Medical assistance in dying, or MAID, is one of the most consequential policy changes of the twenty-first century. MAID allows medical providers to administer lethal drugs upon request to those with an irremediable condition and a foreseeable short amount of time to live.
As of December 9, 2025, MAID has been legalized in nine countries on three continents. More recently, it has been legalized in New York State. A highly debated, controversial ode to individual autonomy, there are many facets of MAID that need to be thoroughly scrutinized in order for it to accomplish the goals and ideals championed by those advocating for it.
As MAID becomes more widely implemented, it has given rise to ethical and moral dilemmas that should give all of us pause as we transition into a new era where death is something to be scheduled.
One major issue concerning MAID is who is qualified to give consent to assisted death, and what is considered adequate consent. This is a particular issue for patients under 18, those struggling with mental health issues, or those with oncoming dementia or cognitive decline. The criteria used to determine when a patient is competent to give consent to MAID are vague and unspecific; medical objectivity is often elusive as discretion is left in the hands of health care providers.
In 2012, an elderly woman living in the Netherlands was diagnosed with Alzheimer’s Disease. She requested to be euthanized when “she could no longer live at home.” In 2016, four years later, the woman was admitted to a nursing home, and her husband, as per his wife’s request, asked that the facility’s geriatrician carry out MAID. On the scheduled day of euthanasia, the geriatrician added a “…sedative surreptitiously to the woman’s coffee.” The doctor would later explain his actions as necessary to prevent a struggle, and prevent the woman, unable to remember her former request, from asking questions or refusing to take it. However, despite the doctor’s efforts, the woman “reacted and tried to sit up” as the injections began.
Her family aided the physicians in holding her down until the procedure was complete and she was no longer alive.
My view is that while the woman made the request for MAID while she was still objectively competent, four years had passed, and accurately gauging her current wishes and quality of life was an impossibility.
Did she change her mind?
Was the quality of life in the nursing home better than she’d expected?
All that we know is that she resisted and was held down.
Issues of consent also arise over children. In Colombia, children over 12 can request MAID independently of their parents. In the Netherlands, that age is 16.
Questions arise, however, over whether it is ethically sound to attribute the same weight to the decisions of those whose brains are not yet fully developed. In other areas of public policy such as the criminal justice system, where the consequences are life and death, children are offered leniency on the understanding that they cannot comprehend the consequences of their actions in the same way as adults. Looking at assisted dying simply as a healthcare decision relegates it to a position that belies its permanence.
In 2023, Canada was the leading provider of MAID. Requirements and regulation, at first, were strict. Now, the criteria for eligibility for MAID in Canada is some of the broadest in the world.
Currently, MAID in Canada is divided into two tracks: Track 1 and Track 2. Track 1 (Bill C-14) passed in 2016 and required those who accessed MAID to have “a grievous and irremediable medical condition that causes them enduring and intolerable suffering to seek medical assistance in dying.” Track 1 limited MAID to only those whose deaths were reasonably foreseeable, such as those suffering from terminal illnesses or conditions with a limited amount of time to live. They had to be over 18, eligible for Canadian healthcare and capable of giving informed consent to MAID.
Track 2 (Bill C-7) passed in 2021 and widened MAID eligibility to those who “were suffering but weren’t actually dying.” Track 2 MAID is highly controversial, even among adamant supporters of the practice. In June 2019, Alan Nichols, a 61-year-old Canadian man with a history of depression and other medical conditions was hospitalized due to “fears that he might be suicidal.” After requesting MAID, Nichols was euthanized within a month purely on account of “hearing loss.” According to his brother, Gary Nichols, Alan was basically “put to death.”
The Canadian government is looking to expand MAID even further, seeking to include those suffering from mental disorders and children deemed to possess “requisite decision-making capacity.” Others have suggested legalizing euthanasia for infants born with “severe malformations.”
Madeline Li, one of the foremost providers of MAID in Canada, has stated that Track 2 MAID does not align with her “understanding of medicine and its purpose.”
“If you want to allow people to end their lives when they want to, then put suicide kits in hardware stores, right?” she said.
One major concern of those in opposition to MAID is that MAID’s original purpose—offering a peaceful, dignified end to those suffering—will be subsumed in the effort to alleviate the financial burden on the state posed by the elderly and disabled.
Normand Meunier, a Canadian quadriplegic man suffering from a respiratory infection, was admitted to hospital in January 2024. Meunier required an alternating pressure mattress, but after four days without a proper bed, Meunier developed a gruesome bedsore and applied for MAID.
“Ninety-five hours on a stretcher. Unacceptable,” his partner, Sylvia Brosseau, said on Radio-Canada.
“I don’t want to be a burden,” Meunier said, before being euthanized on March 29.
Health authorities report that there were 145 alternating pressure mattresses available.
A lack of state support and the failure of the health care system to provide for its most vulnerable citizens could perpetuate a system where minorities are subtly coerced into state facilitated death.
In one of the more extreme cases, in 2020, a 45-year-old man with a severe neurodegenerative disease testified to the Canadian Parliament that he felt coerced into assisted suicide by hospital staff as a result of the exorbitant fees exacted for his care.
“My life was devalued…hospital staff failed to provide me with the necessities of life,” he recounted, all while he was advocating for assistance to live with dignity at home.
“The state, with its almighty power, is tasked with both paying for the support of the old and disabled and regulating their dying,” Louise Perry, a journalist for the New York Times wrote.
As people live longer and have fewer children, welfare states are faced with an impossible task: how to “pay for more old people with less money.”
The role of public policy in MAID is a complex one. Despite a few high-profile cases where the idea of MAID sounds compelling, is it possible for the state to structure a policy around it that causes no harm to those most dependent on its care?
In America, we rely on a system of private health insurance. For patients, this only magnifies the struggles and risks. MAID may seem a compelling alternative to bankrupting both yourself and your family. When health is a commodity and not a right, the economic pressures may drive even those with decades ahead of them to opt for MAID.
Many debate the ethics of allowing health care providers, whose career is built upon healing and caregiving, the right to administer lethal drugs to select patients. Is it ethical to ask health care providers to “don the robes of an executioner?” The words of the Journal of the American Medical Association in 1872 still ring with gravity.
The idea that an individual should have control over all aspects of their life, including when they die, is relatively new and contradicts older, more conservative values. Many religions are in staunch opposition to MAID. The Catholic Church, in particular, has publicly condemned medical assistance in dying. The idea that your body is sacred, a gift given to you by God, is enshrined in Christian values. However, as religion slowly loses purchase in an ever-more scientific world, the value of individual autonomy increases.
As this piece is published, in a controversial case in Spain, a 25-year-old woman, struggling with mental health issues following a sexual assault as a teenager, has been approved for MAID after a long, arduous fight with both the state and her family.
The development and legalization of MAID force us to ask the question:
Who owns a life, and who, ultimately, has the right to decide when a life should end?
