Some of Canada’s latest MAID recipients: An obese woman and a grieving widower

A severely obese woman in her 60s who sought euthanasia due to her “no longer having a will to live” and a widower whose request to have his life ended was mainly driven by emotional distress and grief over his dead spouse are the latest cases to draw concerns that some doctors are taking an overly broad interpretation of the law.

The anonymized cases highlighted in the latest report from the Ontario Coroner’s MAID Death Review Committee include people whose conditions were declared “grievous and irremediable” — incurable — and their deaths reasonably foreseeable because they refused all forms of care or had stopped eating and drinking.

However, Health Canada states that people can’t refuse all or most interventions in order to render themselves eligible for a doctor-assisted death.

In all three deaths, hopelessness, isolation and loneliness were driving factors.

The grieving widower, a man in his 70s identified as Mr. C, had an essential tremor, a movement disorder that caused his hands to shake. His spouse had died in recent years and his tremor “impacted his self-esteem and self-confidence,” according to the panel’s report on MAID deaths in 2024, which was first reported by Canadian Affairs .

Mr. C felt he didn’t have much to offer in a new relationship because of his tremor and thus “had not been able to create a new life path with meaningful relationships” and a sense of purpose, the report reads.

“He requested to access MAID due to same.”

Mr. C had problems eating, and gait and mobility issues. He felt he couldn’t engage in meaningful hobbies. A neurologist confirmed his condition was incurable, however several members of the 16-member death review committee questioned whether an essential tremor fully met the legislative threshold for a grievous and irremediable condition, noting that an essential tremor “rarely progresses to cause severe disability” or incapacity.

Psychological stress can also exacerbate symptoms of essential tremor. Some committee members worried Mr. C’s request for MAID “appeared to be primarily motivated by social withdrawal, grief and hopelessness,” which they believed may have been potentially reversible.

“It’s very sad. This poor man.  I’m concerned that if he had still been in a relationship his essential tremor would be less bothersome,” said Dr. Ramona Coelho, a family physician and committee member.

While he was experiencing trouble eating, his basic activities of daily living weren’t significantly impacted.

“These kinds of cases highlight and validate what the disability community has been trying to point out: MAID is a risk to their right to life,” Coelho said.

Mrs. A, who had morbid obesity, was isolated and mainly housebound. She had high blood pressure, diabetes, severe shortness of breath, and chronic pain. MAID assessors said her condition could potentially improve with medical treatments such as government-funded bariatric surgery, as well as disability and social supports. However, she refused all care.

She hadn’t been to her doctor or diabetes clinic for several years and had stopped taking her medications. Her “re-engagement” with the health system appeared to be primarily for accessing MAID.

“The MAID assessors determined her death to be reasonably foreseeable due to Mrs. A’s decision not to pursue additional treatment,” the report reads.

But Coelho believes the woman was in a state of neglect. “And that to me, that is patient abandonment. ‘Oh, you want to die? Sure, you can die.’”

“I can understand how it can sound like it’s compassionate. It’s what she wants,” Coelho said.

Some members highlighted that a person’s decision to refuse all treatments is a personal choice, “shaped by individual values and lived experience,” and that the MAID provider was respecting Mrs. A autonomy.

“But does that make you eligible for MAID,” Coelho said. “If someone comes to my office and said, ‘I want MAID’ and has had no workup, I will say, ‘I’m here for you, I’d like to explore your suffering. But I cannot say in good faith that you’re eligible for MAID.’”

“When we agreed that MAID would be legal, we said we would give it to people who met certain criteria,” Coelho said.

Mrs. A also showed signs of catastrophic thinking and “profound psychological and existential suffering.”

Both MAID assessors documented that she didn’t have suicidal thoughts. However, loneliness, isolation and psychosocial suffering overlap with suicide risk factors, said psychiatrist Dr. Sonu Gaind, a professor of medicine at the University of Toronto.

“We’re clearly providing MAID to some people who have all the risk factors for being suicidal, especially placing those who are lonely and most marginalized at risk,” said Gaind, who does not sit on the death review panel.

“And then we’re sanitizing it with false reassurances to society from the white lab coat that the person is not suicidal.”

The third case involved Mr. B, a man in his 60s who was living with cerebral palsy in long-term care. He  stopped eating and drinking six to eight weeks before his first MAID assessment. “His intake during this period was limited to one-or-two glasses of a caloric beverage per day,” according to the panel’s report.

He used a wheelchair but could propel and get in and out of it himself.

Mr. B was experiencing “profound psychosocial suffering and loneliness due to limited social relationships and isolation from the community — a lifelong experience,” according to the report. He worried that he would become more dependent as he got older.

Cerebral palsy is an incurable condition, and Mr. B had lost weight and was in an “advanced state of decline,” including signs of kidney failure, because of his decision to stop eating and drinking.

However, his suffering was “mainly psychosocial and existentially oriented,” the report reads.

Some members worried that “self-facilitated decline” by not eating or drinking, instead of condition-driven decline, could undermine MAID safeguards “and create pathways for circumventing eligibility criteria.”

Other members said it’s important to respect a capable person’s right to make their own health decisions, “including the refusal of nutrition or hydration.”

According to Health Canada’s regulatory guidance,  “incurable’ means there are no reasonable treatments remaining where reasonable is determined by the clinician and person together.”

It doesn’t mean that someone must attempt every possible option. “At the same time, a capable person cannot refuse all or most interventions and automatically render themselves incurable for the purposes of accessing MAID.”

The death review panel was established in January 2024. Deaths selected are chosen to “generate discussion, thought and considerations for practice improvement,” according to a preamble.

Of 4,356 reported MAID deaths in Ontario in 2024, most, 88 per cent, met all legislative requirements, according to the report. About 602 required further in-depth review; 281 of those went on to require an investigation.

National Post

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