Shouldn't care come before euthanasia (MAiD)?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Ramona Coelho

On August 29, 2025; I published an article concerning euthanasia approvals for patients who have refused treatment in Ontario (Article Link).

On September 10, 2025, an article by Dr Ramona Coelho that was publised by National Newswatch examined the same issue. Coelho, who is a Member of Medical Assistance in Dying (MAiD) Death Review Committee; (MDRC) Ontario, asks the question: Shouldn't care come before MAiD? Coelho writes:

Some Canadians who receive medical assistance in dying (MAiD) do not receive the care needed to relieve their suffering. Lives are ended because treatments are denied or deemed optional for people in crisis. MAiD, which is both assisted suicide and euthanasia, has become a possible substitute for care. Ontario’s MAiD Death Review Committee’s (MDRC) latest report, Evaluating Incurability, Irreversible Decline, and Reasonably Foreseeable Natural Death, highlights an observation I have made for a long time—the human cost of inadequate medical and social supports. The committee holds diverse views, I share my perspective as a member.

Health Canada guidelines do not permit a patient being approved for euthanasia specifically because they have refused treatment. Coelho explains:

Health Canada clarifies that “irreversible decline” means a severe loss of function, and a person can only be considered incurable if there are no reasonable and effective treatments available. They explicitly state that individuals cannot refuse all treatments to render themselves incurable, and thereby qualify for MAiD.

Coelho outlines several cases from the recent MDRC report:

Consider Mrs. A: isolated, severely obese, depressed, and disconnected from care; she refused treatment and social support but requested MAiD. Instead of re-engaging her with care, MAiD clinicians deemed her incurable because she refused all investigations, and her life was ended.

Or Mr. B: a man with cerebral palsy in long-term care, he voluntarily stopped eating and drinking, leading to renal failure and dehydration. He was deemed eligible under Track 1 because his death was consequently considered “reasonably foreseeable.” No psychiatric expertise was consulted despite signs of psychosocial distress.

Or Mr. C: a man in his 70s with essential tremor, whose MAiD provider documented that his request was mainly driven by emotional suffering and bereavement.

The case of Mrs. A illustrates how some assessors may deem suffering irremediable while failing to establish an accurate prognosis or provide appropriate care. In my view, determinations of incurability must never be based on patient neglect. Similarly, Mr. B, who refused food and drink yet was deemed eligible under Track 1, highlights the Canadian Association of MAiD Assessors and Providers (CAMAP) long-standing guidance that permits broad interpretations of “reasonably foreseeable natural death” (RFND), allowing Track 2 patients to qualify under Track 1 when they refuse interventions that cause a deterioration in their health. For Mr. C, essential tremor is incurable but does not usually cause a serious decline in capability. All these practices appear to contradict guidance from Health Canada.

Coelho continues

Sadly, many MAiD deaths are driven by untreated suffering: isolation, feelings of being a burden, and lack of care. Ableism and ageism play a role, with some assessors judging certain lives as less worthy of living. Disability is often equated with illness, yet disabled individuals are members of a community recognized under the UN human rights standards, and their community faces systemic barriers. Too often, MAiD decisions are made on a case-by-case basis, relying on an outdated medical model of disability and overlooking how lived experience, lack of support, and systemic factors contribute to broader societal inequities that perpetuate disadvantage for people with disabilities.

Coelho concludes by stating:

In March 2025, the United Nations Committee on the Rights of Persons with Disabilities condemned Canada’s MAiD expansion as inherently discriminatory and ableist. Among its findings, it called for genuine oversight to prevent abuse and an immediate repeal of Track 2, including the expansion to mental illness as the sole criterion of eligibility scheduled for 2027.

Canadian oversight is sorely lacking, failing to implement enforceable standards and raise public awareness of human rights transgressions. In British Columbia, internal government documents recently included a briefing note with a recommendation against strict MAiD oversight to avoid discouraging providers amid “high demand.” This raises serious questions about whose interests are being served in the provision of MAiD.

Canada’s legal safeguards are failing. Federal guidelines are being ignored. The public deserves to know: Is Canada building a system that truly protects all Canadians—or one that expedites death for the vulnerable?

Previous article by Dr Ramona Coelho: (Articles Link).