El Podcast

1 in 20 Deaths: Inside Canada’s Assisted Dying System - Dr. Ramona Coelho

Episode Summary

Canada’s MAiD program has expanded quickly—from end-of-life cases to people who aren’t terminal—making it one of the most common ways Canadians die. Dr. Ramona Coelho argues the system’s safeguards and oversight are inconsistent, and that vulnerability (disability, isolation, lack of care) is increasingly driving eligibility and outcomes.

Episode Notes

Canada’s MAiD program has expanded rapidly—Dr. Ramona Coelho argues the system increasingly serves vulnerable people, with uneven safeguards and serious ethical, legal, and social risks.

Guest bio:

Dr. Ramona Coelho (MDCM, CCFP) is a family physician in London, Ontario, a senior fellow with the Macdonald-Laurier Institute, and co-editor of Unravelling MAiD in Canada: Euthanasia and Assisted Suicide as Medical Care. She has provided testimony and policy input on MAiD and serves on Ontario’s MAiD Death Review Committee with the Office of the Chief Coroner.

Topics discussed:

• How MAiD began in Canada (Carter decision → 2016 legislation)
• Track 1 vs. Track 2 and how eligibility broadened
• Euthanasia vs. assisted suicide (Canada vs. U.S. models)
• Oversight gaps, “doctor shopping,” and variable interpretations of the law
• Disability, loneliness, poverty, and access-to-care concerns
• Dementia, capacity, voluntariness, and family conflict
• Proposed/possible expansions (mental illness; mature minors; advance requests)
• Social messaging and suicide contagion risk
• Why jurisdictions (Oregon vs. Canada/Quebec/Netherlands) show different rates

Main points:

• MAiD expanded from “reasonably foreseeable death” to include non-terminal cases (Track 2), increasing reach to people with disabilities and complex social suffering.
• Canadian safeguards and clinical interpretations vary widely, and the ability to “try again” with different assessors can make approvals easier to obtain.
• Canada’s model is overwhelmingly euthanasia (clinician-administered), which she argues changes the social dynamics compared with assisted-suicide regimes.
• She raises concerns about capacity/consent assessments—especially in dementia—and about insufficient access to palliative care and supports before MAiD occurs.
• She argues the policy’s public framing (“choice/compassion”) can obscure structural vulnerabilities (poverty, isolation, lack of services) and broader social harms.

Top 3 quotes:

• “MAiD has become one of the top five ways to die in Canada.”
• “A patient who is very determined…can call back our centralized care coordination service and just keep getting another MAiD practitioner until they find one.”
• “Assisted suicide and euthanasia is sold as compassion and choice, but actually it is accessed by vulnerable people.”

Disclaimer:

Disclaimer: The views and opinions expressed by Dr. Ramona Coelho in this interview are her own and do not necessarily reflect those of her employer, affiliated institutions, advisory committees, or any organization with which she is associated.