Assisted Dying in Canada: Ideology Masquerading as Medicine?
DOI:
https://doi.org/10.7202/1121332arKeywords:
medical assistance in dying, MAID, euthanasia, assisted suicideLanguage(s):
EnglishAbstract
The Canadian medical assistance in dying (MAID) law is commonly understood as a type of medically-based euthanasia and/or assisted suicide (EAS) law. I argue it is instead an autonomy-only EAS regime masquerading as such. The public guidance on the law’s broad eligibility criteria that direct current practice employs novel meanings to familiar terms used in healthcare. The result is that the law gives the impression that Canadian MAID is about something medical, but in reality operates as an autonomy-only model, i.e., “death on autonomous demand” clothed as medical treatment. The implications are significant. It allows bypassing the debates that an autonomy-only system (which is not inherently medical) would need to address, such as whether autonomy-only EAS comports with common morality, whether and how the health care system should be involved, how many resources the state should invest in promoting a death-on-request system, etc. The law also distorts the practice of medicine by using patients’ subjective preference (i.e., patients’ preference), rather than science and evidence, as determining medical standards and in defining terms such as ‘incurable.’ This masquerade has been reinforced by Canadian officials in their public statements. The result seems to be a Canadian public highly supportive of a law that they do not fully understand and indeed would likely disapprove of in its current form, if they did. The Canadian MAID law is a product of flawed democratic policymaking.
References
1. Sypnowich C. Law and ideology. In: Zalta EN, Nodelman U, editors. The Stanford Encyclopedia of Philosophy (Summer 2024 Edition). 22 Oct 2001 [rev. 24 Mar 2024].
2. Oregon Health Authority. Oregon Revised Statute: Oregon's Death with Dignity Act. Government of Oregon.
3. State Government of Victoria. Voluntary Assisted Dying Act 2017. Act no. 61/2017, ver. 003. Victoria, Australia.
4. Griffiths J, Weyers H, Adams M. Euthanasia and Law in Europe. Oxford: Hart Publishers; 2008.
5. Nyquist C, Cohen-Almagor R, Kim SYH. Expert views on medical involvement in the Swiss assisted dying practice: “we want to have our cake and eat it too”? AJOB Empirical Bioethics. 2024;15(1):41-59.
6. Swiss Academy of Medical Sciences. Management of Dying and Death. Bern: House of Academies; 2018.
7. Health Canada. Fifth Annual Report on Medical Assistance in Dying in Canada, 2023. Government of Canada; 11 Dec 2024.
8. Commission fédérale de Contrôle et d’Évaluation de l’Euthanasie. EUTHANASIE – Chiffres de l’année 2022. Santé publique, Sécurité de la Chaîne alimentaire et Environnement; Brussels. 17 Feb 2023.
9. Regional Euthanasia Review Committees. Annual Report 2022. Government of the Netherlands; 12 Sept 2024.
10. Montagna G, Junker C, Elfgen C, Schneeberger AR, Güth U. Long-term development of assisted suicide in Switzerland: analysis of a 20-year experience (1999–2018). Swiss Medical Weekly. 2023;153(3):40010.
11. Kim S, De Vries R, Peteet J. Euthanasia and assisted suicide of patients with psychiatric disorders in the Netherlands 2011 to 2014. JAMA Psychiatry. 2016;73(4):362-8.
12. Nicolini ME, Gastmans C, Kim SYH. Psychiatric euthanasia, suicide and the role of gender. The British Journal of Psychiatry. 2022;220(1):10-13.
13. Asada Y, Campbell LA, Grignon M, Hothi H, Stainton T, Kim SYH. Importance of investigating vulnerabilities in health and social service provision among requestors of medical assistance in dying. Lancet Regional Health Americas. 2024;35:100810.
14. Kim SYH. The unstable boundary of suffering-based euthanasia regimes. American Journal of Bioethics. 2022;22(2):59-62.
15. Health Canada. Model Practice Standard for Medical Assistance in Dying (MAID). Government of Canada; Mar 2023.
16. Health Canada. Advice to the Profession: Medical Assistance in Dying (MAID). Government of Canada; Mar 2023.
17. Canadian Association of MAiD Assessors and Providers (CAMAP). The Interpretation and Role of “Reasonably Foreseeable” in MAiD Practice; Feb 2022.
18. Wiebe K, Mullin A. Choosing death in unjust conditions: hope, autonomy and harm reduction. Journal of Medical Ethics. 2024;50(6):407-12.
19. Li M, Agrba L. I am a MAID provider. It’s the most meaningful—and maddening—work I do. Here’s why. Macleans. 13 Feb 2023.
20. Cecco L. Canada judge halts medically assisted death of woman in rare injunction. The Guardian. 31 Oct 2024.
21. House of Commons. Evidence. Standing Committee on Justice and Human Rights. 44th Parliament, 1st Session, no. 050. 14 Feb 2023.
22. House of Commons. Debates. 44th Parliament, 1st Session, vol. 151, no. 161. 15 Feb 2023.
23. Health Canada. Background Document: The Work of the Medical Assistance in Dying (MAID) Practice Standards Task Group. Government of Canada; 2023.
24. Regional Euthanasia Review Committees. Euthanasia Code 2018. Government of the Netherlands; 10 Jan 2019.
25. De Hert M, Loos S, Sterckx S, Thys E, Van Assche K. Improving control over euthanasia of persons with psychiatric illness: Lessons from the first Belgian criminal court case concerning euthanasia. Frontiers in Psychiatry. 2022;13:933748.
26. Verhofstadt M, Van Assche K, Sterckx S, Audenaert K, Chambaere K. Psychiatric patients requesting euthanasia: Guidelines for sound clinical and ethical decision making. International Journal of Law and Psychiatry. 2019;64:150-61.
27. Choi WJW, Astrachan IM, Sinaii N, Kim SYH. When medical assistance in dying is not a last resort option: survey of the Canadian public. BMJ Open. 2024;14(6):e087736.
28. Canseco M. Most Canadians back status quo on medical assistance in dying. ResearchCo. 5 May 2023.
29. Coelho R, Maher J, Gaind KS, Lemmens T. The realities of Medical Assistance in Dying in Canada. Palliative and Supportive Care. 2023;21(5):871-78.
30. Houses of the Oireachtas. Joint Committee on Assisted Dying Debate - Tuesday, 17 Oct 2023. Government of Ireland; 17 Oct 2023.
31. Reyes R. ‘It’s the most rewarding work we’ve ever done’: Canadian doctor who’s euthanized 400 people proudly shares how she helped kill man deemed incapable of choosing assisted suicide - as another physician says she’s helped 300 die. Daily Mail. 8 Jan 2023.
32. Lyon C, Lemmens T, and Kim SYH. Canadian medical assistance in dying: provider concentration, policy capture, and need for reform. American Journal of Bioethics. 20254;25(5):6-25.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Scott Y. H. Kim
This work is licensed under a Creative Commons Attribution 4.0 International License.
The Canadian Journal of Bioethics applies the Creative Commons Attribution 4.0 International License to all its publications. Authors therefore retain copyright of their publication, e.g., they can reuse their publication, link to it on their home page or institutional website, deposit a PDF in a public repository. However, the authors allow anyone to download, reuse, reprint, distribute, and/or copy their publication, so long as the original authors and source are cited.
_smaller.png){kind=logo}
