Why Track 2 MAiD is Discriminatory
DOI:
https://doi.org/10.7202/1121334arKeywords:
medical assistance in dying, MAiD, euthanasia, disability discrimination, ableism, sexismLanguage(s):
EnglishAbstract
This paper argues that Canada’s Track 2 Medical Assistance in Dying (MAiD) regime is discriminatory against people with disabilities, and has a disproportionate impact on women with disabilities. It is important to expose critical gaps in pro-MAiD advocacy, which obscures how systemic marginalization shapes access to assisted death. Premised on a medical model of disability which exceptionalizes disability-related suffering as uniquely intolerable, Track 2 MAiD poses heightened risks for those already disadvantaged by structural inequalities. By framing death as a medical treatment, the law reinforces ableist assumptions that portray people with disabilities as better off dead instead of providing access to essential supports. These social inequalities are heightened for disabled women who experience alarming rates of male violence, the intersection of medical ableism and sexism, as well as the assumption that women should be caregivers and not those needing care.
References
1. Coelho R, Maher J, Gaind KS, Lemmens T. The realities of medical assistance in dying in Canada. Palliative & Supportive Care. 2023;21(5):871-8.
2. Frazee C. MAID resistance in Canada: sounding the five-minute entreaty. Canadian Journal of Disability Studies. 2024;13(2):1-175.
3. Canadian Association of MAiD Assessors and Providers. The Interpretation and Role of ‘Reasonably Foreseeable’ in MAiD Practice; 2022.
4. Jeanneret R, Close E, Downie J, Willmott L, White BP. ‘My advocacy is not about me, my advocacy is about Canadians’: a qualitative study of how caregivers and patients influence regulation of medical assistance in dying in Canada. Medical Law Review. 2024;32(3):301-35.
5. Human Rights Code. R.S.O. 1990, c. H.19.
6. Alberta Human Rights Act. R.S.A. 2000, c A-25.5.
7. United Nations General Assembly. Convention on the Rights of Persons with Disabilities. UN Doc A/RES/61/106. 12 Dec 2006.
8. Accessible Canada Act. S.C. 2019, c. 10.
9. Canada Disability Benefit Act. S.C. 2023, c. 17
10. Campbell FK. Exploring internalized ableism using critical race theory. Disability & Society. 2008;23(2):151-62.
11. Silverman A. Contending with ableism from internalized ableism to collective action. In: Nario-Redmond MR, editor Ableism: The Causes and Consequences of Disability Prejudice. Hoboken: John Wiley & Sons; 2020. p. 220-65.
12. Grant I. Legislated ableism: Bill C-7 and the rapid expansion of medical assistance in dying in Canada. McGill Journal of Law and Health. 2024;15(2):295-6.
13. United Nations General Assembly. General comment no. 6 (2018) on equality and non-discrimination. UN Doc CRPD/C/GC/6. 9 Mar 2018.
14. Hoye B. Winnipeg woman who chose to die with medical assistance said struggle for home care help led to decision. CBC News. 4 Oct 2022.
15. Favaro A. Woman with chemical sensitivities chose medically-assisted death after failed bid to get better housing. CTV News. 24 Apr 2022.
16. Ministry of the Solicitor General, Office of the Chief Coroner. MAiD Death Review Committee (MDRC) Report 2024 — 3. Government of Ontario; 2024.
17. Health Canada. Fourth Annual Report on Medical Assistance in Dying in Canada 2022. Government of Canada; 2023.
18. Health Canada. Fifth Annual Report on Medical Assistance in Dying in Canada 2023. Government of Canada; 2024.
19. Iezzoni LI, Rao SR, Ressalam J, et al. Physicians’ perceptions of people with disability and their health care. Health Affairs. 2021;40(2):297-306.
20. Lagu T, Haywood C, Reimold K, DeJong C, Sterling RW, Iezzoni LI. ‘I am not the doctor for you’: physicians’ attitudes about caring for people with disabilities. Health Affairs. 2022;41(10):1387-95.
21. McCallum MJL, Perry A. Structures of Indifference: An Indigenous Life and Death in a Canadian City. Winnipeg: University of Manitoba Press; 2018.
22. Lavallee B, Harding L. How Indigenous-specific racism is coached into health systems. In: Gebhard A, McLean S, St Denis V, editors. White Benevolence: Racism and Colonial Violence in the Helping Professions. Winnipeg: Fernwood Publishing; 2022. p. 51-68.
23. Merone L, Tsey K, Russell D, Nagle C. Sex inequalities in medical research: a systematic scoping review of the literature. Women’s Health Reports. 2022;3(1):49-59.
24. Canadian Charter of Rights and Freedoms. Part I of the Constitution Act, 1982, being Schedule B to the Canada Act 1982 (UK), 1982, c 11, s 91(24).
25. Downie J, Schuklenk U. Social determinants of health and slippery slopes in assisted dying debates: lessons from Canada. Journal of Medical Ethics. 2021;47(10):662-9.
26. Downie J. Why feminist philosophy (especially Sue Sherwin’s) matters: Reflections through the lens of medical assistance in dying. International Journal of Feminist Approaches to Bioethics. 2020;13(2):21-7.
27. Bernasky T, Ramji R. Exploring the impact of medical assistance in dying on people with disabilities in Canada: a media analysis. Cape Breton University; 2024.
28. Eldridge v. British Columbia (Attorney General), 1997 CanLII 327 (SCC).
29. Quebec (Attorney General) v. A, 2013 SCC 5 (CanLII).
30. R v. B.F., 2024 ONCA 511 (CanLII), leave to appeal to SCC granted, 2024 CanLII 117915 (SCC).
31. Daigle T. Kenneth Law to plead not guilty to 1st-degree murder charges, lawyer says. CBC News. 25 Jan 2024.
32. Woodward J. Alleged suicide kit salesman files in Supreme Court to contest whether assisted suicide can ever be murder. CTV News Toronto. 7 Oct 2024.
33. Peters G. Reality, not religion, is the reason people need MAiD-free health care. Policy Options. 26 Apr 2024.
34. Henderson C. I went for a mastectomy and they offered me assisted dying, Canadian cancer patient reveals. The Telegraph. 14 Oct 2024.
35. Birrell I. ‘I was offered assisted dying over cancer treatment’: in Canada, a broken healthcare system is killing patients. UnHerd. 30 May 2024.
36. Mentler et al. v. (Canada) Attorney General Notice of Application, Court File No. CV-24-0072847-0000. 25 Sep 2024.
37. Carter v. Canada (Attorney General), 2012 BCSC 886 (CanLII).
38. Fraser v. Canada (Attorney General), 2020 SCC 28 (CanLII).
39. Statistics Canada. Poverty and low-income statistics by disability status. Ottawa: Statistics Canada; 1 May 2025. Table: 11-10-0090-01.
40. Vergara D, Hardy V. Labour market characteristics of persons with and without disabilities, 2023. Juristat, Statistics Canada, cat no. 71-222-X. 13 Jun 2024.
41. UN Committee on the Rights of Persons with Disabilities. Concluding observations on the combined second and third periodic reports of Canada. UN Doc CRPD/C/CAN/CO/2-3. 21 Mar 2025.
42. SK Gaind. MAiD and marginalized people: Coroner’s reports shed light on assisted death in Ontario. The Conversation. 24 Oct 2024.
43. Grant I, Benedet J, Sheehy E, Frazee C. A conversation on feminism, ableism, and medical assistance in dying. Canadian Journal of Women and the Law. 2024;35(1):31-72.
44. Briscoe JC. Affirming dignity: arguments against Medical Aid in Dying. Psychiatric Times. 21 Dec 2022.
45. Nicolini ME, Gastmans C, Kim SYH. Psychiatric euthanasia, suicide and the role of gender. The British Journal of Psychiatry. 2022;220(1):10-3.
46. Nicolini ME, Peteet JR, Donovan GK, Kim SYH. Euthanasia and assisted suicide of persons with psychiatric disorders: the challenge of personality disorders. Psychological Medicine. 2022;50(4):575-82.
47. Kim S. In Canada, MAID has become a matter of ideology. Globe and Mail. 23 Feb 2023.
48. Peters G. Creating a killable class and manufacturing selective suicidality: thoughts of a past and future ironing board. In: Coelho R, Gaind KS, Lemmens T, editors. Unravelling MAiD in Canada: Euthanasia and Assisted Suicide as Medical Care. Montréal: McGill-Queen’s University Press; 2025. p. 204-76.
49. Sinyor M, Pirkis J, Picard A, et al. Towards a shared understanding: Perspectives from Toronto’s first media forum for suicide prevention. Canadian Journal of Public Health. 2016;107(3):330-32.
50. Sareen J, Isaak C, Katz LY, Bolton J, Enns MW, Stein MB. Promising strategies for advancement in knowledge of suicide risk factors and prevention. American Journal of Preventive Medicine. 2014;47(3):257-63.
51. Schüklenk U, Van Delden JJ, Downie J, Mclean SA, Upshur R, Weinstock D. End‐of‐life decision‐making in Canada: the report by the royal society of Canada expert panel on end‐of‐life decision‐making. Bioethics. 2011;25(1):1-73.
52. Downie JG. Dying Justice: A Case for Decriminalizing Euthanasia and Assisted Suicide in Canada. Toronto: University of Toronto Press; 2004.
53. Savage L. Intimate partner violence: experiences of women with disabilities in Canada. Juristat, Statistics Canada. 26 Apr 2021.
54. Cotter A. Violent victimization of women with disabilities, 2014. Juristat, Statistics Canada. 15 Mar 2018.
55. Government of Canada. Fact Sheet: Intimate Partner Violence. 2020 [updated 2021].
56. Statistics Canada. Trends in police-reported family violence and intimate partner violence in Canada, 2023. The Daily. 24 Oct 2024.
57. Devries K, Watts C, Yoshihama M, et al. Violence against women is strongly associated with suicide attempts: evidence from the WHO multi-country study on women’s health and domestic violence against women. Social Science & Medicine. 2011;73(1):79-86.
58. McManus S, Walby S, Barbosa ES, et al. Intimate partner violence, suicidality, and self-harm: a probability sample survey of the general population in England. Lancet Psychiatry. 2022;9(7):574-83.
59. McManus S. Underexamined and Underreported: Suicidality and Intimate Partner Violence: Connecting Two Major Public Health Domains. London: Agenda Alliance; Feb 2023.
60. Boyle Q, Illes J, Simonetto D, van Donkelaar P. Ethicolegal considerations of screening for brain injury in women who have experienced intimate partner violence. Journal of Life and Bio-sciences Research. 2022;9(2):lsac023.
61. Walker N, Beek K, Chen H, et al. The experiences of persistent pain among women with a history of intimate partner violence: a systematic review. Trauma, Violence & Abuse. 2022;23(2):490-505.
62. Ogden C, Tutty LM. My parents, my grandparents went through residential school, and all this abuse has come from it: examining intimate partner violence against Canadian Indigenous women in the context of colonialism. Journal of Interpersonal Violence. 2023;38(23-24):12185-209.
63. Okeke-Ihejirika P, Yohani S, Muster J, Ndem A, Chambers T, Pow V. A scoping review on intimate partner violence in Canada’s immigrant communities. Trauma Violence Abuse. 2018;21(4):788-810.
64. Jitender S, Cox BJ, Stein MB, Affi TO, Fleet C, Asmundson, GJ. Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosomatic Medicine. 2007;69(3):242-8.
65. Satyanarayana S, Enns MW, Cox BJ, Sareen J. Prevalence and correlates of chronic depression in the Canadian community health survey: mental health and well-being. The Canadian Journal of Psychiatry. 2009;54(6):389-98.
66. Pepper D. Abusive partners of disabled women ‘masquerading as carers’ and weaponizing disability — study. The Journal. 24 Oct 2024.
67. Flynn S, Lakkshme Sundaresan S, Price A, O’Neill G. Disabled women’s experiences of intimate partner abuse in Ireland: research project report — executive summary. Ireland: Women’s Aid; 2024.
68. Cotter A. Criminal victimization in Canada, 2019. Juristat, Statistics Canada. 25 Aug 2021.
69. Wiebe K, Mullin A. Choosing death in unjust conditions: hope, autonomy and harm reduction. Journal of Medical Ethics. 2023;50(6):407-12.
70. Cleghorn E. Unwell Women: Misdiagnosis and Myth in a Man-Made World. New York: Dutton; 2021.
71. Temkin SM, Barr E, Moore H, Caviston JP, Regensteiner JG, Clayton JA. Chronic conditions in women: the developments of a National Institutes of Health framework. BMC Women’s Health. 2023;23:162.
72. Gao Z, Chen Z, Sun A, Deng X. Gender differences in cardiovascular disease. Medicine in Novel Technology and Devices. 2019;4:100025-6.
73. Lat TI, McGraw MK, White HD. Gender differences in critical illness and critical care research. Clinics in Chest Medicine. 2021;42(3):543-55.
74. Graf J, Simoes E, Kranz A, Weinert K, Abele H. The importance of gender-sensitive health care in the context of pain, emergency and vaccination: a narrative review. International Journal of Environmental Research and Public Health. 2023;21(1):1-13.
75. Hoffmann DE, Fillingim RB, Veasley C. The woman who cried pain: do sex-based disparities still exist in the experience and treatment of pain? Journal of Law, Medicine & Ethics. 2022;50(3):519-41.
76. Donroe JH, Socias ME, Marshall BD. The deepening opioid crisis in North America: historical context and current solutions. Current Addiction Reports. 2018;5(4):454-63.
77. Statistics Canada. More than half of women provide care to children and care-dependent adults in Canada, 2022. The Daily. 8 Nov 2022.
78. Glantz MJ, Chamberlain MC, Liu Q, et al. Gender disparity in the rate of partner abandonment in patients with serious medical illness. Cancer. 2009;115(22):5237-42.
79. Shakespeare T. Power and prejudice: issues of gender, sexuality and disability. In: Shakespeare T, editor. Disability and Society. London: Routledge; 2016.
80. Latham-Mintus K, Holcomb J, Zervos AP. Linked lives: does disability and marital quality influence risk of marital dissolution among older couples? Social Science. 2022;11:27.
81. Stark E. Coercive Control: The Entrapment of Women in Personal Life. Oxford: Oxford University Press; 2007.
82. Mackenzie F. Safeguarding women in assisted dying: a rapid review to inform the debate on assisted dying in the UK. The Other Half. 22 Nov 2024.
83. Sodha S. Assisted dying seems humane, but can we protect the vulnerable from the malign? The Guardian. 1 Jan 2023.
84. Pullman D. In a familiar voice: the dominant role of women in shaping Canadian policy on medical assistance in dying. Canadian Journal of Bioethics/Revue Canadienne de Bioéthique. 2020;3(3):11-20.
85. Llewellyn J, Downie J. Restorative justice, euthanasia, and assisted suicide: a new arena for restorative justice and a new path for end of life law and policy in Canada. Alberta Law Review. 2011;48(4):965-86.
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