When Care Is Delayed, MAID Becomes an Option – And That’s the Problem

Medical Assistance in Dying (MAID) is often described as a compassionate end-of-life option, reserved for people facing unbearable suffering with no reasonable alternatives. In theory, it is narrow, cautious, and carefully safeguarded.

In practice, the system operating under that name has expanded far beyond its original scope – and it is now intersecting with delayed care, mental health crises, disability, and social vulnerability in ways that deserve serious public scrutiny.

This is no longer a hypothetical concern. It is happening in real time, to real people, inside Canada’s healthcare system.

What MAID Was – and What Changed

When MAiD was introduced federally in 2016 following Carter v. Canada, it applied only to individuals with a reasonably foreseeable natural death – commonly referred to as Track One. The legal change primarily removed criminal liability for physicians and nurse practitioners who assisted in those deaths.

That boundary did not hold.

In 2021, legislative changes introduced Track Two: eligibility for people without a foreseeable natural death. This category fundamentally altered the program’s reach. Under Track Two, individuals may qualify based on a “grievous and irremediable medical condition,” defined broadly and assessed largely through clinician opinion.

Crucially, to qualify, an individual need only demonstrate that their condition causes enduring suffering they find intolerable, and that they perceive no acceptable way to live with it.

That threshold is subjective — and expansive.

Who Now Qualifies

Under Track Two, eligibility has extended to people living with:

• Chronic pain
• Hearing loss
• Vision loss
• Mobility limitations
• Diabetes and other chronic illnesses
• Mental health conditions when paired with another qualifying condition
• Disability combined with social stressors such as housing instability

Multiple documented cases show that mental illness alone is often recorded as a secondary condition, while a physical issue is listed as the primary qualifier – effectively bypassing restrictions intended to delay or prevent MAID for mental illness.

This is not speculative. Provincial MAID reports confirm that large percentages of Track Two cases list “other conditions” as contributing factors – a category that explicitly includes depression, anxiety, and psychological distress.

Care Gaps and the Speed Mismatch

One of the most troubling patterns emerging is the mismatch in timelines:

• Patients wait months or years for specialist care, surgery, or mental health treatment
• MAID assessments and approvals can occur in weeks – sometimes days
• In documented cases, individuals have been approved after virtual consultations without full medical record reviews

This creates a structural imbalance: death becomes administratively easier to access than care.

That imbalance is not theoretical. It has produced cases where individuals approved for MAiD were still actively seeking treatment, or where MAiD approval occurred faster than referrals for surgery, psychiatry, or pain management.

The Catalyst That Exposed the System

Recently, public attention sharpened when an American stepped forward to fund life-saving surgery for a Canadian woman who had been approved for MAiD after being unable to access timely treatment within Canada.

This moment cut through abstraction.

It revealed a system where eligibility for assisted death was processed more efficiently than access to care – and where survival depended not on public healthcare, but private intervention from outside the country.

That should concern Canadians regardless of where they stand politically.

The Ethical Tension Inside Healthcare

Healthcare professionals enter their field to treat, support, and relieve suffering. MAID has placed many clinicians in ethically fraught positions – particularly as eligibility widens and safeguards rely heavily on individual judgment.

MAiD operates largely as a self-reporting system. Oversight is retrospective. Practitioners are protected from criminal liability if they attest that, in their opinion, criteria were met.

There is no mandatory requirement to consult family members. There is no obligation to exhaust all treatment options. There is no requirement to ensure that social determinants – housing, income, support – have been addressed first.

This structure does not require malice to fail. It only requires pressure, scarcity, and normalization.

Normalization Is the Quiet Risk

One of the most consistent warnings from disability advocates is that normalization changes expectations.

When assisted death is framed as compassionate, practical, and efficient – particularly in a strained system — it can subtly shift how suffering is interpreted:

• From something to be addressed
• To something to be resolved

This is especially dangerous for people who are isolated, exhausted, or repeatedly told that help will take time they do not have.

Evidence from advocacy groups and documented cases shows that MAID has been suggested to patients who did not ask for it, including individuals who presented for help during suicidal crises.

That is not an edge case. It is a systemic failure.

What Other Countries Do Differently

Countries often cited in MAiD debates – such as the Netherlands and Belgium – impose stricter requirements:

• Demonstrated exhaustion of all reasonable treatments
• Lengthy assessment periods
• Greater emphasis on palliative and supportive care
• Narrower interpretation of psychological suffering

Canada’s model is distinct in how quickly eligibility expanded and how broadly criteria are applied.

The Question That Remains

This conversation is not about denying suffering. It is about sequence and responsibility.

Before a society offers death, it must ensure that it has genuinely offered:

• Timely medical care
• Adequate pain management
• Mental health treatment
• Disability accommodations
• Social and economic support

When those conditions are not met, MAiD ceases to be a last resort. It becomes a substitute.

And that is not compassion. That is abandonment with paperwork.

Why This Deserves Careful Attention

The expansion of MAiD is not a fringe issue. It reflects how a system responds under strain – and what it chooses to prioritize when resources are limited.

If we are willing to look honestly at the evidence, the trend is clear: when care is delayed, MAiD fills the gap.

The question Canadians must answer is not whether assisted dying should exist – but whether we are comfortable allowing it to function where care has failed to arrive.

That answer will shape who feels valued, supported, and worth the effort to keep alive.