CMDA's The Point

MAiD in Canada

December 19, 2019
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by D. Joy Riley MD, MA (Ethics)

Free trade between Canada and the United States has been a reality since the 1980s. Thaddeus Pope, on his Medical Futility Blog, recently posted a video that shows a Canadian female physician who obviously wishes to export a dangerous idea to her southern neighbor. Although Canada does not hold the corner on the market of assisted suicide or euthanasia, Medical Aid in Dying (MAiD) in Canada is not an import we need in the United States.


Dr. Stefanie Green addresses the Hemlock Society of San Diego in the posted video.

Dr. Green describes herself as “not an ethicist,” nor is she present to talk about the morality of assisted dying. She is present to talk about her work. After practicing as a family physician involved in maternal and newborn care for 10 years, she turned her focus to assisted dying with the change in Canadian law. She describes her current practice as about 90 percent assisted dying, and she states she has helped more than 160 people end their lives thus far. The youngest was 29 years of age, while the oldest was 105 years.


MAiD includes both self-administered and clinician-administered medication to cause death. The latter is intravenous in route. The clinician can be a physician or a nurse practitioner, according to Dr. Green. By law, two witnesses are necessary. This can sometimes present a problem. Therefore, a volunteer witness program exists. These volunteers come to the patient, and after exchanging identifications with him or her, they watch the patient sign the forms. Then the witnesses sign the forms and leave. There is also a 10-day waiting period, but apparently, practitioners can reduce this under certain conditions. The cause of death listed on the death certificate is dependent upon what provincial law dictates. The cause may be described as “MAiD,” “suicide” or the underlying cause of death, with no mention of what precipitated the death. Collecting the data on MAiD, therefore, is not so simple as reading the death certificates.


From June 17, 2016 through November 2019, Dr. Green states that there have been greater than 10,000 MAiD deaths in Canada. She shows several graphs of the data, singling out British Columbia as a major contributor. In British Columbia, it is Vancouver Island that is the “engine” driving the data. Specifically, it is Victoria, where she works, that is the driving force.


Island Health is the health system on Vancouver Island, which has a population of 800,000. One year after the law was changed in Canada, 3 percent of deaths on Vancouver Island were MAiD deaths. Six months after that, the MAiD rate was 4 percent of deaths on the island. Currently, MAiD deaths account for 7 percent of deaths on Vancouver Island. Slightly more of these occur in the hospital than in the home. And, Dr. Green gushes, it is legal to perform MAiD in a national park!


As a MAiD advocate, Dr. Green states she loves most the moment when she informs the patient that he or she can have an assisted death if they want it. She calls this “probably the most therapeutic thing” she can do.


Several entities of the U.S. have legalized assisted suicide, including Colorado, District of Columbia, Hawaii, Maine, New Jersey, Oregon, Vermont, and Washington. By court ruling, California permits physician-assisted suicide, and a Montana judge ruled that the state will not prosecute a physician for the act. These are entities where physicians can write prescriptions for life-ending medications. In his blog, Thaddeus Pope posting decries “the significant side effect and failure rate” of such self-administered drugs.


As a colleague recently pointed out to me, Dr. Green might be surprised to learn that U. S. physicians can legally inject drugs to end life in more states that the ones listed above. It has been legal for a long time, and I suspect Pope is fully aware that this is true. It is just that, south of the Canadian border, we call it “lethal injection,” and it is administered to execute condemned prisoners of the state.

D. Joy Riley MD, MA (Ethics)

About D. Joy Riley MD, MA (Ethics)

Dr. Riley is executive director of The Tennessee Center for Bioethics & Culture and serves on the ethics committee of a Nashville-area hospital. Board certified in internal medicine, her writing and lecture topics include medical ethics, organ transplantation ethics, stem cell research, genetics, end-of-life issues and assisted reproductive technologies. With Scott B. Rae, she co-authored Outside the Womb: Moral Guidance for Assisted Reproduction, and with C. Ben Mitchell, Christian Bioethics.