To assist medical professionals, in 2023 Health Canada released guidance outlining best practices. This guidance was meant to help them figure out patient eligibility for Medical Assistance in Dying (MAID). This unprecedented action came only after growing public pressure and investigative release after investigative release by the Ontario chief coroner’s office. Those reports raised serious questions about whether the existing MAID protocols are sufficiently rigorous.
Health Canada provides guidance in the form of a practice standard. This standard is a step toward ensuring that physicians have clear guidance to assess the eligibility of patients seeking MAID. While these are encouraging steps, how those recommendations will be implemented is still unknown. Despite Minister Murray’s optimism, numerous reports have detailed shocking and inappropriate examples of approved MAID.
The Ontario MAID Death Review Committee, an independent body of the Ministry of Health, has released six reports since October 2024, into many appalling trends. Most alarmingly, these reports recorded cases of patients receiving MAID after having their ability to make medical decisions revoked. Recent high-profile cases have raised alarm over vulnerable patients seeking MAID. Considerations such as social isolation and lack of alternative housing or healthcare resources deeply factor into these requests.
An October 2024 report went so far as to recommend that. More specifically, it recommended a temporary pause on the MAID process for people whose death is not reasonably foreseeable. This recommendation aims to ensure that patients have access to necessary healthcare and social services before considering such a final option.
“This approach to practice recognizes the importance of addressing and resolving suffering in contrast to procedurally qualifying for a MAID death.”
It is disturbing to read in the report that patients have to rush to get proper care and assistance rather than MAID. Health Canada is under immense pressure to provide clear guidelines. These guidelines need to protect socially vulnerable people who are pursuing MAID, even if their death is not soon approaching.
Major funding from Health Canada has gone to the Canadian Association of MAID Assessors and Providers (CAMAP). This funding will help create awareness and educate the public at large about MAID, while evaluations and recommendations are ongoing. From 2021 to 2026, CAMAP received close to $5 million to create a national standardized MAID curriculum. This year alone, Health Canada sent them an additional $1 million to manage their work.
CAMAP is in the process of launching a peer-reviewed journal dedicated to MAID. This important work was made possible with the help of supplemental funding from Health Canada. The organization has since explained that its MAID curriculum is not publicly accessible.
“The curriculum is an accredited professional education program — not a public information product.” – CAMAP
This new curriculum is designed to enhance the knowledge and skills of everyone involved in assessing and providing MAID services. The organization noted that Health Canada’s funding was integral to its development. The support was highly targeted to educators developing resources, curricula and training for MAID assessors and providers.
The Ontario chief coroner’s office has been invaluable in tracking and reporting on MAID cases. Recent research has raised these issues to the level of concern that health professional associations are taking notice and are now more equipped to draft practitioner recommendations.
“Health professional bodies are best positioned to develop practitioner guidance.” – Health Canada
Unfortunately, even with these initiatives, it still appears that little has been done to fully implement previous recommendations given about MAID. CAMAP recognized that all of the recommendations have not yet been implemented.
Leading the CAMAP initiative was president Dr. Konia Trouton, who, in December 2024, signed two groundbreaking reports. These reports made public the findings of the only MAID Death Review Committee in Ontario. Dr. Trouton has been an energetic member of this committee. Perhaps most importantly, she is living CAMAP’s mission by continuing to speak out on these important issues, long after her presidency at CAMAP ended on April 7.
The college remains vigilant for changes based on the MAID Death Review Committee’s recommendations. That further demonstrates their deep commitment to ongoing self-evaluation of all practices and standards.
“The college continues to monitor new MAID Death Review Committee findings and will consider further updates as appropriate.” – The college
Meanwhile, Stephanie Rea, issues manager for the chief coroner’s office, clarified that committee members do not represent their respective organizations but bring independent expertise to the discussions.
As Canada navigates the complex landscape of medical assistance in dying, the interplay between robust training, ethical considerations, and patient welfare remains paramount. Continuing assessments and recommendations have the potential to influence 2021 policies. What’s still uncertain is how stakeholders can best implement this balance between key elements in practice.
