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Better MAiD oversight is needed to protect patients
Building more effective oversight into Canada’s MAiD legislation would protect against doctors who interpret the rules liberally or play loose with safeguards. (File Photo: Unsplash)
Euthanasia rates in Canada continue to rapidly rise year after year, yet there is little oversight to protect Canadians by ensuring compliance with the federal law that regulates medical assistance in dying.
MAiD, which even Canada’s Criminal Code defines as non-culpable homicide, has resulted in scores of controversial instances in which the families and loved ones of patients are left with little or no recourse when the legally dictated process for ending a life is not followed.
Building more effective oversight into Canada’s MAiD legislation would protect against doctors who interpret the rules liberally or play loose with safeguards.
Federal law requires only two physicians or nurse practitioners to decide that a person may be euthanized, and lets patients choose which physicians or nurse practitioners to visit. In 2022, 1,837 physicians and nurse practitioners provided MAiD across Canada. That’s an average of 7.2 deaths per provider. At least one physician has admitted to euthanizing more than 400 patients since Canada legalized MAiD in 2016.
Some Canadian jurisdictions have no designated review process for MAiD, and when reviews do take place, they happen after a patient has died. Reviews of difficult cases are important but so is the opportunity for intervention.
In cases where safeguards have not been followed, families have little recourse to question a doctor’s treatment of their loved one. There is a complaint process that is mandated to be handled through a province’s or territory’s regulatory college, but it holds only the possibility of professional penalties, not legal or criminal accountability.
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In British Columbia, the provincial coroner’s office referred 44 MAiD deaths to the B.C. College of Physicians and Surgeons between 2016 and 2018. None of them resulted in a formal disciplinary hearing. This could be an indication that procedures were properly followed — or it could signal a lack of real oversight and clarity.
Ontario has implemented an oversight system through the Office of the Chief Coroner. In cases where a medical professional has potentially violated the law, the coroner’s office can send the case for review by the regulatory college, or seek police involvement if a violation is serious enough.
However, from 2018-2023, only four of 428 cases of possible criminal violations tracked in Ontario were reported to the regulatory college and none was referred to law enforcement. In 2023 alone, the coroner’s office identified 178 cases of noncompliance. Further, a quarter of all euthanasia providers heard from the provincial coroner’s office at least once about a compliance issue.
Recent reports from the Ontario Coroner’s MAiD Death Review Committee reveal compliance problems such as failure to apply the 90-day waiting period and not ensuring the patient was assessed by a doctor with expertise in their condition. In at least one case, committee members believed the patient suffered solely from mental illness and thus should not have been deemed eligible for MAiD.
The Ontario reports also outline cases of complex conditions, mental illness, and socioeconomic vulnerabilities where MAiD was offered to a patient without physicians adequately addressing the source of suffering.
Quebec has a Commission on End-of-Life Care that oversees MAiD in that province. In 2021-22, the commission referred 15 cases of possible non-compliance with the law to Quebec’s regulatory college, but they appear to have been largely disregarded.
In 2022-23, the Quebec commission reported another 23 cases of possible non-compliance to the regulatory college. In 16 of these, the commission believed that the patient did not have a serious and incurable illness. That is no small matter when determining MAiD eligibility. Yet the president of the regulatory college responded by saying that more than 99 per cent of MAiD deaths were administered according to regulations and that the college would ensure that nothing discourages physicians from administering MAiD.
These are a few examples that illustrate why Canadians need better review processes to ensure that MAiD regulations are followed or to determine if MAiD should even take place.
In Spain, a review must take place before euthanasia is administered. An assessment is made by two physicians, and if someone is deemed eligible, the file is sent to a commission for review by a medical professional and a lawyer. If they disagree on eligibility, the case then goes to an evaluation committee for a final ruling. This structure is an important safety net for protecting patients.
MAiD is unique as a legal medical method for ending a life. As such, its implementation demands not only appropriate legislation but also clear safeguards and review systems to protect all parties.
MAiD cases that raise questions about eligibility or whether safeguards are being followed should be reviewed prior to euthanasia. As well, all cases of non-compliance with the law must be held to full accountability with strong safeguards fully applied.
How many more cases of noncompliance will be found before Canadian governments start to take action?
This article first appeared on Policy Options and is republished here under a Creative Commons license.
