Some advocates fear Canada and the U.S. will use assisted dying to curb elder and health care costs

WASHINGTON, D.C. — Emergency rooms are known for long waits — whether in Canada or south of the border — but they’re still among the shortest delays in health care.

Seeing a specialist, however, can take months, sometimes leaving nervous Canadians languishing as they await treatment, surgery, or both. In the U.S., the wait times are shorter, but access may be limited by one’s ability to procure and pay for insurance.

Still, there is one medical procedure patients are opting for, at least in Canada, that offers a quick path to treatment: Medical Assistance in Dying, aka MAID.

Ethicists argue passionately about whether it’s good or bad for patients and society — discussing everything from the need to offer trauma-free ends, to the system’s possible abuse, and people being encouraged to die. Those debates have been playing out for years, but another concern is emerging over elder care. As health care costs mount for governments, employers, and individuals in both countries, their low-fertility populations are aging and becoming more expensive to care for. Could both countries begin turning to MAID to cut costs?

Some critics say it’s already happening in Canada and fear it could one day happen in the U.S.

“MAID has already become in Canada a form of elder care,” said Alexander Raikin, fellow in bioethics and American democracy at the Washington-based Ethics and Public Policy Center.

“The people who are dying from (Canada’s) MAID are disproportionately vulnerable. They’re disproportionately disabled. They’re disproportionately elderly,” he added, arguing the data reflect that shift.

Others go further.

“It’s not even hypothetical. It’s Canada today,” said Lyman Stone, a demographer with the Pronatalism Initiative at the Institute for Family Studies.

In Canada, MAID — medical aid in dying or aid in dying — is available to adults whose deaths are reasonably foreseeable, as well as those suffering from a grievous or irremediable condition where death is not reasonably foreseeable. For now, the rollout to patients with mental health illnesses is delayed until next year, though that is being challenged. In 2024, 16,499 opted for MAID, representing 5.1 per cent of Canadian deaths that year, a 0.4 per cent increase from 2023.

MAID came into effect in June 2016, following Parliament’s passing of federal law to implement the Supreme Court’s Carter decision, overturning the criminalization of assisted suicide. In less than a decade, MAID has gone from a criminal act to accounting for roughly one in 20 Canadian deaths.

In the U.S., meanwhile, 14 states have medical aid in dying laws, allowing for prescribed drugs to be taken by patients. Patients must have a prognosis of death within six months. There’s no centralized U.S. tally, but for the jurisdictions that report, data shows that 1,242 people ingested prescribed aid-in-dying medication in 2024.

In both Canada and the U.S., most reported recipients are seriously ill, and in Canada, they are typically elderly as well.

Some demographers and health experts fear that MAID will become increasingly attractive as a way of curbing growing elder-care costs.

The over-85 contingent in Canada is the fastest-growing segment by age, and it’s forecasted to more than double over the next 20 years. In the U.S., meanwhile, there were 58 million over the age of 65 in 2022, but by 2050, that group will explode to roughly 82 million. Seniors in both countries will soon represent nearly a quarter of each population.

For some, those demographic pressures point to a troubling incentive structure.

Sally Pipes, president, CEO, and Thomas W. Smith Fellow in Health Care Policy at the California-based Pacific Research Institute, said she fears MAID is a symptom of the financial strains on the Canadian health care system.

“This is a way for Canada, for the Canadian healthcare system, to reduce the cost of healthcare and reduce the waiting list,” she said.

While MAID may be billed as “an act of compassion,” Pipes added, “it’s really how government-run healthcare systems respond to the reality of scarce public resources.”

She and Raikin also say that MAID should not be offered merely as a first resort.

“It is very difficult to not see assisted suicide or euthanasia as some sort of escape hatch,” said Raikin, “or maybe overflow valve is a better way of putting it.”

When you have long wait times and sick populations, he explained, “it’s very difficult when you have a legalized pathway of suicide that does not become a tempting program.”

But health care providers are not allowed to recommend MAID as a substitute for care, and there are multiple assessments and consent requirements.

Proponent Udo Schuklenk, a philosophy professor at Queen’s University, Kingston, says professional ethics should mitigate abuse.

Opponents “need to do better than to say clinicians raise MAID in certain circumstances with patients because they might actually be under a professional obligation to do that so that people can make an informed choice.”

There are also legal ramifications for wrongdoing. In Canada, for example, if physicians don’t follow all the rules, they can face culpable homicide charges.

Stone also refers to the cost of treatment as a factor.

There are “news stories of people who don’t even have a lethal condition. They go in for a potentially disabling condition, and they’re referred for MAID, because their condition’s expensive,” he said.

Stone was referring to MAID’s eligibility for some patients whose death is not imminent, including those with serious disabilities — a scenario that has drawn intense scrutiny.

Stone claims that Canada’s policy direction is unambiguous.

“Canada has some of the lowest disability funding of any developed country. It has one of the most eugenic immigration policies of any developed country that is as strict (with) quality health and performance standards for immigrants,” he said.

“And now it has one of the most permissive regimes for physician-assisted suicide, for state-sponsored suicide, of any country in the world.”

He characterized the system as recruiting healthy immigrants to work while providing minimal support for the disabled and making it as easy as possible for the state to shed the financial burden through assisted suicide.

Could abuse become a problem? Could it happen in the U.S., with an aging population creating similar budgetary problems?

“Some states may solve (climbing elderly care costs) through something like the Canadian approach,” said Stone. “Others will not.” But he said a reckoning will also come: “Will it be that we raise taxes on workers or that we cut benefits for retirees?”

“Cutting benefits for retirees will have a somewhat similar effect as the Canadian solution.”

Proponents of MAID push back on those concerns.

“Anything can be abused,” said Thaddeus Pope, professor of medical law and clinical ethics at Mitchell Hamline School of Law. “And everything is abused.”

“But it’s ridiculous to say any service that you provide would ever be provided at a hundred per cent perfect level. Nothing is.”

And the data, he says, shows that it’s not happening at scale. With a sample size now of 12,000 to 14,000 assisted-suicide deaths in the U.S. since 1997, there are very few reports of wrongdoing.

Health Canada’s data also shows no clear evidence of a widespread pattern of MAID being used to trim health-care costs, with only a small percentage of cases citing any external pressure.

“It’s pretty darn safe,” Pope said, noting that there’s “absolutely zero evidence” of MAID being foisted upon people to trim healthcare costs.

“We treat the crap out of people,” Pope said, noting how oncologists are making a lot of money off of continued treatments.

“The problem is not that we’re hastening people into death to save money; the problem is that we are foisting more and more and more treatment upon people because it benefits the healthcare providers, even though it doesn’t benefit the patients.”

“The far bigger risk is not letting people die,” he said.

National Post

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