MAID approved for Canadian woman who could no longer cook, say U of T doctors in NYT oped

Two Canadian psychiatrists who work with patients with advanced cancer have written an editorial for the New York Times in which they argue that the Canadian use of Medical Assistance in Dying (MAID) has gone too far, too fast.

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Under the title “We Implemented Canada’s Assisted Dying Law. We’re Concerned,” psychiatry professors at the University of Toronto Dr. Gary Rodin and Dr. Madeline Li relate their personal experience with a woman in her 70s who was the matriarch of her family and made Sunday dinners.

“She sought and received approval for assisted dying after she lost the ability to cook,” the doctors write. “She felt she had lost her value to her family. Through counselling, she came to understand that her family valued who she was, not what she did for them. She decided not to go through with ending her life, at least for now. That Christmas, her family gathered and she sat proudly at the table, while others did the cooking and serving.”

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Another of their patients, a man in his 80s, refused a new treatment that might extend his life and instead requested and was approved for MAID.

“He survived the Holocaust as a child and viewed the freedom to choose the timing of his own death as a way of reclaiming what Hitler had taken away from his parents,” they write. “However, his living family’s grief mattered to him, too, and they had concerns about him giving up too soon.”

Again through counselling, he chose to delay the procedure and, months later, continued to live a meaningful life. “Eventually he got sicker and Dr. Li told him he was at risk of losing capacity to consent to assisted dying. This time, he chose the procedure, fully supported and surrounded by his family.”

The doctors also cite a 2024 report of people seeking assisted death in the context of poverty or loneliness, “raising concerns that they may feel they have no other options.”

The MAID program began in Canada in 2016 as an option for patients with a “reasonably foreseeable” natural death, but in 2021 the “foreseeable death” requirement was removed.

“Today, Canada’s system is one of the most permissive in the world,” they write, “allowing assisted dying for almost any form of subjectively intolerable suffering that has a medical basis, or even for medically unexplained physical symptoms.”

Canada has the fastest growth rate of assisted dying in the world, “increasing 16-fold in the eight years since legalization.” The procedure now accounts for more than five per cent of all deaths in the country, they add.

Rodin and Li have a long history with MAID. Both have counselled patients about the procedure and assessed whether they were eligible. One has administered the drugs to end patients’ lives. National Post has reached out to them for more information.

In 2017 they were among the authors of the paper “Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada” in the New England Journal of Medicine.

That paper discussed the recent implementation of a hospital-based MAID program at the University Health Network (UHN) in Toronto. The program involved a three-team system: a clinical team providing patient care; a two-physician assessment team to determine whether a patient meets legal requirements; and an intervention team to perform the final assessment and provide MAiD.

It noted that, “as in other jurisdictions, many patients changed their minds about pursuing MAID after making the request and receiving approval.” It added: “The lack of provision in the Canadian legislation for such reversals may cause distress in people who want certain and timely access to MAID but are not yet prepared to receive it.”

In their Times op-ed, published Monday, the doctors write: “Canada’s system for assisted death is no longer an option of last resort. Too many people are receiving the procedure without the opportunity for careful reflection about it with a health provider. In some cases, patients are being approved who should not be.”

They say they are not against MAID, but in favour of a pause by providers and reflection by patients to “consider and truly understand alternatives that might relieve their suffering and allow them the possibility of more time to live meaningfully.”

They add: “The problem is that there has become far more focus on whether patients can get an assisted death and not enough on whether they should.”

Most patients benefit from counselling and reflective conversations, but “unfortunately, psychological care of this kind for patients requesting assisted dying is not routinely offered by doctors or other health care providers, nor is it routinely covered by insurance,” they write. “It should be the standard of care and fully funded.”

Canada’s most recent annual report on MAID found that 98 per cent of people assessed for it were found to meet the criterion of “intolerable suffering,” and more than 92 per cent were approved for the procedure.

“In contrast, in the Netherlands, which legalized medical assistance in dying nearly 25 years ago, it’s common for cases to be rejected because a doctor judged that the patient’s suffering was not unbearable or that they did not pursue alternate treatment options.”

They conclude that a society that permits assisted dying should also ask whether it has done enough to help people sustain their sense of dignity and meaning in life. “Death must not become the only kind of relief people can imagine.”

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