Same-Day Medically Assisted Deaths Raise Concerns in Canada

In Canada, if you need a hip or knee replacement, you’ll need to wait about six months. Want to die by medically assisted suicide? Step right up. You can do that the same day.A new report from Ontario’s Chief Coroner has revealed that 65 people in the province died by assisted suicide or euthanasia on the same day they made their requests in 2023, sparking renewed concerns about safeguards in Canada’s Medical Assistance in Dying (MAiD) program.The Medical Assistance in Dying Death Review Committee report also found that an additional 154 people died the day after making their requests, raising questions about whether adequate time is being provided for reflection and whether proper end-of-life care alternatives are being offered.Among the cases detailed in the report was that of “Mrs. B,” a woman in her 80s experiencing complications from heart surgery who initially chose palliative care at home. After discussing assisted dying with her family, her spouse requested an assessment on her behalf.However, Mrs. B told the assessor she “wanted to withdraw her request, citing personal and religious values and beliefs,” expressing a preference for hospice care instead.When hospice palliative care was denied, her spouse requested another assessment. Despite the first practitioner expressing “concerns regarding the necessity for ‘urgency’ and… the seemingly drastic change in perspective of end-of-life goals and the possibility of coercion or undue influence (i.e. due to caregiver burnout),” Mrs. B was ultimately approved by two separate assessors and died the same day.The new report notes that “most often, the provision of MAiD within the same day or next day of a written request is completed for persons who present with profound intolerable suffering, severe clinical and functional decline (i.e., imminent death), and/or when there is a risk for loss of decisional capacity to provide informed consent.”But committee members expressed concern that the ease of accessing assisted dying compared to quality end-of-life care may be influencing decisions. The report states that “[m]any members opined that poor quality end-of-life care potentially impacted the request for a brief MAiD provision timeline.”“Some members expressed their concern that access to MAiD was more easily organized and accessible in this circumstance than the previously requested and preferred option for end-of-life care,” the report added.Canada’s original MAiD legislation, passed in 2016, included a mandatory 10-day waiting period between requesting and receiving assisted dying. Parliament eliminated this requirement in 2021 for individuals whose deaths were deemed “reasonably foreseeable,” though no specific criteria were established for determining when same-day procedures should be permitted.At the end of the report, the committee concluded that “most members agreed that a person’s request for an urgent MAiD provision should not be prioritized over maintaining MAiD practices that are thorough, complete, representative of quality care, and meeting legislative requirements of eligibility and safeguards.”

Same-Day Medically Assisted Deaths Raise Concerns in Canada

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