Ep. 4: The Hard Question of Assisted Death
EPISODE DESCRIPTION
Canada’s Medical Assistance in Dying (MAID) has expanded significantly in recent years, raising complex questions about autonomy, suffering, and how societies approach the end of life.
In this episode, Matti explores how MAID works, how it compares to assisted dying laws in parts of the United States, and why the issue continues to spark debate. It’s a conversation about ethics, policy, and the difficult decisions people face at the end of life.
TRANSCRIPT
Hello and welcome to the It’s Gonna Be Fine podcast.
Remember a few weeks ago when we were talking about how winter might be over? I was feeling pretty optimistic about that. Well, as I record this right now, about an hour ago, there was snow. Just snow falling. I had no idea it was coming.
So that was wishful thinking.
But believe it or not, today we’re not here to talk about the snow. We have a much heavier topic to discuss. And by the end, hopefully we’ll still feel that it’s going to be fine.
Earlier this month, there was an eye-catching article in The Free Press about assisted death. It’s actually a topic I don’t think a lot of us think about very often. I know I don’t. But when I do think about it, there’s a lot at play.
When I came across this article and started looking into what it was discussing, it reminded me just how complicated—and important—this subject really is.
The article, written by Rupa Subramanya, highlighted a statistic that immediately caught my attention: one in twenty deaths in Canada now occur through a government-run assisted death program.
One in twenty deaths. That’s five percent.
Whether or not you have strong feelings about the issue, that’s the kind of number that makes you stop and think.
So naturally, I wanted to learn more.
What Is MAID?
The Canadian program is called MAID, which stands for Medical Assistance in Dying.
It’s designed for people with what the government describes as “grievous and irremediable” medical conditions.
To qualify, a person must have a serious illness, disease, or disability; be in an advanced state of decline that cannot be reversed; and experience unbearable suffering that cannot be relieved under conditions they consider acceptable.
One important detail is that a person’s condition does not necessarily need to be terminal in order to qualify.
In other words, someone does not have to be expected to die in the immediate future to be eligible.
There’s also a mental health component to this discussion. Currently, a mental illness alone does not qualify someone for MAID. However, according to information on the Canadian government’s website, that could change in March 2027.
Eligibility is assessed individually, taking a person’s specific circumstances into account.
Consent is also a major component. Individuals must provide informed consent when requesting MAID and again immediately before receiving it, except in certain circumstances where advance consent may apply. People can also withdraw their request at any time.
The Safeguards
As you might imagine, there are safeguards built into the process.
Before MAID can be provided, there must be two independent medical assessments. A written request must be signed by an independent witness. The individual must be informed that they can withdraw their request at any time, and final consent must be obtained before the procedure takes place.
For people whose natural death is not considered reasonably foreseeable, there are additional safeguards.
One of the medical practitioners involved must have expertise related to the person’s condition. The individual must be informed about other options that could help relieve suffering, including palliative care, counseling, community services, mental health support, or disability services.
The patient and practitioner must discuss those options, and the patient must seriously consider them.
There’s also a minimum ninety-day assessment period before eligibility can be approved, unless there is concern that the individual may lose the capacity to consent during that time.
So while there are two different tracks—one for reasonably foreseeable deaths and one for those that are not—both involve multiple safeguards and review processes.
Some Statistics That Raised Questions
Once I understood the basics of the program, a few statistics stood out.
According to the article, in 2023, 219 people in Ontario received MAID by the end of the day following their request, and roughly thirty percent received it on the same day.
Prior to 2021, there was a mandatory ten-day reflection period after submitting a written request. That waiting period was removed, which helps explain how some cases can move more quickly today.
To be clear, I have to assume many of those same-day or next-day cases involved people whose deaths were already foreseeable. Otherwise, the ninety-day assessment requirement wouldn’t apply.
Still, the speed of some of these cases raises questions, and it’s one reason the topic has generated debate both inside and outside the medical community.
How Does This Compare to the United States?
The United States has similar programs, but only in certain states.
One of the major differences is that eligibility generally requires a terminal illness. The programs are more narrowly focused on people who are expected to die within a foreseeable period of time.
There are also waiting periods and multiple requests built into the process.
I remember following the blog of a woman who was terminally ill several years ago. She lived in California and wrote openly about her experience, including the option of physician-assisted death.
I remember her describing the paperwork, the multiple requests, and the safeguards that were required before she could access the medication.
So these programs certainly exist in the United States, but they tend to be structured differently.
Where Things Get Complicated
I think many people can understand the argument for allowing someone with a terminal illness to choose how they spend their final days.
If someone is suffering, in pain, and not going to recover, people often ask: why force them to endure that?
In some ways, it reminds me of conversations around life support. Many people choose not to be kept alive by machines indefinitely because they feel there comes a point where continuing treatment no longer aligns with their wishes.
Of course, other people feel differently. Some believe in maintaining hope for as long as possible.
But at least in terminal cases, most people can understand the basic question being asked.
Things become more complicated when the illness isn’t terminal.
Take ALS, also known as Lou Gehrig’s disease.
It’s a devastating condition that often involves a gradual loss of physical function over time.
The question becomes: at what point does someone get to say they’re done?
Who decides that?
The patient? The doctor? The government?
For one person, continuing life with significant limitations may feel completely worthwhile. For another, it may not.
That’s what makes these decisions so difficult. They’re deeply personal.
There are similar questions surrounding cancer, chronic pain, and other serious conditions that may not immediately lead to death but can dramatically affect quality of life.
What happens if treatments exist, but a person doesn’t want to endure them?
What role should age play?
Would a thirty-year-old view these decisions differently than an eighty-year-old?
How much flexibility should a system allow?
It’s incredibly difficult to create rules and categories for situations that are so individual.
The Government’s Role
Another layer of complexity is the role of government and healthcare systems.
Providing medical care costs money. Long-term treatment requires resources.
That creates uncomfortable questions.
Could governments or healthcare systems develop incentives that don’t always align perfectly with the interests of individual patients?
Could financial pressures influence policy decisions?
These aren’t easy questions, but they’re important to consider.
That’s one reason I become cautious whenever government involvement expands in areas this personal.
There’s the individual’s perspective. There’s the government’s perspective. There’s the healthcare system’s perspective. And there are the beliefs and values of the medical professionals involved.
All of those perspectives intersect.
Who Gets to Decide?
Another example that comes to mind is amputation.
Many people who lose a limb go on to live fulfilling, meaningful, and happy lives.
But what if someone decides they don’t want to live that way?
Do we have the right to tell them they must?
Should something like that ever qualify for a program such as MAID?
Again, who gets to decide?
These questions don’t have simple answers.
When I think about them, I generally find myself focusing on the individual. This is someone’s life. They’re the person who has to live it.
That doesn’t mean someone should be able to make an irreversible decision without exhausting other options. I think treatment options should be explored. Mental health concerns should be addressed. Safeguards should exist.
But I also think it’s important not to dismiss the experiences and wishes of people facing circumstances most of us hope we never have to face ourselves.
If there is a role for programs like this, I tend to think they work best as a partnership between patients, their families where appropriate, and the medical professionals they trust.
I also believe waiting periods make sense, although the appropriate length may vary depending on the situation.
Ultimately, this isn’t a black-and-white issue.
In fact, that’s probably the biggest takeaway.
Nothing about this is simple.
Every case has context. Every person has different circumstances. Every decision involves competing values.
The challenge is finding a balance between respecting a person’s dignity and autonomy while also ensuring that appropriate safeguards are in place.
Final Thoughts
Heavy stuff today.
But I still believe that if we continue talking about difficult topics like this—and if we approach them with common sense, curiosity, and civility—we can navigate them thoughtfully.
And ultimately, it is going to be fine.
Thanks so much for joining us. We’ll see you next time.
This transcript has been lightly edited for readability.
