A new Health Canada report says the number of medically assisted deaths in 2022 was more than 30 per cent higher than the year prior.
Medically assisted deaths constituted 4.1 per cent of all deaths in Canada last year, said the report, which was published on Tuesday.
The report is a comprehensive overview of Canada’s medical assistance in dying (MAID) law and its effects. The law is set to extend access to medical assistance in dying to those whose sole medical condition is a mental illness in March 2024.
Experts and advocates who spoke with CBC News questioned whether the MAID growth rate and the percentage of deaths should be causes for concern. Some cited perceived gaps in the data.
The report says 13,241 people received medically assisted deaths in 2022 — a 31.2 per cent jump over 2021.
It says 44,958 people have received medically assisted deaths since the introduction of federal legislation in 2016.
Rebecca Vachon, the program director for health at the non-partisan Christian think tank Cardus, described the year-over-year MAID growth as “alarming.”
To access MAID, an individual must have a serious illness, disease or disability which causes irreversible decline and unbearable suffering that “cannot be relieved under conditions [the patient considers] acceptable,” says the federal government.
“We should be ensuring that we never get to that point because we have better care available,” Vachon said.
Jocelyn Downie is a professor at Dalhousie University who researches end-of-life law. She was also a member of the legal team representing Lee Carter and other appellants in Carter v. Canada, the Supreme Court case which ruled people with grievous and irremediable medical conditions should have the right to ask a doctor to help them die.
Downie said she doesn’t think the year-over-year MAID growth is unexpected or disturbing.
“When you have something that’s illegal, and it becomes legal, you are going to have an increase in the numbers,” she said. “And it’s going to take a little while for the numbers to settle.”
Downie also said that if the only people accessing MAID are those with a “grievous and irremediable medical condition, which is what the evidence shows, then it’s not a bad thing to have more of that.”
Critics question strength of data
Vachon also criticized the portion of the report that focuses on palliative care, and called for greater investments so patients don’t feel the need to request “premature deaths.”
According to the report, palliative care is a holistic approach that treats people with serious illnesses. It includes “physical, social, psychological, and spiritual needs as well as emotional support,” the report says.
In 2022, MAID practitioners reported 77.6 per cent of MAID recipients — 10,169 people — received palliative care. Nearly half received it for a month or more.
Vachon said the report doesn’t explain the quality of palliative care and instead uses the term as a “checkbox” to indicate it has been provided.
The report does not provide any metrics on the quality of palliative care, but does say that 87.5 per cent of MAID recipients who did not receive palliative care — 2,250 people — were reported to have access to the service.
The report also says more information about where palliative care was received and the types of care offered are to be included in a follow-up report in 2024.
Downie said the federal government can pursue “parallel tracks” by allowing MAID access while also improving care and other social services.
“One thing is just the moral argument that you don’t hold individuals hostage for systemic failings,” she said.
Dr. Sonu Gaind, psychiatrist-in-chief at Sunnybrook Health Sciences Centre in Toronto, expressed concern about how the report describes people who accessed MAID whose natural deaths were not reasonably foreseeable. According to the report, 3.5 per cent of all MAID recipients — 463 people — did not have reasonably foreseeable deaths.
“The proportion of MAID recipients whose natural death was not reasonably foreseeable continues to remain very small compared to the total number of MAID recipients,” the report says.
In 2021, just 2.2 per cent of MAID recipients — 223 people — were patients whose natural deaths were not reasonably foreseeable. Gaind said the report “completely minimizes the numbers.”
Gaind also said the report contains no data related to equity and diversity issues or marginalized populations. According to the report, that information will be included in the 2024 report.
“They’re saying that won’t be recorded until next year’s report,” Gaind said. “And yet, we’re still going ahead with further expansion.”
MAID expansion set for March 2024
The new report comes as the federal government prepares to expand MAID eligibility to those whose sole underlying condition is a mental illness.
The expansion originally was planned for 2023. The federal government tabled a bill delaying the move until March 2024 to provide more time for provinces, territories and doctors to develop guidelines.
Some advocates are still concerned about the additional delay. Dr. Chantal Perrot is one of them; she’s a MAID provider and board member with Dying with Dignity Canada, a charity committed to protecting end-of-life rights.
“It doesn’t seem to be that there’s really a will on the part of the government to follow through with this,” Perrot said, adding government committees “are started and then stopped” on the issue.
Vachon, who said she was “very concerned” about the planned expansion, cited September polling data from Angus Reid in partnership with Cardus. In that poll, 82 per cent of respondents agreed that “MAID eligibility should not be expanded in Canada without improving access to mental health care first.”
Conservative Party Leader Pierre Poilievre has said a government led by him would repeal MAID for the mentally ill.
Downie said the upcoming expansion is “essential” because she thinks excluding people with mental disorders on the basis of their diagnosis is “discriminatory.”
“To exclude in that way is stigmatizing, it’s paternalistic,” Downie said. “I don’t think there’s any justification for the exclusion.”
Downie said she expects an “incredibly small number” of people with mental disorders will get access to MAID due to the request and assessment processes.
“Many will be found not to be eligible, many will be diverted by actually getting access to different kinds of services and supports,” she said.
People suffering solely from a mental illness will be eligible for MAID as of March 17, 2024.