MAID has been embraced as a way to prevent needless suffering since it was legalized in Canada in 2016.megaflopp/Getty Images/iStockphoto
There are two principal types of stories about medical assistance in dying routinely published in the Canadian media.
The first is a person fighting for improved access to MAID because of a perceived flaw in current legislation. Someone like Sandra Demontigny, a 46-year-old Quebec woman with early onset Alzheimer’s who has been granted an advanced request for MAID, and would like other Canadians to have that same ability. (Currently, advanced requests are only allowed in Quebec.)
The second is the story of a person who has chosen MAID to end their suffering, and a family member is bitterly opposed to the choice, or a person even having that choice. A recent example is the case of Kiano Vafaeian, a 26-year-old who was granted MAID on Dec. 30, 2025, because of his unbearable suffering.
Since then, his mother, Margaret Marsilla, has been calling for the law to be greatly restricted, arguing her son’s condition was treatable and he shopped around for a doctor to provide MAID. (Mr. Vafaeian, an Ontario resident, travelled to B.C. for the procedure.)
Quebec’s advance-request MAID program offers a complicated example for other jurisdictions
What these two archetypal stories have in common is that they are outliers, mired in difficult legal and ethical challenges.
Since it was legalized in Canada in 2016, MAID has been embraced as a way to prevent needless suffering, principally by people whose death is imminent.
In the vast majority of the 76,475 MAID cases that have taken place from 2016 to 2024, the person’s choice to end their life was unambiguous, legal and supported by their family.
In other words, MAID is now somewhat routine in cases where death is reasonably foreseeable, just as palliative sedation (allowing people to die without intervening, other than administering pain medication) used to be, and appropriately so.
MAID deaths where death is not imminent, but where a person’s suffering is deemed unbearable, are still a tiny minority of cases – 732 of the 16,499 deaths in 2024.
The big difference between cases like Ms. Demontigny and Mr. Vafaeian is that, in the former, the patient voice is front and centre, and in the latter, the patient voice has been silenced and co-opted.
Ontario woman calls for reform after her son ‘shopped’ for MAID approval in B.C.
“Nothing about me without me,” is the rallying cry of patient activists. Meaning, patients should have agency, and be the ultimate decision-makers in their care.
Yet, the MAID stories that tend to get the bulk of media coverage involve ugly family dynamics. We’ve seen cases where a father sued to prevent an adult daughter from choosing MAID, and another where a common-law partner sought an injunction to block the choice of their significant other.
We have third parties, a family member and/or anti-choice activist, telling us a person’s suffering should continue, and claiming this is compassionate.
The courts are a terrible place to resolve complex family disputes. But when Solomonesque arbitration is required, we should always err on the side of patient choice.
We must also be wary of claims like “doctor shopping is wrong.” There are roughly 100,000 doctors and 9,000 nurse practitioners in Canada but, in 2024, only 2,266 of them performed a MAID procedure. Shop you must.
Our MAID laws need expansion, not contraction. There are some serious issues on the table. One is allowing people with serious neurological conditions like dementia to make advanced requests for MAID. Without that option, people with these conditions have to engage in a dangerous balancing act, where they must choose death while they are still deemed competent, or risk losing agency. The celebrated children’s author Robert Munsch has drawn attention to this dilemma.
The other thorny issue (at least politically) is allowing MAID for people whose sole underlying condition is mental illness, known as MAID-SUMC. The federal government has punted this issue forward a number of times already, and is currently promising to set standards in 2027.
Of the nine countries that allow assisted death for those not at end of life, only Canada excludes people with mental illness. We have to stop pretending that the suffering of people with untreatable mental illness is somehow lesser than those with an untreatable physical illness, and that those with mental illness are necessarily incapable of rational choice.
Last year, a 91-year-old Quebec man, profoundly depressed since the death of wife during the pandemic, killed himself after being denied MAID.
That’s not the kind of story that gets much media attention because it reminds us of an uncomfortable reality: People who want to end their suffering will find a way to do so.
The state should not be preventing them from doing so in a humane and dignified manner. It should respect patient choice in how they live and how they die.