MAiD in Canada: A Sober Second Look — Introduction and Overview

Mots-clés :

• aide médicale à mourir,
• AMM,
• Canada

Keywords:

• medical assistance in dying,
• MAiD,
• Canada

In June of 2016 Canada’s parliament enacted legislation to permit medical assistance in dying (MAiD). The measure has been widely embraced. In less than a decade, Canada has become one of the most prolific providers of medical assistance in dying in the world, with more than 15,000 MAiD deaths reported in 2023. Annually, almost 5% of all deaths in Canada are actively assisted by a physician or nurse practitioner. Quebec is now the most liberal MAiD regime in the world with over 7% of deaths resulting from MAiD (1). Many view the expanding use of MAiD in Canada as evidence of the realization of a previously unmet need. Advocacy groups call for further expansion. Others are concerned that expansion has already been too rapid, that safeguards are inadequate to protect some vulnerable groups from feeling compelled to choose MAiD, and that further efforts to extend access should be curtailed. It is this ongoing debate on whether and how to manage Canada’s evolving MAiD regime that motivated us at the Centre for Bioethics at Memorial University to convene a symposium on MAiD in the fall of 2024. The title of the symposium was: MAiD in Canada: A Sober Second Look. A majority of the papers included in this special issue were presented initially at that symposium. In the spring of 2024, we issued a call for abstracts on any aspects of MAiD. The submitted abstracts went through blind review, and ten papers were accepted for presentation. We made the deliberate decision to keep the symposium small, and to avoid concurrent sessions, thus allowing all attendees to participate in every session. In addition to ten accepted papers, we were pleased to have four invited keynote speakers, each of whom is an active contributor to the current MAiD debates. We were fortunate to host Isabel Grant (University of British Columbia Allard School of Law), Scott Kim (National Institutes of Health, Department of Bioethics, USA), Trudo Lemmens (University of Toronto Faculty of Law and Dalla Lana School of Public Health), and Wayne Sumner (University of Toronto Department of Philosophy). We thank each of our keynotes for their contributions but want to extend a special word of gratitude to Professor Sumner. When we first issued our call for papers, we’d already confirmed the other three keynotes, and we included information about their participation in that call. Each of those individuals is known to harbour reservations about aspects of Canada’s current MAiD regime. Professor Sumner contacted us when he saw the call for papers, noting that our symposium might be viewed as an echo-chambre in which only those who shared negative perceptions of MAiD were given a voice. We took his concerns seriously and extended an invitation for him to join us as a fourth keynote. He graciously accepted. His contributions throughout the symposium did much to enhance the quality of the discussion and debate and his contribution to this issue serves as a counterpoint to several of the other papers. Despite the at times passionate and animated discussion, a genuine sense of community emerged as interlocutors engaged in respectful dialog throughout the two days of our meeting. We were pleased that many participants commented later that the symposium provided a safe and constructive environment in which to discuss the issues. This special issue is comprised of eleven papers, only eight of which were presented as part of the symposium at Memorial University. After consultation with the journal editorial team, the papers by Pesut et al. and Pullman were included to help round out this collection. The perspective piece by Trudo Lemmens, one of our …