Sophia, a 51-year-old Ontario woman, chose medical assistance in dying (MAiD) after reportedly searching in vain for two years for housing free of cigarette smoke and chemical cleaners. Diagnosed with severe multiple chemical sensitivities (MCS), she told supporters that she felt the system had treated her as “expendable trash” before her death was approved.
Her experience, which CTV News later reported as the first publicly documented MAiD death involving MCS, has become a focal point within a broader debate: do systemic failures, such as poverty, inadequate housing and gaps in disability support, influence some Canadians’ decisions to seek medical assistance in dying?
The statistics surrounding MAiD suggest that Sophia’s story is not an isolated incident, but part of a larger trend.
MAiD deaths are rising and emotional suffering is becoming more apparent
Canada’s MAiD law, passed in 2016, operates under two eligibility pathways. Track 1 applies to adults whose death is “reasonably foreseeable”, such as those with advanced cancer or end-stage diseases. Track 2, approved in 2021, applies to adults whose natural death is not reasonably foreseeable but who have a permanent medical condition that causes enduring and intolerable suffering.
Both pathways are seeing a significant rise in reports of emotional and psychological suffering being involved.
Health Canada reported that 76,475 Canadians have received MAiD since 2016, with 16,499 in 2024 alone, accounting for 5.1% of all nationwide deaths recorded that year. Notably, Track 2 provisions represented 4.4% of the 2024 cases, with 45.5% of those recipients reporting that they were in receipt of disability support services.
The intersection of disability and psychological distress mirrors the “social vulnerability” Sophia experienced. Loneliness was identified in nearly 22% of Track 1 cases and 44% of Track 2 cases, while emotional distress was reported by 58% of Track 1 recipients in 2024, up from 39% in 2023, while among Track 2 recipients, it rose from 35% to 63%.
This trend cannot but raise questions about the systemic environment in which these choices are being made.
Poverty increases vulnerability for disabled people
According to Disability without Poverty, more than 1.5 million Canadians with disabilities live below the poverty line. For these people, the “choice” to seek MAiD is often influenced by the reality that 30% are pushed out of the labor force, and 75% of those employed report workplace harassment, violence, and persistent wage gaps.
When such systemic economic failures persist, the line between “voluntary choice” and “coerced necessity” could begin to blur.
This reality is what drove Global News to report in 2022 that poverty and the lack of adequate care were driving some disabled Canadians to consider MAiD as an alternative to a life of unbearable hardship.
It is this fear that prompted the critique from Dr David Henderson, a Nova Scotia palliative care physician and ex-chair of the Canadian Society of Palliative Care Physicians. Arguing before a parliamentary committee that existing safeguards were insufficient, he warned that “the government has given health care professionals essentially a license to kill without having significant checks in place to ensure that people are assessed properly and thoroughly”.
Critics warn MAiD risks replacing care
Hence, disability advocates and physicians argue that Canada’s expanding MAiD program raises difficult questions as to whether adequate care and social support are always available before assisted dying is approved. They point to long waits for specialists, surgery and community services, alongside rising health-care spending and ongoing pressure on hospitals due to Canada’s aging population.
Alexander Raikin, a Washington-based bioethics researcher, warned that MAiD is increasingly functioning as a form of elderly care for some vulnerable Canadians, and argued that financial pressures within the health-care system could create unintended incentives.
Consent concerns and questions about safeguards
These concerns extend to the clinical process itself. Since 2020, Ontario’s Chief Coroner has identified cases in which MAiD was approved despite incomplete documentation of the patient’s decision-making capacity.
Reports by the MAiD Death Review Committee have flagged cases involving cognitive decline, heavy sedation, and assessments completed based on limited interaction with patients. Some cases have been reported to have relied on prior waivers without confirming the person still wished to die, while others were conducted virtually, raising doubts about whether existing safeguards had been applied consistently. Such procedural gaps might echo the sense of being “expendable trash” that Sophia described.
Supporters of the current framework, however, maintain that clinicians have a legal obligation to discuss all the appropriate treatment and end-of-life options with eligible patients, and that informing patients about MAiD is not the same as encouraging it.
Track 2 faces mounting legal and human-rights opposition
The tension between bodily autonomy and social protection explains the current growing legal and human rights scrutiny of Canada’s Track 2 MAiD program. The Canadian Human Rights Commission has told the United Nations that although many Canadians with disabilities face barriers to adequate housing, healthcare or community support, the decision to seek MAiD should never be a byproduct of these failures.
Several disability organizations have also spoken against Track 2. They argue that the current framework risks undermining the right to life, equality and independent living for people with disabilities. On the other hand, supporters of Track 2 argue that excluding people solely because they are disabled would deny them the same bodily autonomy available to Canadians whose deaths are reasonably foreseeable. They contend that strengthening social support should complement rather than replace access to MAiD.
Mental illness expansion remains under debate
The debate is further complicated by upcoming legislative changes. The federal government is considering expanding MAiD to include mental illness. If approved by Parliament, this is expected to take effect in March 2027. At that point, Canadians over the age of eighteen with mental illnesses, including depression or personality disorders, could access MAiD if they meet other eligibility requirements.
Experts remain deeply divided. Some argue that mental illnesses cannot yet be assessed with sufficient certainty to distinguish irremediable suffering from suicidal crises that may respond to treatment. Others contend that excluding mental illness alone would unfairly deny equal access to competent adults enduring intolerable suffering.
Beyond MAiD: A sustainable development challenge
Ultimately, the case of Sophia and the rising number of people with a disability receiving MAiD under Track 2 point to a challenge that goes beyond end-of-life care. As Canada joins other countries in refining its assisted-dying laws, the central question remains as to whether a society can ensure the dignity of its most vulnerable citizens if it cannot guarantee them basic support in terms of housing, healthcare and community.
