MacDonald Laurier Institute
Rushing to death in Canada’s MAiD regime

By Ramona Coelho for Inside Policy
Canada legalized Medical Assistance in Dying (MAiD) in 2016, encompassing both euthanasia and assisted suicide. Initially limited to those nearing their natural death, eligibility expanded in 2021 to individuals with physical disabilities, with eligibility for individuals with mental illness in 2027. Parliamentary recommendations include MAiD for children. A recent federal consultation explored extending MAiD to those who lack capacity via advance directives, an approach Quebec has already adopted, despite its criminal status under federal law.
Despite its compassionate framing, investigative journalists and government reports reveal troubling patterns where inadequate exploration of reversible suffering – such as lack of access to medical treatments, poverty, loneliness, and feelings of being a burden – have driven Canadians to choose death. As described by our former Disability Inclusion Minister, Canada’s system at times makes it easier to access MAiD than to receive basic care like a wheelchair. With over 60,000 MAiD cases by the end of 2023, the evidence raises grave concerns about Canada’s MAiD regime.
I am a member of Ontario’s MAiD Death Review Committee (MDRC). Last year, the Chief Coroner released MDRC reports, and a new set of reports has just been published. The first report released by the Office of the Chief Coroner, Waivers of Final Consent, examines how individuals in Track 1 (reasonably foreseeable natural death) can sign waivers to have their lives ended even if they lose the capacity to consent by the scheduled date of MAiD. The second, Navigating Complex Issues within Same Day and Next Day MAiD Provisions, includes cases where MAiD was provided on the same day or the day after it was requested. These reports raise questions about whether proper assessments, thorough exploration of suffering, and informed consent were consistently practised by MAiD clinicians. While MDRC members hold diverse views, here is my take.
Rushing to death, Ignoring Reversible Causes of Suffering
In the same-day or next-day MAiD report, Mrs. B, in her 80s, after complications from surgery, opted for palliative care, leading to discharge home. She later requested a MAiD assessment, but her assessor noted she preferred palliative care based on personal and religious values. The next day, her spouse, struggling with caregiver burnout, took her to the emergency department, but she was discharged home. When a request for hospice palliative care was denied, her spouse contacted the provincial MAiD coordination service for an urgent assessment. A new assessor deemed her eligible for MAiD, despite concerns from the first practitioner, who questioned the new assessor on the urgency, the sudden shift in patient perspective, and the influence of caregiver burnout. The initial assessor requested an opportunity for re-evaluation, but this was denied, with the second assessor deeming it urgent. That evening, a third MAiD practitioner was brought in, and Mrs. B underwent MAiD that night.
The focus should have been on ensuring adequate palliative care and support for Mrs. B and her spouse. Hospice and palliative care teams should have been urgently re-engaged, given the severity of the situation. Additionally, the MAiD provider expedited the process despite the first assessor’s and Mrs. B’s concerns without fully considering the impact of her spouse’s burnout.
The report also has worrying trends suggesting that local medical cultures—rather than patient choice—could be influencing rushed MAiD. Geographic clustering, particularly in Western Ontario, where same-day and next-day MAiD deaths occur most frequently, raises concerns that some MAiD providers may be predisposed to rapidly approve patients for quick death rather than ensuring patients have access to adequate care or exploring if suffering is remediable. This highlights a worrying trend where the speed of the MAiD provision is prioritized over patient-centered care and ethical safeguards.
MAiD without Free and Informed Choice
Consent has been central to Canadians’ acceptance of the legalization of euthanasia and assisted suicide. However, some cases in these reports point to concerns already raised by clinicians: the lack of thorough capacity assessments and concerns that individuals may not have freely chosen MAiD.
In the waiver of final consent report, Mr. B, a man with Alzheimer’s, had been approved for MAiD with such a waiver. However, by the scheduled provision date, his spouse reported increased confusion. Upon arrival, the MAiD provider noted that Mr. B no longer recognized them and so chose not to engage him in discussion at all. Without any verbal interaction to determine his current wishes or understanding, Mr. B’s life was ended.
In the same-day or next-day MAiD report, Mr. C, diagnosed with metastatic cancer, initially expressed interest in MAiD but then experienced cognitive decline and became delirious. He was sedated for pain management. Despite the treating team confirming that capacity was no longer present, a MAiD practitioner arrived and withheld sedation, attempting to rouse him. It was documented that the patient mouthed “yes” and nodded and blinked in response to questions. Based on this interaction, the MAiD provider deemed the patient to have capacity. The MAiD practitioner then facilitated a virtual second assessment, and MAiD was administered.
These individuals were not given genuine opportunities to confirm whether they wished to die. Instead, their past wishes or inquiries were prioritized, raising concerns about ensuring free and informed consent for MAiD. As early as 2020, the Chief Coroner of Ontario identified cases where patients received MAiD without well-documented capacity assessments, even though their medical records suggested they lacked capacity. Further, when Dr. Leonie Herx, past president of the Canadian Society of Palliative Medicine, testified before Parliament about MAiD frequently occurring without capacity, an MP dismissed her, advising Parliament to be cautious about considering seriously evidence under parliamentary immunities that amounted to malpractice allegations, which should be handled by the appropriate regulatory bodies or police. These dismissive comments stand in stark contrast with the gravity of assessing financial capacity, and yet the magnitude is greater when ending life. By way of comparison, for my father, an Ontario-approved capacity expert conducted a rigorous evaluation before declaring him incapable of managing his finances. This included a lengthy interview, collateral history, and review of financial documents—yet no such rigorous capacity assessment is mandated for MAiD.
What is Compassion?
While the federal government has finished its consultation on advance directives for MAiD, experts warn against overlooking the complexities of choosing death based on hypothetical suffering and no lived experience to inform those choices. A substitute decision-maker has to interpret prior wishes, leading to guesswork and ethical dilemmas. These cases highlight how vulnerable individuals, having lost the capacity to consent, may be coerced or unduly influenced to die—whether through financial abuse, caregiver burnout, or other pressures—reminding us that the stakes are high – life and death, no less.
The fundamental expectation of health care should be to rush to care for the patient, providing support through a system that embraces them—not rush them toward death without efforts to mitigate suffering or ensure free and informed consent. If we truly value dignity, we must invest in comprehensive care to prevent patients from being administered speedy death in their most vulnerable moment, turning their worst day into potentially their last.
Dr. Ramona Coelho is a family physician whose practice largely serves marginalised persons in London, Ontario. She is a senior fellow at the Macdonald-Laurier Institute and co-editor of the new book “Unravelling MAiD in Canada” from McGill University Press.
Immigration
Mass immigration can cause enormous shifts in local culture, national identity, and community cohesion

By Geoff Russ for Inside Policy
It matters where immigrants come from, why they choose Canada, and how many are arriving from any single country. When it comes to countries of origin, immigration streams into Canada have become wildly unbalanced over the last decade.
Few topics have animated Canadians more than immigration in the past year.
There is broad consensus among the public that the annual intake of newcomers must fall, and polling shows both native-born and immigrant citizens agree on this. In Ottawa, the Conservative opposition has called for lower numbers, and the Liberal government ostensibly concurs.
While much of the discussion surrounding immigration has focused on economic factors like affordability and the shrinking housing supply, less attention has been paid to the cultural and political changes of welcoming more than 5 million people into the country since 2014.
Specifically, attention must be paid to the possible outcomes of importing hundreds of thousands of people from regions embroiled by war or prone to conflict. This is a necessity as digital technology proliferates and guarantees the world will be interconnected, but not united.
Mass immigration brings in far more than just people. It can cause enormous shifts in local culture, national identity, political allegiances, and community cohesion.
It matters where immigrants come from, why they choose Canada, and how many are arriving from any single country. When it comes to countries of origin, immigration streams into Canada have become wildly unbalanced over the last decade.
In 2023, almost 140,000 people immigrated to Canada from India, while the second-largest intake came from China, with 31,770 people.
This new trend is at odds with Canada’s historical immigration policies, which were more evenly weighted by country. In 2010, the top three national pools of immigration were the Philippines at 38,300 newcomers, India with 33,500, and China with 31,800.
Other countries that Canada has received increasing numbers of migrants from includes Syria, Pakistan, and Nigeria.
Past federal governments took consideration for details like economic needs and capacity for integration. Canadian immigration policy in 2025 should take into account modern communications and conflicts within certain regions as well.
21st century technology continues to advance and innovate at dizzying speeds, giving rise to immersive social platforms and instant messaging platforms like WhatsApp or Signal. This has brought the world closer together, but rather than promoting peace and understanding, it has amplified foreign conflicts and brought them to our own backyards.
Tens of thousands of migrants from the Levant have arrived since 2015, a region where anti-Zionism is deeply ingrained in the cultures, as well as full-blown antisemitism.
Since the outbreak of the Israel-Hamas War in 2023, the entire West has borne witness to antisemitic violence in Europe and North America, often perpetrated by ideologically motivated migrants.
Earlier this year, a Syrian migrant in Germany went on a stabbing spree with the intent of murdering Jews, while last September, Canadian police foiled the plot of a Pakistani man in Ontario who had planned to commit a mass killing of Jews in New York City.
Canada’s political culture has been profoundly affected by these same waves, with demographic changes forcing the federal government to alter its longstanding foreign policy positions. For example, the newly-minted Minister of Industry Mélanie Joly allegedly remarked last year that her shifting stance on the Israel-Hamas war was due to the “demographics” of her Montreal riding.
Montreal itself has become a hotbed of anti-Israeli and anti-semitic violence. Riots, property damage, and the storming of the McGill University campus have been carried out by radicals inspired by Hamas and their allies.
In 1968, the great Canadian thinker Marshall McLuhan co-authored War and Peace in the Global Village, which warned of the consequences of modern technologies erasing the boundaries of the world. McLuhan explicitly cautioned that technology would make the world smaller, and lead to conflict in his theorized global village.
Today, that village is one where Jewish students are routinely harassed on college campuses in Vancouver and Toronto, while synagogues are burnt to the ground in Melbourne. It does not matter whether the victims are Israeli or not. They are seen by their assailants as legitimate targets as part of an enemy tribe.
On May 21, two staffers at the Israeli embassy in Washington DC were shot dead by a man shouting pro-Palestinian slogans.
These sorts of imported feuds go beyond the Middle East. Global tensions in regions like the Indian subcontinent present another threat of foreign-inspired and funded violence, as well as undue political shifts.
India and Pakistan are locked in a long running standoff over the disputed territory of Kashmir.
Last month, several tourists were murdered in Kashmir by militants that India accused Pakistan of backing, leading to several low-level exchanges between the Indian and Pakistani militaries before a ceasefire was brokered. Tensions are far from dissipated, and the possibility of a full-scale confrontation between India and Pakistan remains high.
Considering those two rivals have massive diasporas in the West, a potential war on the subcontinent could radically change domestic politics in countries in Canada, Australia, and Britain.
In 2022, violent clashes broke out between Hindu and Muslim youths in the British city of Leicester following a cricket match between India and Pakistan. The street battles lasted for weeks, and threatened to restart later that year following an escalation in India and Pakistan’s clash over Kashmir. In London, demonstrators from the Pakistani and Indian communities came close to violence.
If a sporting rivalry can inspire hooliganism, a war will spark something far worse, and the globalization of the Israel-Gaza conflict is a glimpse into what that might look like.
There is historical precedent in Canada for how overseas conflicts affect domestic politics.
During the 19th century, hundreds of thousands of Irish—both Catholic and Protestant—emigrated to Canada before and after Confederation in 1867. They brought their religious feuds with them.
The militantly anti-Catholic Orange Order, run by Protestants, became one of the most powerful political forces in Ontario. They held a virtual monopoly on municipal politics in Toronto, excluded Catholics from jobs in the public service, and took part in brawls with the city’s Irish Catholic community for more than 100 years.
Thomas D’Arcy McGee, one of the Fathers of Confederation and an Irish Catholic migrant, was murdered for speaking out against the republican Fenian Brotherhood, which had infiltrated politics both in Canada and the United States.
Integration throughout successive generations mitigates and even practically eliminates the impact of imported conflicts. This was the case with the Irish sectarian divide, though it took over a century to fade away.
Worth noting is that roughly 300,000 Ukrainian refugees currently reside in Canada, having been admitted under a special visa program following the Russian invasion in 2022. It is intended to be temporary, with the expectation of repatriation once a stable peace returns to Ukraine.
Similarly to Irish-Canadians, the vast majority of the established Ukrainian-Canadian community has its roots in pre-modern Canada, and is largely well-integrated into the country’s social fabric. To date, there has been no major violence or anti-social harms inflicted upon their Russian-Canadian counterparts despite the war, or vice-versa.
Furthermore, the Canadian government has a longstanding close relationship with Kyiv, and there is far more trust and transparency regarding intent and collaboration. This is not the case with governments like China and India, the former of whom actively interferes in our elections, and the latter of which has been accused of assassinating dissidents on Canadian soil.
The existence of the iPhone, the internet, and opportunistic foreign governments makes it incredibly dangerous to not change course. That is not to imply that the average migrant is an active foreign agent. But the sheer quantity makes vetting them all a challenge.
Mitigating these threats requires strategic planning when crafting immigration policy.
Other parts of the world like Southeast Asia, Southern Europe, and Latin America are relatively stable and peaceful and are potential sources of newcomers with far lower risk of foreign interference and diasporic violence.
At-play is the stability, unity, and integrity of our political system. Canadian politics must remain fully Canadian in its focus and priorities. That cannot happen if we sleepwalk into becoming a battleground for the rest of the world.
Geoff Russ is a writer and policy analyst, and a contributor for the Macdonald-Laurier Institute.
Health
Medical organizations and media let Canadians believe gender medicine is safe and universally accepted. It’s not

The Macdonald Laurier Institute
14 physicians sign statement for Inside Policy
Many Canadians are likely unaware that several other medically advanced countries—like Britain and multiple EU member states—have restricted hormone therapies and surgical interventions which have documented harms and no clear benefits, writes a group of Canadian doctors.
Following similar actions by peer countries around the world, United States President Donald Trump signed a Jan. 28 executive order declaring his administration will not “fund, sponsor, promote, assist, or support” so-called “gender-affirming” medical treatment for minors—which prescribes hormone therapies and surgical interventions that change sex-determined physical characteristics. Now, a recent report from the U.S. Department of Health and Human Services confirms what many other medical bodies and advanced countries have already recognized: the science and reasoning behind this form of medicine is deeply flawed.
This news appears shocking to many ordinary Canadians, as well as legacy media outlets like The Globe and Mail. That’s largely because Canadian medical organizations and governing bodies—presumed by the public to speak for physicians—have vocally supported “affirmation”: an approach that unquestioningly supports the choice of patients to undergo these treatments. This has left the public with the false impression that such treatments are safe, effective, and universally accepted by physicians. We, a group of 14 Canadian physicians, feel it is vital for the public to know that many—and perhaps most—physicians believe there must be restrictions on gender therapies that permanently change a minor’s body.
Many Canadians are likely unaware that similar restrictive policies are already in place in other medically advanced countries, like Britain and several EU member states.
Most notably, the U.K. government commissioned Dr. Hilary Cass to produce what has become known as the Cass Report, a thorough review of the literature around the treatment for gender dysphoria. Cass investigated whether there is actually proof that these therapies “save lives,” as many activists will insist, or if there is evidence that such interventions make patients’ lives better? Dr. Cass concluded that although medical treatments for gender dysphoria can cause significant harm (as is the case with any medical intervention), there is no conclusive proof of benefit. Hormone therapy and surgeries can lead to chronic pain, incontinence, sterility, and more. They are permanent and irreversible. Therefore, Britain and many other countries restrict most of these treatments for minors.
Here in Canada, Alberta has been the leader in following the evidence. In 2024, the province introduced legislation mandating a minimum age before children could consent to make these permanent, life-altering changes to their bodies. Many physicians were involved with drafting the well-considered legislation. Many more applauded it—some publicly, others quietly.
Despite that, the usual suspects leapt forward to pillory Premier Danielle Smith’s government. The CBC, Globe and Mail, and other legacy media outlets ran headlines like: “Medical experts warn Danielle Smith’s restrictions on gender affirming care will harm vulnerable youth in Alberta.” Most articles quoted bodies such as the Alberta Medical Association (AMA), Canadian Pediatric Society (CPS), and the venerable Canadian Medical Association (CMA), all of which very quickly released statements decrying Alberta’s stance. Such articles give the public the impression that these organizations speak for physicians, expressing a majority, if not unanimous, view.
These organizations do not speak for all physicians. It is hard to know what percentage of physicians oppose “gender-affirming care” for minors because many are afraid to speak their minds in a climate where any dissent is couched as “transphobia.” Physicians who speak out have been subject to investigations and penalties by regulatory organizations, particularly after the passing of federal Bill C-4 in 2022, which potentially makes it a criminal offence to refuse support of a child’s belief that he or she is transgender.
In 2025, one needs to take statements from physicians’ groups with a grain of salt.
Engagement with the CMA is in decline. In 2018 (when membership remained mandatory for doctors in many provinces), the association claimed 87,000 members. By 2024, membership dropped to 75,000 despite an increase in the number of physicians in Canada. Many are members only in a nominal sense, and have little meaningful involvement with the CMA. Rather than taking the pulse of the medical profession as a whole, seeking diverse viewpoints, and making statements that represent this range of views, the CMA is captured and directed by a radical progressive fringe. Unfortunately, this fringe retains the historical imprimatur of being the “voice of physicians” in Canada.
The same phenomenon has occurred with provincial physicians’ organizations like the AMA, which collect mandatory dues but seek minimal engagement from members. Activists have exploited this vacuum to take the helm of these organizations.
This same phenomenon can be seen in organizations like the CPS, CMA, and similar specialty bodies. Their mission statements and missives increasingly read like Marxist screeds rather than wise and measured comment. Just one such example is the CMA’s “ReconciliACTION Plan,” which “challenges anti-Indigenous structures in the health care system.” When physicians with more conservative and scientifically-based views attempt to engage these groups, they have often been met with indifference or hostility, and are systematically prevented from holding positions within these organizations.
This shows that these organizations do not speak for all physicians. When mainstream media rely on such organizations as their sole source for “expert” comment, they miss the real story and avoid engaging with facts. Legacy media portrays this as a battle between science-denying right-wing bigots on one side, and empathetic experts on the other. This could not be further from the truth.
The science is not “settled” by any means. So-called “gender-affirming care” has proven risks and harms, but unproven benefits. It is not “life-saving,” but it is permanently life-altering. We are 14 of the many physicians who strongly believe that minors should not be allowed to make such decisions. The self-proclaimed “experts” do not speak for us.
Written and signed by,
Dr. Arney Lange MSc, MD, FRCPC
Dr. Brent McGrath, MD, FRCPC
Dr. Chris Millburn MD
Dr. David Zitner MD
Dr. Dion Davidson MD, FRCSC, FACS
Dr. Duncan Veasey MD
Dr. Julie Curwin MD FRCPC
Dr. Lori Regenstreif MD, CCFP (AM), FCFP
Dr. Mark D’Souza MD, CCFP (EM), FCFP
Dr. Martha Fulford MD, FRCPC
Dr. M.J. Ackermann MD
Dr. Richard Gibson MD, FCFP
Dr. Roy Eappen MDCM, FRCP (C)
Dr. Shawn Whatley MD, FCFP (EM)
This statement is an initiative of the Macdonald-Laurier Institute, written and signed by concerned physicians from across Canada who are calling for a more careful, evidence-based, and ethically responsible approach to the treatment of gender issues.
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