FIRST READING: Why Canadian doctors have a ‘duty’ to suggest death as a ‘care option’

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In 2024, a Nova Scotia grandmother was in a hospital gown being prepared for breast cancer surgery when, out of the blue, a doctor suggested she could instead consider death.

“He asked ‘Did you know about medical assistance in dying?’” the woman said in an interview with the Christian Medical and Dental Association.

That same year, Tracy Polewczuk, a woman with spinal bifida seeking treatment for chronic pain stemming from a broken leg, said she was given an unprompted offer of MAID at a Montreal hospital.

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Bill Gardner, a professor at the University of Ottawa Faculty of Medicine, wrote in 2023 of being given just two options for a throat cancer diagnosis:  palliative care or MAID.

Miriam Lancaster, 84, had just arrived at Vancouver General Hospital with severe back pain when she was offered MAID in the ER. “(The doctor) came in and said, ‘Miriam, I understand you’re in a lot of pain. We can offer you MAID,’” Lancaster’s daughter told National Post.

Larry Holland, a Catholic priest having a hip fracture treated at Vancouver General Hospital in early 2026 said he was offered MAID twice. As Holland described it to Canadian Catholic News, he was told the hip fracture could potentially deteriorate to the point where it became a terminal condition, and that MAID was something they were required to “discuss with someone who’s been given a terminal diagnosis.”

In the world’s 20 or so other jurisdictions with some form of legal euthanasia, the above scenarios would likely represent a breach of medical ethics – if not criminal law.

In August, Australia’s Northern Territory legalized what they call “voluntary assisted dying,” but specifically included a “gag clause” prohibiting doctors from making unsolicited offers of assisted suicide.

The California law legalizing “aid-in-dying” prohibits “coercion or undue influence” and even takes pains to assure doctors that they don’t have to answer a patient’s questions about euthanasia if they don’t want to.

But no such guardrail exists in most of Canada. In fact, it’s the precise opposite: one of the aspects of the Canadian MAID regime that most sets it apart from the rest of the world is the view that doctors have a duty to inform patients when they become eligible to die.

Health Canada’s official MAID guidelines, known as the Model Practice Standards for Medical Assistance in Dying, require doctors and nurse practitioners to “take reasonable steps to ensure persons are informed of the full range of treatment options available to relieve suffering.”

Rather than MAID discussions being patient-initiated, the guidelines specifically urge that they be doctor-initiated.

Under a section titled “duties to persons potentially eligible for MAID,” doctors and nurse practitioners are told not to “assume all persons potentially eligible for MAID are aware that MAID is legal and available in Canada.”

The only time to hold back on such information, the guidelines state, is if there’s some sign that MAID may conflict with a “person’s values and goals of care.”

Only Alberta in 2026 introduced the first legislation in Canada to bar unsolicited offers of MAID.

Health Canada developed its MAID guidelines and training protocols with the Canadian Association of MAID Assessors and Providers (CAMAP).

And CAMAP’s own materials are even more overt in citing a duty to inform patients of their eligibility for death.

A 2022 paper by CAMAP frames MAID as a “clinical care option” and states “clinicians have a professional obligation to their patients to bring up MAiD.”

The paper assures readers that while “counselling or aiding suicide” remains illegal, the legal definition of “counsel” is distinct from the medical definition.

“’Counsel’ as commonly used for instance by a nurse, means communication, information sharing, active listening, patient education and the provision of psychological support,” it reads. “There is no legal restriction on who can raise the subject, i.e., the healthcare professional or patient.”

Contrast this with the 2021 “end of life” guidelines published by the Royal Dutch Medical Association.

The Netherlands legalized euthanasia in 2002 – 14 years before Canada – and has eligibility criteria that are even more liberal than Canada’s. The Netherlands, unlike Canada, will occasionally approve assisted suicide for children and patients whose only underlying condition is mental illness.

But the official Dutch “end of life” care guidelines do not present assisted suicide as one of a range of treatment options.

Rather, it’s listed as “an extreme remedy in situations in which there are no reasonable treatment options to relieve the patient’s suffering.” Dutch doctors are told that “it is essential that, when talking about end-of-life care, the physician and the patient consider the entire range of end-of-life care options.”

There are other world jurisdictions in which doctors are encouraged to bring up assisted suicide as an unsolicited care option. In 2017, the Australian state of Victoria became the first in that country to legalize assisted suicide, but did so with a “gag clause” preventing physician-initiated discussions of the topic.

This was repealed in 2025 with the support of the Royal Australian College of General Practitioners, which complained that the clause prohibited “open, honest conversations with patients about all their end-of-life options.”

But the difference is that Australia’s voluntary assisted death is still strictly limited to patients with a terminal illness.

In Canada, ever since 2021, MAID has been available for anyone with a “grievous and irremediable” illness, regardless of whether it’s life-threatening.

As such, virtually any chronic condition that imposes undue pain or discomfort is, under Health Canada guidelines, something for which doctors are duty-bound to inform their patients that they can obtain MAID.

In one recent case highlighted by the New York Times, a woman in her 70s obtained approval for MAID due to a condition that rendered her unable to cook – only to forego the procedure after learning through counselling that her family “valued who she was, not what she did for them.”

For at least the last few months, there’s been a pretty steady train of Indigenous leaders calling for Canadians to be jailed for speech.

Specifically, for the alleged crime of “residential school denialism.”

In June, Nancy Karetak-Lindell, an Inuk Senator, introduced a surprise amendment to a House of Commons bill prescribing two-year jail terms for “condoning, denying or downplaying the Indian residential school system” (it was ultimately defeated).

NDP MP Leah Gazan, a member of the Wood Mountain Lakota Nation, tabled a private member’s bill pledging jail for all those “condoning, denying, downplaying or justifying the Indian residential school system.”

And in July, the Assembly of First Nations voted unanimously on a special resolution calling on the federal government to make it a crime to deny the “genocide” of residential schools.

But then, on Friday, Manitoba Premier Wab Kinew, who is Anishinaabe, said “no.”

“I don’t think we can criminalize this,” he said in a radio interview with CBC, adding that “educating people” was better than jailing them.

First Reading is a Canadian politics newsletter curated by the National Post’s own Tristin Hopper. To get an early version sent directly to your inbox, sign up here.

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