Toronto Psychiatrists Who Assess Patients for Assisted Death Warn Canada Is Approving People It Shouldn’t

Two University of Toronto psychiatrists who have spent years inside Canada’s assisted-death system are now warning that it has gone too far. In a New York Times essay published Oct. 5, Dr. Gary Rodin and Dr. Madeline Li wrote that “Canada’s system for assisted death is no longer an option of last resort,” and that “In some cases, patients are being approved who should not be.”

That is not a warning from a religious group or a pro-life activist. It comes from two professors of psychiatry who work with advanced-cancer patients, who have counseled and assessed patients for medical assistance in dying, known in Canada as MAID, and one of whom has administered the drugs that end a patient’s life. They say the procedure can be the right choice for some. Their complaint is about how fast and how easily Canada now gets there.

Insiders, not outside critics

Rodin and Li are best known for developing a counseling approach called Managing Cancer and Living Meaningfully, or CALM, which helps patients with advanced cancer stay engaged in life while preparing for its end. A randomized trial of the program, published in the Journal of Clinical Oncology in 2018, found it reduced depressive symptoms in patients with advanced cancer.

From that vantage point, they describe a system that has drifted. “Too many people are receiving the procedure without the opportunity for careful reflection about it with a health provider,” they wrote. “Reports have emerged of people seeking assisted death in the context of poverty or loneliness, raising concerns that they may feel they have no other options.”

The numbers behind the warning

Canada’s program began in 2016 for patients whose natural death was “reasonably foreseeable.” In 2021, Parliament removed that requirement. Today, the authors write, Canada’s system is “one of the most permissive in the world,” and assisted death has increased 16-fold in the eight years since legalization.

Health Canada’s own figures back up the scale. Its sixth annual report found that 16,499 people received MAID in 2024, and that 5.1 percent of everyone who died in Canada that year died this way. The government counts 76,475 assisted deaths since legalization.

Rodin and Li point to another number that should stop readers cold. In 2024, they wrote, “98 percent of people assessed for medical assistance in dying in Canada were found to meet the criterion of ‘intolerable suffering’ and over 92 percent were approved for the procedure.” By contrast, they note, in the Netherlands it is common for requests to be rejected because a doctor judged that the suffering was not unbearable or that alternatives had not been tried.

A law with almost no brakes

The authors lay out how little stands between a request and a death. Two clinicians must approve. The vast majority of cases fall under Track 1, for patients whose death is considered reasonably foreseeable, though the law sets no time frame. Those patients “can request the procedure and get it quickly — sometimes even on the same day.” Only Track 2 cases, for people without a life-threatening illness, carry a 90-day waiting period.

And there is no requirement to try anything else first. “There is no requirement in either track that patients attempt treatment to relieve their suffering,” they wrote. “Nor does the law specify adequate safeguards to protect vulnerable individuals whose decision may be affected by social disadvantage.” They describe seeing patients request assisted death after a new cancer diagnosis or a flare-up of an existing illness and “get the procedure within a matter of days.”

“Whether they should”

The most damning part of the essay is the authors’ explanation for how this happened. Assisted death in Canada, they wrote, is the product of a decades-long campaign to enshrine it as a right, and activists who helped write the rules remain wary of anything they call “gatekeeping.” As a result, many doctors now see their main job as confirming legal eligibility. “The problem is that there has become far more focus on whether patients can get an assisted death and not enough on whether they should.”

They cite a study in which one MAID provider described being “just a conduit really for someone’s desires and someone’s choices,” and another who said determining suffering “is entirely up to the patient — 100 percent,” even though the law requires a clinician to confirm it.

Their own research, they wrote, shows that “the loss of the will to live is not a fixed state. It fluctuates. It can be treated. And it can be misread.”

The patients who changed their minds

Rodin and Li describe a woman in her 70s, the matriarch who made her family’s Sunday dinners. She sought and received approval for assisted death after she lost the ability to cook, feeling she had lost her value to her family. Some headlines turned that into a claim that she was approved because she could not cook. Rodin told The Canadian Press that was wrong: “This patient had an underlying health condition that qualified her for MAID,” he said, adding that the anecdote was meant to show how psychological factors can affect patients’ decisions. Through counseling, she came to understand that her family valued who she was, not what she did. She decided not to go through with it, at least for now. That Christmas, she sat at the table while others cooked and served.

They also describe a Holocaust survivor in his 80s who was approved for assisted death but chose to delay after counseling, and went on to find months of meaning in his life before eventually choosing the procedure with his family around him.

Their prescription is modest: counseling and reflective conversation should be the standard of care for anyone requesting assisted death, and it should be fully funded. Today, they note, it is not routinely offered or covered. “Death must not become the only kind of relief people can imagine,” they concluded.

Alex Schadenberg of the Euthanasia Prevention Coalition, which opposes assisted death outright, republished much of the essay but argued that since no one can be forced into counseling or a pause under current law, the only real fix is to end the practice.

When the doctors who assess patients for Canada’s assisted deaths say it is approving people who should not be approved, the country has run out of excuses for not listening.

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