2024. The people receiving it are predominantly women (56.7 percent in 2024), with a median age of 75.9 years, the majority of whom have lived with their condition for more than a decade. In 2024, 61.5 percent self-identified as having a disability. Only 23.2 percent received palliative care before dying — down from 29.6 percent the year before.

That last number deserves to be read slowly. Nearly eight in ten people who received non-terminal MAiD in 2024 did not receive palliative care. Among those who required but did not receive palliative care, 91.2 percent confirmed that services were accessible to them. They could have accessed palliative care. They did not. Then they received MAiD. The government reports this as a sign of appropriate patient choice. It is also consistent with a system in which the path to death is faster and better resourced than the path to care.

The suffering data

Health Canada asks practitioners to report the sources of suffering cited by MAiD recipients. In 2024, 50.3 percent of Track 2 recipients cited feeling like a burden on family, friends, or caregivers as a contributing factor. For Track 2, 44.7 percent cited isolation or loneliness.

Feeling like a burden is a documented primary driver of suicidal ideation. It is precisely the cognitive state that crisis psychiatry is designed to identify and treat as a distortion, not a terminal prognosis. When half of all non-terminal MAiD recipients report it as a significant factor in their decision, the system is not responding to irremediable suffering. It is ratifying a social failure and calling it compassion.

The voluntariness gap

In 2024, in 21.2 percent of Track 1 cases, the practitioner selected only one source of information when determining that the request was voluntary. One source. For an irreversible decision. In the same year, 45 people were found ineligible specifically because their request was determined to be the product of external pressure. Those are the cases where pressure was identified. The data offers no information about cases where it was not.

IV. Six Cases. Six Failure Modes. One System.

The following documented cases are not presented as representative of all MAiD provisions. Most people who access MAiD in Canada do so with genuine informed consent, in genuine irremediable suffering, with adequate assessment. The cases below document specific failure modes in a system without adequate mechanisms to detect or stop them.

Jolene Van Alstine, 45, Saskatchewan

Van Alstine has normocalcemic primary hyperparathyroidism — a rare but treatable parathyroid disease. The treatment is surgery. No Saskatchewan surgeon was available to perform it. To obtain a referral to an out-of-province specialist, she first needed an endocrinologist appointment in Saskatchewan. No Saskatchewan endocrinologist was accepting new patients. The system had produced a closed loop.

She was approved for MAiD. Her appointment was set for January 7, 2026. Her approval was later pulled on a procedural technicality. American broadcaster Glenn Beck saw coverage of her case on social media, contacted her husband, and arranged surgical consultations in Florida. As of January 2026, she was alive.

Her assessor, Dr. George Carson, confirmed to CBC News that the approval criteria were met. He did not establish that her condition was medically irremediable. He established that the Saskatchewan healthcare system had failed to treat it. Those are not the same thing, and the framework Canada built was supposed to require the distinction.

Kristin Logan, Campbell River, BC

Logan, a dual Canadian-American citizen and US Air Force veteran, was diagnosed with stage four ovarian cancer. Per her husband Donovan James, Canadian doctors told her MAiD was her only option because they had no treatment available. A chemotherapy requisition was placed and then disappeared. She met her oncologist only by phone. She accessed treatment in Washington state under her US veteran benefits. She has since achieved multiple remissions.

Her own words: ‘How can you prioritize cases so that people with aggressive stage four cancer get seen by someone and when they do get seen, they get offered treatment and not MAID like I was the first time?’

Miriam Lancaster, 84, Vancouver

Lancaster was taken to Vancouver General Hospital with severe back pain. According to her and her daughter, the first thing a physician said was an offer of MAiD — before any diagnostic tests had been conducted. She declined. She was diagnosed with a fractured sacrum, a painful but treatable injury. She made a full recovery and climbed an active volcano in Guatemala in February 2026.

She later noted that her husband had also been offered MAiD at the same hospital ten days before his death from metastatic cancer in 2023 — also unsolicited.

Fr. Larry Holland, 79, Vancouver

Holland, a Catholic priest, was admitted to Vancouver General Hospital after fracturing his hip on Christmas Day 2025. He was not terminally ill. He was offered MAiD twice during his recovery — first by a physician, then weeks later by a nurse — despite having told staff he is a Catholic priest morally opposed to euthanasia.

Vancouver Coastal Health confirmed in writing that staff ‘may consider bringing up MAiD based on their clinical judgment, provided they possess the necessary knowledge and skills to do so.’ That written confirmation is the institutional anchor for a pattern that Lancaster, Holland, and Chilliwack patient Pat Gray all experienced at facilities in the same health authority catchment: not rogue physicians, but documented institutional policy producing documented outcomes.

The policy document behind that outcome is CAMAP’s guidance on ‘Bringing up Medical Assistance in Dying as a clinical care option,’ which explicitly instructs practitioners not to assume patients oppose MAiD because of their faith, citing Roman Catholic nuns as an example. The Canadian Association of MAiD Assessors and Providers is funded by Health Canada.

Kiano Vafaeian, 26, Ontario/BC

Vafaeian received MAiD on December 30, 2025 in Vancouver, after being denied multiple times in Ontario and traveling to British Columbia where he was approved under Track 2. He had Type 1 diabetes, partial vision loss, and a history of mental health struggles. His family was not informed of his approval; they learned of his death days later through estate paperwork.

University of Toronto law professor Trudo Lemmens stated the case raises serious questions about whether non-treating physicians can approve MAiD when the patient is clearly battling mental health issues. The College of Physicians and Surgeons of BC told the Globe and Mail it had never disciplined a doctor in relation to medically assisting someone’s death.

Thomas Dillon, 45, London, Ontario — and Dr. James MacLean

In June 2023, Dr. James MacLean assessed Thomas Dillon for MAiD outside a Tim Hortons in London, Ontario, after exchanging dozens of text messages with him. MacLean then drove Dillon personally to the location where MAiD was administered in January 2024. Dillon’s family was not informed. His sister had arrived at the Tim Hortons to accompany her brother; MacLean drove him instead.

The College of Physicians and Surgeons of Ontario found that MacLean’s conduct crossed professional boundaries and risked appearing coercive. A broader review of his general practice found his conduct exposes or is likely to expose patients to harm or injury in five of twenty charts reviewed — a 25 percent harm rate. In a second case, MacLean failed to administer one of the three drugs used in assisted death; the patient resumed breathing after being pronounced dead. MacLean had already left.

The CPSO’s response: a minimum six-month supervision period beginning April 15, 2026. MacLean is permitted to continue providing MAiD throughout that supervision period.

Ontario’s MAiD Death Review Committee tracked 428 possible Criminal Code violations between 2018 and 2023. It referred zero to law enforcement. The MacLean case is what that zero looks like in practice.

Dr. Ramona Coelho, a member of the Ontario MAiD Death Review Committee and a senior fellow at the Macdonald-Laurier Institute, responded to the MacLean findings with this: ‘What is striking is not only the seriousness of the concerns identified in these cases, but the limited regulatory response.’

V. The Psychiatric Frontier Canada Is Not Ready For

The AMAD committee has recommended that Parliament indefinitely exclude mental illness from MAiD eligibility. That recommendation is correct. The clinical infrastructure required to implement psychiatric MAiD safely does not exist. What the recommendation does not say — but what the evidence from those same AMAD hearings establishes — is that the accountability infrastructure required to implement the current system safely does not exist either.

Dr. Allison Crawford, chief medical officer of Canada’s 9-8-8 suicide crisis helpline, testified to AMAD that up to 7 percent of all interactions with the service involve mention of MAiD, and that 74 percent of those callers had experienced suicidal thoughts in the previous 48 hours. She stated there is currently no reliable clinical method to distinguish between suicidal intent and a reasoned wish to die in the context of psychiatric MAiD.

Dr. John Maher, Chief of Psychiatry at an Ontario hospital and editor-in-chief of the Journal of Ethics in Mental Health, told AMAD he personally challenged an approval he believed was illegal — a patient with schizophrenia approved on the basis of a skin condition a dermatologist said could be treated with a cream, and a sore ankle. The patient was psychotic and delusional at the time. ‘People are clearly getting MAID for reasons that are frankly illegal,’ Maher told the committee.

Dr. Harvey Chochinov, one of Canada’s most respected palliative psychiatrists, testified that at least half the people who would die by MAiD for mental illness would have gotten better.

These are not positions from the fringes of the debate. They are the testimony of the government’s own expert witnesses, to the government’s own committee, about the government’s own system.

The Netherlands is frequently cited as evidence that psychiatric MAiD can be implemented safely. Dutch psychiatric euthanasia rose from 2 cases in 2011 to 219 in 2024, with a disproportionate increase among young adults and, more recently, minors — including an autistic teenager who described his life as joyless and had attempted suicide two years before being euthanized. Dr. Sonu Gaind, past president of the Canadian Psychiatric Association, commented on that case: ‘The threshold for assisted death in Canada is actually lower than the Netherlands. If MAID for sole mental illness is opened up in Canada, the numbers would significantly exceed what you see in the Netherlands.’

That is the model jurisdiction telling Canada: we have gone further than you understand, and your system is built to go further still.

VI. Who Bears the Weight

Track 2 MAiD recipients in 2024 were 56.7 percent women, with a median age of 75.9 years, the majority living with conditions they had managed for more than a decade. Sixty-one percent self-identified as having a disability. Half reported feeling like a burden. Nearly half in Track 2 cited isolation or loneliness.

Senior women in Canada earn 26 percent less in retirement than senior men. Government transfers make up 43 percent of their total income. Twelve percent live in housing that is unaffordable or below acceptable standards. Women are twice as likely to work part-time, reducing their pension contributions across careers spent disproportionately in unpaid caregiving. They become the people with no one to care for them.

Ontario coroner data shows that people in the lowest material resource category make up 20 percent of the general population and 28.4 percent of Track 2 MAiD recipients. People in the worst housing instability category make up 34.3 percent of Track 1 deaths and 48.3 percent of Track 2.

The Lancet noted in 2024 that Canada does not require MAiD to be a last resort, and that women seek and receive psychiatric MAiD at two to three times the rate of men.

None of this requires that anyone in the system intended to harm elderly women. What it requires is that the system knows these facts — they are in its own annual reports — and has not structurally adapted to address them. The palliative care investment gap is undocumented at the federal level. The disability support crisis is noted in the data and unremedied in policy. The housing instability of Track 2 recipients is recorded and unaddressed. The law does not require MAiD to be a last resort. The expansion proceeds.

There is a version of targeting that does not require intent. It requires only that a system produce disproportionate harm to a specific population, have the data to show it, and decline to act. At some point, sustained inaction in the face of documented disparity becomes its own form of decision.

VII. What Today’s Report Does and Doesn’t Answer

The AMAD committee’s recommendation for indefinite exclusion of mental illness from MAiD is the right call. The clinical tools to assess irremediability in mental illness do not exist. The method to distinguish a suicidal crisis from a settled wish to die does not exist. CAMH itself, which provides capacity assessments for psychiatric MAiD, has stated that no reliable method exists to make that distinction. Proceeding without those tools on a fixed political timeline would be, in Dr. Maher’s word, reckless.

But here is what the recommendation does not do: it does not address the 428 Criminal Code violations Ontario tracked and did not refer. It does not address the Tim Hortons assessment, the six-month supervision, the continued provision. It does not address Jolene Van Alstine’s closed referral loop, Kristin Logan’s lost chemotherapy requisition, Miriam Lancaster’s unsolicited emergency room offer, Fr. Larry Holland’s twice-repeated offer during hip fracture recovery. It does not address the Track 2 palliative care rate that fell from 29.6 to 23.2 percent in a single year while the program expanded.

If Parliament wants to invoke the notwithstanding clause — which CBC News has reported is under consideration, and which would mark the first time the federal government has used that override in 44 years of Charter history — to protect an indefinite exclusion from constitutional challenge, that may be necessary. But a clause protecting the exclusion does not build the accountability infrastructure the system already lacks.

Dr. Ramona Coelho, writing in The Hill Times on May 20, framed it precisely: ‘Suffering is shaped not only by illness, but also by trauma, poverty, isolation, and lack of access to care. The ethical obligation of medicine is to respond to that complexity with treatment, supports, and time. Yet assisted death is already occurring in cases where suffering is driven by unmet medical needs, psychiatric illness, trauma, isolation, and socioeconomic vulnerability.’

And then: ‘Pausing the practice for mental illness should only be the start.’

The committee has recommended the start. The country has not yet begun the conversation about what comes after it.

VIII. The Line Canada Said It Would Never Cross

I support assisted dying. I support the right of a competent person in genuine irremediable suffering to choose death with dignity, in a system that has genuinely tried everything else. I supported it when Carter was decided. I supported it when Bill C-14 passed ten years ago today.

What I cannot support is the system Canada has built to administer that right.

A system with a 78 percent approval rate is not carefully assessing whether each request meets a rigorous standard. A system that processes death in 13 days while rehabilitation waits 30 weeks has not equalized its options. A system that tracked 428 possible Criminal Code violations and referred zero to law enforcement does not take its own rules seriously. A system that allowed a physician to assess a patient at a Tim Hortons, drive him to his death, leave a second patient breathing after pronouncing him dead, and receive six months of supervised practice as a consequence — while continuing to provide MAiD throughout — has not built a gate. It has built a door.

The promise that made MAiD acceptable was that it would be the last resort of a system that had exhausted every other option. Canada has not exhausted its options. It has underfunded them, understaffed them, and made them inaccessible. Then it built a process that moves from request to death in 13 days and called it compassion.

Ten years in, 100,000 deaths later, on the day a parliamentary committee recommended the first structural limitation the program has ever received, the question is not whether to pause the expansion. The question is whether Canada is willing to hold the system it already has to the standard it promised.

The evidence says it has not been. The evidence also says it could be. That distinction is the only thing that separates a program worth defending from one that has quietly become something else.

Key Statistics — Health Canada Annual Reports

Editor’s Notes and Sources

This investigation is built on primary government sources. The statistical spine is Health Canada’s Fifth Annual Report on Medical Assistance in Dying in Canada (2023 data, published December 2024) and Sixth Annual Report (2024 data, published November 2025), available at canada.ca. All percentages and case volumes cited are from these primary documents unless otherwise noted.

Case file sources:

Jolene Van Alstine: CBC News (Dec 10, 2025); Global News; CTV News Regina; Toronto Sun; CBN News (Jan 9, 2026). Assessor Dr. George Carson’s comments confirmed on record to CBC.

Kristin Logan / Donovan James: Global News; Campbell River Mirror. Core narrative confirmed by Global News; social media updates not independently verified and not cited.

Miriam Lancaster: National Post (Sharon Kirkey, March 27, 2026). Account based on patient and family statements; no independent regulatory investigation findings have been publicly reported.

Fr. Larry Holland: BC Catholic (primary — official media of the Archdiocese of Vancouver); Catholic Register (corroborating); Vancouver Coastal Health written statement (institutional anchor).

Kiano Vafaeian: Globe and Mail (Feb 6, 2026); Global News (Jan 30, 2026). CPSO statement confirmed. Family allegations regarding coached testimony denied by Dr. Wiebe.

Thomas Dillon / Dr. James MacLean: Globe and Mail (broke the story); National Post (Sharon Kirkey); CPSO regulatory findings (public document). Dr. Coelho response on record.

AMAD committee testimony: Dr. Crawford, Dr. Maher, Dr. Mishara, Dr. Chochinov, and Dr. Gupta testified before the Special Joint Committee on Medical Assistance in Dying in spring 2026. Testimony citations should be verified against Hansard transcripts at parl.ca before publication. Secondary reproduction via regional press (Peace Arch News, Black Press regional syndication) and advocacy outlets used for sourcing notes in the research brief; Hansard is the citable primary source.

AMAD committee report, June 17, 2026: CBC News (Jennifer La Grassa, Olivia Stefanovich, Raffy Boudjikanian); Globe and Mail. The committee’s formal written report is the primary document and should be obtained directly from parl.ca.

Parliamentary Budget Office cost estimates: PBO, Costing Bill C-7: An Act to Amend the Criminal Code (Medical Assistance in Dying), October 2020. Peer-reviewed cost literature: Trachtenberg & Manns, CMAJ, 2017; Jamil & Pearce, OMEGA Journal, February 2025.

Ontario violation tracking: Ontario MAiD Death Review Committee Reports (2024–2025), confirmed via The New Atlantis / leaked Ontario compliance data (February 2025).

Dr. Coelho quotation: ‘MAID committee hearings exposed a deeper problem,’ The Hill Times, May 20, 2026, via Macdonald-Laurier Institute.

Dr. Sonu Gaind quotation: National Post (Sharon Kirkey), March 23, 2026.

CAMAP guidance document: ‘Bringing up Medical Assistance in Dying as a clinical care option,’ publicly available via CAMAP’s website. Funding relationship with Health Canada confirmed via Health Canada grant records.

Notwithstanding clause consideration: CBC News (June 16, 2026).

Gender analysis data: Women and Gender Equality Canada, December 2025; Ontario Human Rights Commission; LEAF, 2023; Lancet Regional Health — Americas, June 2024; Ontario coroner data via The Conversation, October 2024.

Dutch data: Netherlands Regional Euthanasia Review Committees Annual Report 2025.

The Old Guardian is an independent investigative journalism outlet. Investigations are built on primary government sources, peer-reviewed literature, and documented case files. Secondary and advocacy sources are not cited as primary evidence. This editorial represents the views of the author.