The Ethical Crossroads of MAiD, Organ Donation, and Biotech Expansion — Part 1 (Revised Oct 31, 2025)
This essay expands on a piece first published earlier this year exploring Canada’s MAiD system and its intersection with healthcare economics and organ donation. Since then, new federal data, a 2025 Cardus report, and multiple coroner’s reviews have deepened the ethical and statistical picture. What follows is an updated and extended version — Part 1 of a continuing series on MAiD and the evolving definition of medical ethics in Canada.
Introduction
Canada’s Medical Assistance in Dying (MAiD) began as a narrow exception for the terminally ill. In practice, it has become a fast‑expanding program where non‑terminal illness, disability, and even social conditions are routinely present in approvals. The central question of Part 1 remains: has a personal right been reframed into a systemic expectation? New national data and institutional reports now push that question from hypothesis to evidence.
What Changed Since We First Published
A September 2025 research report from Cardus, In Contrast to Carter, audits federal, provincial, and peer‑reviewed data and finds that the safeguards promised by the courts and Parliament have not materialized. It concludes that Canada has effectively created “MAiD on demand,” with a disproportionate impact on people living with disabilities and other vulnerable groups. This report strengthens and quantifies the concerns raised throughout this series.
1) MAiD’s Expansion and the Reality on the Ground
MAiD was legalized on the assurance of strict limits and rigorous clinical scrutiny. The program has since expanded to include people who are not dying, with mental illness alone scheduled to become an eligible sole condition in 2027. Cardus’ audit shows how the ground actually shifted:
From 2019 to 2023, at least 42 percent of all MAiD deaths were people who required disability supports.
More than 1,000 Canadians who died by MAiD in that period needed disability services but did not receive them.
In 2023, about 78 percent of recorded MAiD requests resulted in a MAiD death. Approvals have become the norm rather than the exception.
Reported suffering now frequently includes social factors: in 2023, almost half of MAiD recipients were documented as feeling like a burden, and 22 percent cited isolation or loneliness as part of their suffering.
Neurological conditions are rising within MAiD approvals. In 2023, 241 people with dementia died by MAiD; in 106 cases, dementia was the sole condition.
These numbers paint a simple picture: the people MAiD was supposed to protect from pressure are now heavily represented among those receiving it.
2) Natural Life Expectancy and the Broken Premise
MAiD’s legal foundation leaned on the idea that it would apply mainly to patients near natural death. Quebec’s public reporting shows a different reality. In 2023–24, at least 1 in 5 MAiD recipients were estimated to have more than six months of natural life remaining at the time of death. Earlier international evidence used to reassure Canadians suggested this would be closer to 1 in 500. That is not a marginal deviation. It is a reversal of the premise.
3) Consent, Capacity, and the Speed of the Pathway
The legal promise was rigorous scrutiny, careful capacity assessment, and protection against situational vulnerability. Yet the current pathway moves fast. Nationally in 2023, the average time from request to provision was under two weeks, and same‑day or next‑day provisions do occur. When the vast majority of requests are approved, and when approvals routinely include disability, dementia, loneliness, and perceived burden, the idea that most vulnerable patients are being screened out becomes difficult to defend.
4) Organ Donation and the “Final Gift” Narrative
Canada is a world leader in organ donations from MAiD patients. Framing this as a “final act of generosity” has grown more common, and it intersects uncomfortably with system incentives: governments save on long‑term care costs when MAiD is chosen; transplant programs benefit when organ supply increases; biotech and device firms are investing in new supply channels for transplantation. Voluntary donation is honorable. The pressure created by these incentives is not. The ethical risk is that a personal choice can be nudged into a perceived duty.
5) Who Benefits When Death Becomes a System Pathway?
Public finance: federal estimates have long acknowledged net savings when MAiD replaces extended care. The number may be a small fraction of total health spending, but it is a real policy incentive.
Transplant ecosystem: expanding supply lines through MAiD aligns with institutional goals to reduce waiting lists. That alignment deserves scrutiny, not silence.
Biotech expansion: xenotransplantation, organ preservation, and bioprinting firms are scaling. MAiD is not their driver, but the cultural normalization of death as a clinical solution lowers resistance to industrialized end‑of‑life logistics.
6) Language, Normalization, and Policy Drift
Narratives matter. The vocabulary has shifted from last‑resort compassion to socially useful choice. Patients are told that choosing MAiD can spare loved ones, relieve strained systems, and make a final contribution. That framing converts intimate suffering into a utilitarian calculation. Once embedded, it is hard to roll back.
7) The Line We Cannot Cross
Relieving suffering is a medical duty. Eliminating the sufferer is not. When approvals concentrate among those without adequate supports, when loneliness and “being a burden” are common drivers, and when approvals are granted at scale and speed, the line between compassion and coercion becomes razor thin.
Data Box — Key MAiD Findings (2025)
42% of all MAiD deaths (2019–2023) involved people requiring disability supports.
1,017 Canadians died by MAiD while still waiting for disability services.
78% of MAiD requests now result in death — up from 59% in 2019.
49% of recipients felt they were a burden; 22% cited loneliness or isolation.
241 people with dementia died by MAiD in 2023; in 106 cases, dementia was the only diagnosis.
Conclusion
Part 1 opened with a question about drift. The 2025 data answer it. Canada’s MAiD regime has moved from a narrow exception to a normalized pathway, with the heaviest impact borne by the disabled, the cognitively impaired, and the socially isolated. That is not an argument against empathy. It is an argument against policy that mistakes the removal of a person for the remedy of their pain.
Editor’s Notes
Substantiation: All new figures in this revision draw from national reporting and the September 2025 Cardus audit of MAiD outcomes. The numbers are used here to quantify trends already flagged in earlier drafts.
Scope: This part focuses on the ethical and structural drift. Later parts examine case studies, organ‑donation mechanics, and the mental‑illness expansion queued for 2027.
Standing standard: We continue to apply the North Star Accord principles. Claims are either sourced to institutional reporting or clearly sign‑posted as analysis. Where safeguards are asserted by policy but contradicted by outcomes, we defer to outcomes.
If Part One showed how MAiD expanded, Part Two exposes what that expansion actually did.
The safeguards that were supposed to protect the vulnerable didn’t fail quietly, they failed out in the open. And the system kept moving anyway.
In Part Two, we break down the oversight gaps, the ethical breaches, the rejected palliative care cases, and the data Canada hoped you wouldn’t read closely.
Read Part Two here →
