Premier Danielle Smith speaks to the media at the Legislature in Edmonton in December, 2025.AMBER BRACKEN/The Canadian Press
The scale of growth of Canada’s assisted-dying industry has become an easy talking point for skeptics both in Canada and abroad. The New York Post, in typical tabloid fashion, announced that Canada will “soon cross the sickly six-figure threshold” of 100,000 deaths by medical assistance in dying (MAID), noting the figure will surpass the number of Canadian deaths during the Second World War. Conservative MPs cited that figure in social-media posts, adding that what was once pegged as a “last resort” has metamorphosed into an entirely different operation. During a press conference announcing new restrictions on MAID in Alberta, Premier Danielle Smith noted the pace of growth in MAID deaths in cautionary terms (up 64 per cent nationally between 2021 and 2024), saying these trends “should give anyone pause.”
But the raw numbers, and the growth of those numbers, don’t necessarily indicate that something is amiss. Indeed, in my personal view, it would not be a bad thing if 100,000 terminally ill cancer patients were able to avoid a final few weeks of agony by choosing to die on their own terms. We know that that’s not been the case in Canada, of course, but those types of deaths do represent the vast majority of MAID cases. In 2024, for example, more than 95 per cent of MAID cases were of “Track 1,” meaning the patients’ deaths were “reasonably foreseeable.”
It is not insignificant that 4.4 per cent of approved requests – or 732 people in 2024 – were helped to die under “Track 2,” where their deaths were not considered “reasonably foreseeable.” It’s in this category where you’ll find the edge cases: the 26-year-old with chronic but not fatal conditions, including mental health challenges, who went to B.C. to seek MAID when he was denied in Ontario, for example. But it is a mistake to use these edge cases, and the increase in MAID generally, as evidence of the dysfunction of the entire operation. Tens of thousands of terminally ill Canadians have been able to decide when and how they die, affording them some dignity in their final days. That is a good thing, and worth protecting.
Alberta to restrict MAID, including for patients with incurable conditions
That is why those who support MAID eligibility requirements as laid out in the government’s original 2016 legislation, before Quebec’s superior court found the condition that death be “reasonably foreseeable” unconstitutional, should welcome Ms. Smith’s proposed legislation. That legislation would restrict MAID only to those with terminal illnesses, and would prohibit it for patients whose sole underlying condition is mental illness (who will become eligible in 2027). The changes proposed by Ms. Smith’s government restore reasonable limits as to what individuals can and should expect from their government (i.e., that the state should help individuals alleviate their suffering, not end their lives because of it) and thus restore some integrity to MAID as it exists in Canada.
We have a habit in this country of adopting policy and then watching, slack-jawed, as it spirals out of control. There is perhaps no better example than what has happened with safe-consumption sites, safe-supply programs, and drug decriminalization pilots across Canada. In theory, these initiatives should work to curb overdose deaths and address addiction by keeping people alive long enough to access rehabilitation programs. But that only works if there are strict controls that, for example, address the potential diversion of safe-supply drugs into communities, and if they are implemented in tandem with significant investment in rehabilitation programs. That didn’t happen in Canada; what did happen was that drug paraphernalia and violence spilled out from safe consumption sites into nearby communities, and decriminalization resulted in the proliferation of open drug use. These initiatives are now being rolled back or scrapped entirely.
There’s a parallel to be drawn with the way access to MAID has evolved over the past decade. We have watched, slack-jawed, as what was supposed to be a tightly controlled system providing dignity in death for the terminally ill turned into one where veterans are offered death instead of counselling, where a woman suffering with obesity was accepted for MAID, and where a woman with dementia was helped to die after a family member twice referred her for MAID.
In one year, Canadians whose sole underlying condition is mental illness will have the state’s assistance in ending their life, which invites all sorts of complicated questions about the capacity to consent. The risk for everyone is that MAID becomes so out of control, so unchecked, that someone comes along and scraps the entire thing, notwithstanding the Supreme Court’s decision in 2015. That’s why restoring some sanity to MAID laws in Canada is so important now. And proponents of MAID for the terminally ill should be the loudest supporters.