Psychological concerns were also paramount.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Ontario’s MAID Death Review Committee (MDRC) released it’s fifth report on August 25, 2025. The MDRC is a body of the Ontario Coroner’s Office that is composed of 16 people who are charged with examining Ontario euthanasia reports that may have concerns.

The reports from the MDRC committee concern people who have already died by euthanasia.

Meagan Gillmore wrote an article that was published by Canadian Affairs on August 27 examining the most recent report concerning euthanasia deaths on patients who had refused treatment, or had psychological concerns.

Gillmore begins her article with the story of Mr. C:

A widowed, elderly man with a body tremor was approved for medical assistance in dying (MAID) despite loneliness and poor self-esteem motivating his application, a new report from Ontario’s chief coroner’s office says.

The man, called Mr. C in the report, had an essential tremor, which causes uncontrollable shaking, often of the hands. Tremors are incurable neurological conditions, but not fatal.

Mr. C’s tremors had made it difficult for him to participate in hobbies and social activities. A widower in his 70s, he “did not perceive that he had much to offer in a new relationship” because of the tremor, the report says.

Mr. C said he “experienced profound hopelessness and loneliness” and could not find meaningful relationships or fulfillment after his spouse’s death. His MAID provider noted he applied because of bereavement and emotional suffering.

He was approved for Track 2 MAID, which is MAID for people whose deaths are not reasonably foreseeable.

Mr. C is one of three individuals profiled in a new report by Ontario’s MAID Death Review Committee, which examines how MAID assessors interpret the legal eligibility criteria for MAID.

Gillmore explains that:

Guidance released by Health Canada in 2023 says a patient and doctor must together decide if a patient’s condition is incurable, after considering available treatments and the patient’s overall health and values. Patients are not required to try treatments, but must be informed of means to relieve their suffering.

The guidance says a person cannot make themselves eligible for MAID by refusing all or most available treatments.

The most recent report from the MDRC raises concerns that people are being approved even when it is unclear why they refused all treatments. Gillmore then writes about Mrs A:

In one case, a woman in her 60s was approved for MAID after declining every treatment offered to treat her obesity and related chronic conditions, including type 2 diabetes and depression.

The woman, called Mrs. A, was approved for Track 1 MAID, which is MAID for people whose natural death is reasonably foreseeable.

In the years before her death, Mrs. A refused offers of health care and stopped taking her medications because she “no longer had the will to live,” the report says.

Her MAID assessors believed she would improve with proper health and home care. They offered her weight loss surgery, medication and disability supports. She declined everything, saying they would not help her.

The MDRC committee were divided on Mrs A. Gillmore reports:

Some committee members said Mrs. A should not have been eligible for MAID because she declined all treatments. Some also said it was not clear whether the MAID assessors had determined why she refused treatments.

“MAID legislation requires more than a respect for autonomy, it also mandates the application of clinical expertise to ensure that reasonable care options are considered,” they said.

Other members said Mrs. A’s MAID assessors respected her autonomy and that refusing treatment is a personal decision.

Gillmore states that the report uncovers “ableist concerns” concerning the term “irreversible decline in capability:

Health Canada’s guidance helps MAID assessors determine if a patient has an “irreversible decline in capability.”

According to the guidance, the decline in capability does not need to be related to symptoms of an illness or disability. It can include decreased job opportunities or ability to participate in meaningful activities.

Gillmore then reports on the case of Mr B.

The report tells the story of a man in his 60s, known as Mr. B, who had cerebral palsy and had lived in long-term care for several years.

Mr. B “expressed profound psychological suffering and loneliness,” the report says, which increased when he moved to long-term care.

He used a wheelchair, but was able to push it, transfer out of his chair and toilet himself. He was scared that he would lose those abilities as he aged.

Six to eight weeks before his MAID death, Mr. B voluntarily stopped eating and drinking. The report does not say why or whether MAID assessors tried to determine his reasons for doing so.

In approving him for Track 1 MAID, his assessors said Mr. B’s death was reasonably foreseeable because he had stopped eating and drinking and had signs of kidney failure. His dependency on others showed he was in an “irreversible state of functional decline,” the assessors said.

In other words, Mr. B. stopped eating and drinking to be approved for Track 1 MAiD. Track 1 MAiD is for people who have a terminal condition. There is no waiting period for Track 1 MAiD.

The MDRC committee were divided on Mr B. Gillmore reports:

A few members did not think Mr. B’s dependency and need for long-term care fulfilled that criteria. Needing help is part of many disabilities, including cerebral palsy, they said.

“Framing such dependency as evidence of an irreversible decline in capability potentially risks introducing an ableist perspective, wherein inherent disability-related needs are mischaracterized as functional decline that is aligned with an irreversible trajectory, rather than a person’s basic care needs,” these members said.

The report also raised concerns about unmet psychological needs influencing MAID requests. Gillmore explains:

Currently, the law prohibits eligibility for MAID on the basis of a mental health condition alone.

Gillmore comments on the reports findings concerning psychological suffering.

Yet, Mr. B’s MAID assessors noted his suffering was “primarily psychosocial and existential.” Several committee members said he should have had a psychiatric assessment to determine whether he was suicidal.

Members also said a psychiatric assessment would have helped determine Mrs. A’s MAID eligibility. If she had declined, the MAID practitioner would have had to say that her eligibility could not be determined.

The Ontario’s ministry of the solicitor general told Gillmore:

MAID requests have become more complex since 2021 when the federal government removed the requirement that someone’s death be reasonably foreseeable to qualify for MAID.

“The interpretation of illness and function of decline are more challenging for MAID assessors and providers to evaluate,” the statement says.

The MDRC committee were divided MAiD for psychological reasons. Gillmore reports:

A few members of the committee said current MAID practices need to be re-evaluated.

They said clarity is needed about whether a person’s refusal of routine treatments or food and water qualifies them as being in an irreversible state of decline.

These members also said further guidance is needed about how to assess a decline in capability when a person’s disability means they always depend on others for some care.

Gillmore ended the article by stating:

There were 4,958 MAID deaths in Ontario in 2024; coroners’ investigations were started in 299 — or six per cent — of these cases, the office of the solicitor general said in its statement. Five investigations are ongoing.

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