In 2016, 1,108 Canadians died by medical assistance in dying. By 2024, the figure had risen to 16,499 — a fifteen-fold increase across eight years. One in twenty Canadian deaths is now medically assisted. No comparable jurisdiction on earth has scaled at this pace.
This article examines where the money flows, who controls the standards, and whether the oversight mechanisms have kept pace with the expansion.
The Trajectory
Canada legalized medical assistance in dying in June 2016. The first year was modest: 1,108 deaths, overwhelmingly among terminally ill cancer patients exercising what most Canadians understood as a final act of autonomy. That understanding has since been tested.
By the close of 2024, cumulative MAID deaths in Canada had reached 76,475. The annual count has risen without interruption.
- 2016: 1,108
- 2018: 4,478
- 2020: 7,595
- 2022: 13,241
- 2024: 16,499
For context: the Netherlands required 32 years for assisted dying to reach 3% of all deaths. Canada arrived at that threshold in five.
The Provincial Disparity
Three provinces account for 85% of all MAID deaths: Quebec (36.4%), Ontario (30.0%), and British Columbia (18.2%). The raw numbers, however, obscure a more revealing distribution.
Quebec's MAID rate — 7.3% of all deaths — exceeds that of the Netherlands, a country with four decades of practice. British Columbia sits at 5.5%. Ontario, despite its status as Canada's most populous province, registers 3.2%.
That gap invites scrutiny. A province's MAID rate reflects an interplay of cultural norms, religious demographics, palliative care infrastructure, and provider availability. But there is another variable embedded in the data that receives remarkably little public discussion: physician compensation.
MAID is publicly funded through provincial health insurance. Every assessment, consultation, medication procurement, and provision is billed to taxpayers — at rates that vary significantly by province.
For a 90-minute MAID assessment plus a $200 provision fee:
- Alberta: ~$822
- New Brunswick: ~$800
- Quebec: ~$700
- Saskatchewan: ~$666
- Ontario: ~$440
Ontario pays the lowest rate in the country.
In 2017, the Globe and Mail reported that Ontario's compensation structure was already deterring physicians from participating in MAID. The pattern in the aggregate data is difficult to ignore: the provinces offering the highest compensation report the highest MAID rates; the province offering the least reports the lowest rate among the three largest.
Correlation is not causation, and responsible analysis demands caution. But if MAID is a constitutional right, access should not hinge on what a physician is compensated to provide it. And if compensation is influencing utilization rates, the question of what this system is optimizing for becomes harder to avoid.
The Larger Arithmetic
Direct physician billing for MAID runs into the millions annually. With approximately 5,000 MAID deaths in Ontario last year, even at the country's lowest reimbursement rate, the figures accumulate quickly.
But direct billing is the smaller number.
A 2017 study published in the Canadian Medical Association Journal estimated that MAID could reduce aggregate healthcare expenditures by $34.7 million to $138.8 million annually through the elimination of end-of-life care costs. A 2025 study in the journal Omega extended this analysis to the potential fiscal impact of expanding eligibility to “vulnerable populations.”
The Catholic Register distilled the dynamic in five words: “Dead people don't cost money.”
No government official frames MAID as fiscal policy. But the structural incentive operates independently of anyone's stated intentions. Each MAID death eliminates ongoing expenditures: healthcare, disability supports, housing assistance, social services. At 16,499 deaths per year, the cumulative fiscal effect is straightforward arithmetic — and it consistently lands on the side of the ledger that favours lower numbers.
The Governance Structure
MAID in Canada operates under a layered regime of federal legislation, provincial health ministry directives, and medical regulatory oversight. The individuals who shape its clinical standards constitute a notably small group.
The Canadian Association of MAID Assessors and Providers (CAMAP) serves as the principal professional body. Founded in 2017, it received $3.3 million from Health Canada in 2021 to develop a national, accredited MAID training curriculum.
A structural feature of CAMAP's bylaws warrants attention: maintaining membership requires performing at least one MAID assessment annually. A physician with reservations about current practice — one inclined to exercise greater caution or raise more demanding questions — is excluded from the organization that writes the professional standards.
The overlap between advocacy and governance compounds this concern.
A 2024 peer-reviewed analysis in the American Journal of Bioethics by Lyon, Lemmens, and Kim documented that at least four current or recent CAMAP directors simultaneously serve on the Clinician Advisory Council of Dying With Dignity Canada (DWDC), the country's foremost MAID advocacy organization. A fifth is a former DWDC executive. Six CAMAP directors and seven DWDC advisory council members participated in developing the national MAID curriculum — the same curriculum funded by $3.3 million in public money.
CAMAP's training materials are not publicly available.
The researchers characterized this arrangement as “policy capture” — a term from political science describing the condition in which a concentrated group with aligned interests acquires disproportionate influence over the regulatory framework governing a broader population.
The Cases
Aggregate data reveals institutional patterns. Individual cases reveal what those patterns mean in practice.
Amir Farsoud was 54, living in St. Catharines, Ontario, in 2022. He had chronic back pain, which satisfied the eligibility threshold. His stated reason for applying was that he faced imminent eviction and had exhausted his housing options.
He was approved.
The case became national news when CityNews Toronto reported it. A pharmacist named Chanpreet Purba organized a GoFundMe campaign that raised over $60,000. Farsoud secured housing and withdrew his application. He wanted to live. He could not afford to.
Christine Gauthier, a former Paralympian and military veteran, testified before a parliamentary committee in December 2022 that she had spent five years requesting a wheelchair ramp from Veterans Affairs Canada. During that period, she stated, a caseworker offered her medical assistance in dying — in writing. Veterans Affairs told the committee they found “no indication” of such an offer in their files. Gauthier maintains she possesses the postage slips confirming delivery. The matter was referred to the RCMP. At least four other veterans received similar offers, all originating from the same caseworker.
Kiano Vafaeian was 26 when he died by MAID in December 2025. He had Type 1 diabetes, partial blindness resulting from a car accident at 17, and depression. His family had intervened to prevent a prior MAID attempt in 2022 after his mother discovered the scheduled appointment and recorded a conversation with the administering physician.
Multiple Ontario physicians determined that Vafaeian did not have a terminal condition. He travelled to British Columbia, where he was seen by Dr. Ellen Wiebe, a provider who has administered more than 400 MAID deaths since 2016, the highest known individual figure in Canada. His family alleges that Wiebe coached him on meeting the eligibility criteria. Three days before his death, he posted photographs from a resort in Mexico. His parents learned of his death after the fact.
Individually, each case was reported, debated, and largely absorbed into the news cycle. Considered together, they delineate a pattern that demands examination: a system in which safeguards exist in statute but may not be functioning as designed.
What Ontario Will Not Disclose
Ontario reviews every MAID death through a committee housed within the Office of the Chief Coroner. The MAID Death Review Committee comprises physicians, social workers, ethicists, lawyers, and disability experts. Since the autumn of 2024, the committee has produced at least five reports.
None have been released to the public.
What is known about these reports derives from secondhand journalism and from a February 2026 paper in BMJ Supportive & Palliative Care, co-authored by committee members themselves. That paper documented “safeguard failures” in Canada's MAID system, drawing on Ontario cases as illustrative examples.
Canadian Affairs has reported that the committee identified cases in which patients cited isolation and fear of homelessness as motivating factors for requesting MAID. In other instances, patients who declined available treatment were approved regardless. Committee members concluded that psychiatric assessments should have been mandatory.
Shena Media has filed three Freedom of Information requests to examine what these reports contain:
- 1
Ministry of Health: Total OHIP billings under MAID-specific fee codes, complaints received, and any directives governing how MAID is to be discussed with patients.
- 2
Ontario Health atHome: Call scripts and protocols employed by the MAID Care Coordination Service, referral volumes, and whether staff are directed to raise MAID proactively with callers.
- 3
Chief Coroner's Office: The complete text of the unreleased MAID Death Review Committee reports, disaggregated case data, and records of referrals to regulatory bodies and law enforcement.
Responses are due within 30 days. We will publish what we receive.
The Question
In eight years, Canada has constructed something without precedent: the fastest-growing medically assisted death program in the world, administered by the only jurisdiction that permits nurse practitioners to deliver the lethal drugs, overseen by a professional body whose membership criteria structurally exclude cautious voices, and funded by a public health system that realizes a fiscal benefit from every death it authorizes.
The majority of MAID providers entered this work out of genuine commitment to alleviating suffering. The majority of MAID deaths are precisely what the legislation intended — a merciful conclusion to intolerable pain, chosen freely by the person enduring it.
But institutions designed with sound intentions are not immune to drift, particularly when the same narrow group trains the assessors, establishes the standards, advises the advocacy organizations, and reviews the outcomes — all while the public is denied access to the findings. The structural conditions for regulatory capture are present. History offers abundant evidence of what follows when oversight becomes performative.
The question is whether 16,499 deaths per year warrants more than five confidential reports and a $3.3 million training program administered by those with the greatest stake in continued expansion.
Canadians built this system. Canadians fund it. Canadians are entitled to see how it operates.