The case of an Ontario doctor who was formally cautioned by a professional regulator but was nevertheless allowed to continue providing medical assistance in dying has divided experts over whether oversight of MAID is strong enough.
The College of Physicians and Surgeons of Ontario, which regulates the practice of medicine in the province, evaluated complaints related to two MAID patients who received the procedure in 2024 from James MacLean, a family physician in London.
The college’s Inquiries, Complaints and Reports Committee determined that he had crossed professional boundaries, failed to adhere to protocols, displayed a lack of judgment and dealt with patients in a way that risked looking like coercion. A broader investigation into his practice found that his conduct “exposes or is likely to expose patients to harm or injury in five out of twenty [patient] charts reviewed,” a summary of the committee’s decision says.
Although the college has the ability to escalate its concerns to a professional tribunal with the power to suspend or revoke a physician’s licence, it instead issued Dr. MacLean a caution, which is a remedial step that does not amount to formal disciplinary action. It also accepted his voluntary undertaking to practise under certain conditions, including a six-month clinical supervision period and unannounced inspections of his practice locations and patient records.
The college’s decision to allow Dr. MacLean to continue providing MAID, which was first reported this week by The Globe and Mail, is being viewed by some doctors and legal experts as evidence that oversight of medically assisted death is not stringent enough – even in cases where a provincial regulator has found significant concerns with a physician’s MAID practice.
“It reveals a remarkable lack of serious enforcement of standards and regulatory intervention,” said University of Toronto health law professor Trudo Lemmens, who until recently served on a committee within the Office of the Chief Coroner of Ontario that reviews complex medically assisted deaths after the fact.
“The reports are shocking. But what is perhaps most shocking is how the college does not even deem this to require disciplinary proceedings.”
But other experts and advocacy organizations, including Dying With Dignity Canada, argue that existing protections are sufficient and that individual cases are not representative of problems in the MAID system more broadly.
“This case shows that the oversight system is working,” said Jocelyn Downie, a professor emeritus at Dalhousie University’s faculties of law and medicine who has long studied MAID.
“There were concerns about conduct, the concerns were reported, the college investigated, made findings and responded with corrective measures.”
According to documents prepared by the college and reviewed by The Globe, the college did not escalate its concerns to the Ontario Physicians and Surgeons Discipline Tribunal, which adjudicates allegations of professional misconduct or incompetence made by the regulator.
The complaints against Dr. MacLean centred on the deaths of 45-year-old Thomas Dillon and 67-year-old Bradley Stewart. Dr. MacLean assessed Mr. Dillon for MAID outside of a Tim Hortons, exchanged dozens of text messages with Mr. Dillon and drove him to the MAID location – conduct the college said crossed boundaries and risked looking like coercion. In the case of Mr. Stewart, Dr. MacLean used inadequate medication from a backup MAID kit, resulting in Mr. Stewart being declared dead only to spontaneously resume breathing.
Family alarmed that doctor can still offer MAID despite complaints
Dr. MacLean declined The Globe’s requests for comment. In his submissions to the college, he defended his MAID practice and agreed to take steps to improve it. He stated that he used his best judgment and sought to honour his patients’ wishes.
Toronto psychiatrist Sonu Gaind said the deaths of Mr. Dillon and Mr. Stewart are not outliers. “That our laws allowed this to happen is way bigger than any one physician’s practice,” said Dr. Gaind, past president of the Canadian Psychiatric Association and chair of the Expert Advisory Group on MAID and Mental Illness.
But Eric Mathison, an assistant professor of philosophy at the University of Toronto Scarborough and a former clinical ethicist, said the college’s response should reassure the public because it chose to take steps to correct issues with the doctor’s practice.
“A single physician’s conduct shouldn’t lead us to conclude that MAID itself needs more safeguards any more than a single bad driver means we need to overhaul the driver’s licensing system,” he said.
Dr. MacLean has been practising under supervision since October, 2025, while the committee investigated the complaints. Under provincial law, the college has the power to suspend a doctor’s licence on an interim basis during such an investigation period.
In a statement, College of Physicians and Surgeons of Ontario spokesperson Laura Zilke said, “decisions are made on a case-by-case basis” and are “grounded in the evidence before the committee and its public protection mandate.” She noted that the committee’s detailed deliberations are confidential.
After the mandatory supervision period, which will end as early as this October, Dr. MacLean will submit to an assessment of his practice that will rely on chart reviews and may include feedback from patients and interviews with colleagues.
“The results of the assessment may form the basis of further action by the college,” Ms. Zilke said.
Health Canada spokesperson Karine LeBlanc said provincial and territorial governments have exclusive jurisdiction over the regulation of health care delivery and work in conjunction with professional regulators on oversight.
“The provincial and territorial regulatory bodies have a mandate to protect the public with respect to medical services, and MAID is no exception,” she said.
The families of Mr. Dillon and Mr. Stewart said they will appeal the college’s decision.