David Joles/The Associated Press
Ontario is overhauling its body that reviews complex medically assisted deaths, narrowing its membership, scaling back its scope and shifting its role away from independent oversight toward supporting the system it is meant to scrutinize, according to documents obtained by The Globe and Mail.
Two former members say the proposed new version of the committee is designed to be less rigorous and to provide less oversight.
Until March 25, Ontario had a 16-member committee that reviewed MAID deaths that had occurred in the province. The MAiD Death Review Committee was established by Ontario’s Chief Coroner, Dr. Dirk Huyer, in January, 2024. It was described in a committee annual report that year as the first of its kind in Canada to have experts from different fields to “provide enhanced evaluation of MAiD deaths and to explore end-of-life complexities that have systemic and practice implications.”
But the committee is at the end of its two-year term, and Dr. Huyer issued a call for new members April 2 in a document obtained by The Globe and Mail. The posting differs in several ways from the version issued in late 2023.
According to the new posting, the committee will have only six to eight members instead of 16. Members will meet five times a year, as opposed to the commitment in 2024 to meet 10 times. The new meetings will last two to three hours, compared with the earlier commitment to meet for four to five. The new committee will review 20 deaths a year. In 2024, the posting called for a review of 25 complex cases, although the coroner’s office says only 14 were examined.
Robyn Urback: Restoring sanity to MAID laws in Canada will protect them
Membership in the new committee will be limited to those “interested in supporting MAiD practice,” the posting from last week shows.
Language emphasizing “independent expert review” has been removed, replaced with a focus on providing “guidance to practitioners” and efforts to “support emerging MAiD practice.”
The change in the committee follows several stories that have prompted criticism that Canada’s MAID practices have gone too far. Last month, the Alberta government introduced legislation to increase oversight in that province and to bar cases where patients have incurable conditions but their deaths are not reasonably foreseeable.
MAID has been available in Canada for 10 years, after a Supreme Court decision in 2015 permitting assistance in dying to “competent adults who are suffering intolerably as a result of a grievous and irremediable medical condition.”
In 2021, the law was expanded to those enduring intolerable suffering but not approaching their natural deaths. Canada has twice delayed further expanding eligibility for the procedure to those with mental illness alone.
Alberta to restrict MAID, including for patients with incurable conditions
Trudo Lemmens, who has expressed concerns with MAID and Canada’s expansion of eligibility, says he has been told his services are not required on the new committee.
Dr. Lemmens wrote a sharply worded letter to Dr. Huyer on Monday objecting to the changes. The letter was later provided to The Globe.
Dr. Lemmens teaches health law at the University of Toronto and has appeared as an expert witness in front of several parliamentary committees on MAID, including an appearance in Britain.
“The new approach now proposed by the Chief Coroner’s office fundamentally veers the MDRC away from its public-interest mandate: providing independent, interdisciplinary review to inform coroner recommendations and promote patient safety, transparency, and accountability,” Dr. Lemmens wrote.
“These changes were also framed as a response to negative – and allegedly sensationalist – media coverage of MDRC reports and specific cases.”
Dr. Huyer’s office did not make the chief coroner available for an interview. In response to e-mailed questions, his office said the change in the committee is in line with other death review committees overseen by his office.
“There are no significant changes to the frequency of committee meetings,” the statement said.
The statement said the original committee reviewed 14 cases in 2024, but the new committee aims to review 20 in the years ahead.
“When a MAiD death involves complex circumstances outside of the MDRC collective expertise, we may select from the pool of applicants or request participation of other experts as needed, to facilitate the necessary review and analysis of a particular issue.
“We do not have criteria that exclude individuals from membership.”
But Dr. Lemmens wrote the change in committee members and structure is in line with “demands from MAID providers for less transparency, less scrutiny, and diminished accountability.”
He warned the changes risk creating a “regulatory Potemkin Village” – a system that appears rigorous while obscuring troubling cases – in a domain where outcomes are “final and irreversible.”
An e-mail from the Office of the Chief Coroner to the committee last November, obtained by The Globe and Mail, informed members of “ongoing concerns from the broader MAiD practice community on the perception and function of the MDRC.”
“While the feedback highlighted important issues, it also prompted recognition of the need for solution-oriented dialogue.”
Ramona Coelho, a family physician from London, Ont., who served on the original committee until it was dissolved this month, said she is “deeply concerned” by the changes.
The committee had been “one of the only mechanisms in Canada for detailed, transparent, independent review of MAID deaths.
“Restricting membership to only those explicitly supportive of MAID risks turning oversight into an affirmation process,” she said.
By reviewing individual deaths in detail, Ontario’s MAiD Death Review Committee had been raising questions about how MAID is granted for people who are not nearing their natural deaths.
Opinion: In the MAID debates, the patient’s voice must take precedence
Their reports and case studies generated significant media attention because they highlighted cases that tested the boundaries of the law and revealed patterns in the people accessing it.
In one example from a 2024 report, a woman in her 50s with a history of depression and suicidality and a severe sensitivity to chemicals ended her life through MAID after failing to secure housing that met her medical needs.
In another from the same report, a man in his 40s with inflammatory bowel disease, mental illness, a history of suicidality, and addictions ended his life after a physician introduced MAID as an option during a psychiatric assessment. The provider drove the man to a location where his life was ended despite the MAID provider documenting his family’s concerns with the request.
Provincial health authorities are responsible for delivering MAID and conducting oversight of the practice.
The provinces have established different ways of delivering oversight. In British Columbia, an administrative team employed by the provincial health authority reviews documentation after every MAID death.
Isabel Grant, who teaches criminal law at the University of British Columbia, said MAID providers should not be afraid of close scrutiny.
“The new committee sounds like it is simply in place for a small group of MAID providers to endorse the work of other MAID providers,” Prof. Grant said.
“It may make some people feel better about MAID in Ontario, because the problems will be hidden from public scrutiny, but that is not oversight. This is a real loss for Ontario, and for Canada more widely.”
Editor’s note: A previous version of this article incorrectly stated the Supreme Court’s decision that allowed for MAID occurred in 2016. The decision was handed down in 2015. The article incorrectly said the decision allowed access to medical assistance in dying if a person’s death was “reasonably foreseeable.” The ruling did not include that statement.