Author: Katie Engelhart

One of the doctors wanted to know why, despite everything, Paula Ritchie was still alive. “I’m just curious,” she said. “What has kept you from attempting suicide since August of 2023?”“I’m not very good at it,” Paula said. “Obviously.” Then she started to cry. She said that everything was getting worse. She said she didn’t want to suffer anymore. “This is a more dignified way to go than suicide.”Listen to this article, read by Gabra ZackmanPaula was lying in the big bed that she had pulled into the center of the living room, facing an old TV and a window that looked out on a row of garbage bins. The room’s brown linoleum floors were stained, and its walls were mostly unadorned. On a bookshelf, there was a small figurine of an angel, her arm raised in offering. At 52, Paula had a pale, unblemished face and a tangle of dark hair that fell around her waist. The day before the appointment, in January this year, she washed her hair for the first time in weeks, but then she was not able to lift herself out of the bathtub. When, after hours, she managed to get out, her pain and dizziness was so bad that she had to crawl across the floor.Dr. Matt Wonnacott sat in a folding chair at the foot of the bed. He was there as Paula’s “primary assessor”: one of two independent physicians, along with Dr. Elspeth MacEwan, a psychiatrist, who drove through the snow to Smiths Falls, Ontario, to evaluate Paula’s eligibility for Canada’s Medical Assistance in Dying (MAID) program — what critics call physician-assisted suicide.“You’re a difficult case,” Wonnacott admitted. Another clinician had already assessed Paula and determined that she was ineligible — but there was no limit to how many assessments a patient could undergo, and Paula had called the region’s MAID coordination service every day, sometimes every hour, demanding to be assessed again, until the nurse on the other line had practically begged Wonnacott and his colleagues to take Paula off her roster.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Canada’s MAID law, which expanded the right to die to people without a terminal illness, raises ethical and medical dilemmas.In 2023, one out of 20 Canadians who died received a physician-assisted death, making Canada the No. 1 provider of medical assistance in dying (MAID) in the world, when measured in total figures. In one province, Quebec, there were more MAID deaths per capita than anywhere else. Canadians, by and large, have been supportive of this trend. A 2022 poll showed that a stunning 86 percent of Canadians supported MAID’s legalization.But in some corners, MAID has been the subject of a growing unease. While MAID in Canada was initially restricted to patients with terminal conditions — people whose natural deaths were “reasonably foreseeable” — the law was controversially amended in 2021 to include people who were suffering but who weren’t actually dying: patients who might have many years or even decades of life ahead of them. This new category includes people with chronic pain and physical disabilities.For The New York Times Magazine, I interviewed dozens of clinicians, ethicists, lawyers, advocates and patients about how MAID in Canada works. Here is what I learned:The criteria for MAID in Canada is among the broadest in the worldWhen Canada’s first MAID law, Bill C-14, passed in 2016, it had strict eligibility criteria: Patients needed to be over 18, eligible for Canadian health care and mentally competent to consent to death. They needed to have a “serious and incurable illness, disease or disability”; be in an “advanced state of irreversible decline in capability”; and have “enduring physical or psychological suffering” that was “intolerable.” Their natural deaths also had to be “reasonably foreseeable.” In other words, they had to be dying. Early MAID patients were often people in their 70s or 80s with terminal cancer.In 2021, the Canadian government passed Bill C-7, which removed the criteria that a patient’s death be “reasonably foreseeable.” Now Canadians who are chronically sick or disabled — with conditions ranging from quadriplegia to multiple sclerosis to blindness to early-stage Parkinson’s to chronic back pain — can receive assisted deaths from doctors or nurse practitioners. Within Canada, this newer kind of MAID is known as Track 2.Track 2 is controversial, even among MAID supportersSome clinicians who are involved with MAID objected to the legal expansion. They argue that it isn’t really “assistance in dying” if the patient isn’t dying.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.