Patient Ombudsman Report 2024/2025
December 8, 2025
Intelligence, artifice and ethics: thinking about AI in health care
December 10, 2025
The Sixth Annual Report on Medical Assistance in Dying in Canada was released in November 2025. What follows is an idiosyncratic (Rob Butcher) summary and review.
Highlights
16 499 people received MAID in 2024. This represents 5.1% of deaths in Canada in 2024. In other words, slightly more than 1 in 20 of the people who died last year in Canada had medical assistance to do so.
The annual growth rate of the number of MAID provisions has also slowed significantly to 6.9% growth between 2023 and 2024. (This is down from an over 30% rate of increase a few years ago and almost 16% in 2023
95.6% of MAID provisions were “Track 1” for those whose natural death is reasonably foreseeable. Although Track 2 (for those whose natural death is not reasonably foreseeable) made up only 4.4% of total provisions Track 2 represented almost 25% of requests that were assessed as ineligible.
Applications received but MAID not provided
Notably, more than 4000 people made an application for MAID but died before MAID could be provided. It seems significant that approximately 20% of MAID applications result in the patient’s death before MAID can be administered. However, it does not seem to be that barriers caused the majority of these cases. In 41% of these cases the person did not pick a date for MAID provision, and in these cases the median time between assessment and death by other causes was 45 days. By comparison the median time between assessment and provision for all Track 1 (people for whom a natural death is reasonably foreseeable) was 15 days. It seems to be that, as predicted, some people are using MAID as an end of life option or possibility, that ultimately, they do not choose to exercise. (This connects with the results of the federal government consultation on attitudes to expanding MAID to those who make advance requests. The dominant reason given in support of expanding access to MAID was “individual choice about end of life care.” Choosing not to have MAID: by not setting a date, (1661 cases) by withdrawing a request because other means have been accepted to relieve suffering (315 cases) or simply changing one’s mind (261 cases) is a person exercising control at the end of their life as much as is the choice to go ahead with MAID.
Suffering
The top four reasons most frequently cited for suffering start from loss: loss of dignity (63.5) loss of independence (73.5) loss of ability to perform the activities of daily living (85.4) and loss of ability to engage in meaningful activities.(95.1) (%s are frequency of that characteristic reported by MAID practitioners for patient suffering. Practitioners usually reported more than source of suffering so totals exceed 100%) Dignity, independence and the ability to look after oneself and engage in meaningful activities are taken (by those who choose MAID) to be essential elements of a life worth living. Their loss constitutes existential suffering. However, the logic of loss is a contrast: between what I once had and my current state. But to experience (feel) loss I must be able to make the contrast between then and now. This is relevant in the context of discussions of the possible extension of MAID to those who make advance requests. It would be reasonable for a person to say now (while capable) that if they no longer had dignity and independence and were no longer able to perform the activities of daily living or engage in meaningful activity then that would constitute their future suffering. However, even if they have lost those capacities, they may not have experienced (felt) that loss. So, are they actually suffering?
The current Quebec legislation that permits advance requests requires that the person must be (when MAID is administered):
- in a medical state that gives a competent professional cause to believe, based on information at their disposal and their clinical judgment, they are experiencing enduring and unbearable physical or psychological suffering that cannot be relieved under conditions considered tolerable
So, should the practitioner assess suffering according to the MAID criteria of suffering listed above – the criteria the person concerned may well have listed themselves, or should the medical practitioner attempt to assess whether the person is “experiencing” (feeling) that suffering through knowledge of their loss.
The word “experience” is part of the problem here. It can mean both “to live through” (she experienced life at home through COVID) and to “feel” (he experienced searing pain.) The person who has made an advance request for MAID may be at the stage where they are experiencing (living through) diminished or absent independence, a lack of dignity and the inability to care for themselves and engage in meaningful activities, but where they do not experience (feel) any pain, discomfort or discomfiture.
Vulnerability
Concerns have been expressed on the possibility of various forms of vulnerability leading to increased pressure to pursue MAID over other alternatives. In particular, social isolation and loneliness, perceived burden on others, disability, poverty and race. The report looks at each of these conditions in turn. The evidence, as described in the report does not show significantly increased rates of MAID (over the general population) for members of any of those groups. (Please see report for details.)
Back to the numbers, 785 people waived their final consent and 349 people were transferred from one location to another for MAID because their original location would not permit MAID on the premises. In Ontario 48% of provisions were in a person’s home followed by 26% in hospital. No-one chose to administer MAID themselves, all provisions were by health care professionals.
