Dying of a Terminal Illness is not Rare
No, you should not be concerned about the MAiD usage rate
In 2023, 4.7% of Canadian deaths were from MAiD. Lots of people online are balking at such a “high” number, and using it to imply that something nefarious and dystopian is going on. For example:
This reaction is, frankly, unwarranted. The crude MAiD usage rate does not reveal one way or the other whether there is underlying coercion going on. If one is concerned about how Canada has rolled out the MAiD process, the MAiD usage rate is the least important part to fixate on.
How would someone go from being sympathetic to terminally ill patients wanting to die with dignity, to then balking at how many patients are choosing MAiD? My best guess is that people probably took the “safe, legal, and rare” slogan about abortion and transferred it over to MAiD. So then, they figure, if MAiD becomes common, then that’s a sign of foul play. Except... dying of a terminal illness isn’t rare. That’s exactly what the “terminal” part of “terminal illness” means! It should be entirely mundane and unsurprising for the MAiD usage rate to approach the rate of people who currently die from said terminal illnesses. And I’ll tell you right now, that rate is a lot higher than 4.7%.
2023 Canadian MAiD Statistics
Health Canada publishes statistics every year about MAiD usage. The 2023 annual report goes into extensive and exhaustive detail about the medical backgrounds of these cases.
Table 2.1a in the report shows that in 2023, there were:
19,660 total MAiD requests
15,343 were ultimately provided MAiD
Of the 4,317 who were not provided MAiD,
915 had the request denied
496 withdrew from the process
2,906 died of another cause
MAiD in Canada is split into Track 1 (where death is “reasonably foreseeable”, i.e. terminal illness) and Track 2 (where death is “not reasonably foreseeable,” but the patient has some chronic condition or disability which they report makes their quality of life intolerable).1 The overwhelming majority (95.9% in 2023) of MAiD provisions are done for terminal conditions under Track 1.
Here are the exact numbers in chart form:
Breaking this down into what specific conditions lead to patients requesting MAiD,
For those who received MAID under Track 1 [n=14,721], cancer was the most frequently cited medical condition (n=9,435), followed by “other” conditions (n=3,918), then cardiovascular conditions, such as congestive heart failure, atrial fibrillation or vasculopathy (n=2,416).2
Compare these MAiD numbers to the overall number of deaths from these conditions.3 In 2023, the leading single cause of death in Canada was malignant cancer (25.9% of all deaths), followed by cardiovascular disease (17.7%) and accidents (6.3%). If we compare total cancer deaths to the number of MAiD provisions that include “cancer” on the application, we find that about 11% of those terminally ill cancer patients chose to die using MAiD. And that’s just for cancer, without including all the other myriad conditions that would qualify someone for MAiD.
Currently, only a small fraction of cases from the top two killers of Canadians are being provided MAiD.
MAiD usage has been growing year on year, although the rate of increase slowed a bit for 2023. We’ll see how the 2024 numbers look, once the report is ready in February of 2026.
I don’t know where exactly the MAiD usage rate will eventually plateau for Canadian society. There will always be people who die in accidents. There will always be people who become incapacitated, and whose loved ones insist on every possible intervention. There will always be people who prefer hospice, or prefer to pursue aggressive treatment right up until the bitter end. But given the adoption curve so far, I expect the proportion of Canadians who request MAiD to increase substantially in the coming years.
Consider taking this to the extreme. What would a hypothetical MAiD usage rate of 100% look like? On the one hand, we could imagine a techno-utopia where nobody dies in accidents or drops dead suddenly from heart attacks. There are cures for all major diseases. Everyone lives to a ripe old age before their bodies inevitably start breaking down, at which point it is culturally expected for people to choose to pass peacefully and painlessly while surrounded by loved ones. This place would have a MAiD rate approaching 100%. On the other hand, an authoritarian regime where the government murders patients for the slightest issue… would also have a MAiD rate approaching 100%. The crude MAiD usage rate, in and of itself, says nothing about the underlying amount of foul play and coercion in the system.
It’s important to be concerned about foul play and coercion. I am, too. But someone who generally supports MAiD shouldn’t be surprised by a usage rate of 4.7%, when ~26% of Canadian deaths are from cancer alone.
Canada’s Real Problem
By law, MAiD in Canada must be administered by a doctor or nurse. This is typically an appointment for an injection.4 This means that every patient that is provided MAiD requires a significant amount of clinicians’ time - in counselling patients on their options, in assessing patient diagnoses, in filling out the paperwork, in approving/denying requests, and in the final provision itself. Doctors and nurses must make time in their schedules to do all of this. One clinician can only provide MAiD to so many patients per day, per month, per year.
MAiD is subject to the same constraints regarding budgets, waitlists, and backlogs as any other procedure in a socialized medical system like Canada’s. The entire process must be budgeted and planned for.
Look at those 2023 numbers again. Just under 3,000 patients died of another cause while navigating the bureaucracy to receive MAiD. Three thousand! That’s nearly one sixth of total MAiD requests. And this is despite how, for the moment, only a small fraction of patients facing a terminal diagnosis or a serious chronic condition even request MAiD to begin with. What is going to happen in the future, if MAiD becomes more culturally accepted? How are provincial health services actually going to meet this future demand? They are already failing to meet the existing demand.
Expanding MAiD capacity to reach more terminally ill patients would require provincial health services to make a conscious effort to hire more doctors and nurses for MAiD. They would need to allocate scarce resources for this purpose, and... well... the headlines write themselves: “Government allocates funding to kill patients instead of treat them.” Given that healthcare spending is subject to the political process, would Canadian voters tolerate putting more resources toward this? Time will tell.
I am concerned that the MAiD usage rate will plateau - not because it will eventually reflect the true proportion of Canadians who want MAiD, but because provincial health services max out the number of cases they can handle per year.
So to that 4.7%, I say: those are rookie numbers. Canada could be doing so much better.
A small number of MAiD requests are not given a track, because the requests are either withdrawn, denied, or the patient dies of another cause before a doctor can assess which track they belong to.
The numbers add up to more than 14,721 because any given MAiD request can list more than one condition.
It is difficult to make an exact comparison between cause of death and MAiD, because these statistics are maintained by two different agencies within Canada and have different reporting requirements. Cause of death is determined after the fact by a clinician or medical examiner, and these cases are tracked as vital statistics by Statistics Canada. Meanwhile, MAiD requests and provisions are tracked by Health Canada. Any given MAiD request can list more than one diagnosis, and which ones are included in the application is up to the patient. However, comparing the two can give us a general idea of the proportions involved.
The well-known “MAiD cocktail,” a potent mix of opioids and digoxin that a patient picks up from a pharmacy to drink later at home, is almost exclusively done in the US.