Medical Assitance in Dying in Canada

First Annual Report on
MEDICAL ASSISTANCE IN DYING

IN CANADA
2019
Health Canada is the federal department responsible for helping the people of Canada
maintain and improve their health. Health Canada is committed to improving the lives of all of
Canada’s people and to making this country’s population among the healthiest in the world as measured
by longevity, lifestyle and effective use of the public health care system.
Également disponible en français sous le titre :

Premier rapport annuel sur l’aide médicale à mourir au Canada, 2019
To obtain additional information, please contact:
Health Canada
Address Locator 0900C2
Ottawa, ON K1A 0K9
Tel.: 613-957-2991
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Fax: 613-941-5366
TTY: 1-800-465-7735
E-mail: hc.publications-publications.sc@canada.ca
© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2020
Publication date: July 2020
This publication may be reproduced for personal or internal use only without permission provided
the source is fully acknowledged.
Cat.: H22-1/6E-PDF
ISBN: 2563-3643
Pub.: 200125
TABLE OF CONTENTS
Highlights............................................................................................................................................. 5
Minister’s Message............................................................................................................................. 7
Introduction......................................................................................................................................... 9
1.0 The Evolution of Federal MAID Legislation.............................................................................. 10

1.1 Public Debate on Assisted Dying in Canada........................................................................... 10
1.2 The Development of Canada’s Legislation on MAID.................................................................11
Table 1.2 – Bill C-14 Eligibility Criteria and Safeguards..............................................................12
1.3 Implementation of MAID Across Canada.................................................................................13
2.0 Methodology and Limitations................................................................................................... 14

2.1 Data Collected Under the Federal Regulations.........................................................................14
2.2 Data Collected Through Interim Reports..................................................................................15
2.3 Methodological Notes............................................................................................................ 16
2.4 Data Limitations......................................................................................................................17
3.0 Cases of MAID in Canada......................................................................................................... 18

3.1 Number of Reported MAID Deaths in Canada (2016 to 2019)...................................................18
Chart 3.1: Total Reported MAID Deaths in Canada, 2016 to 2019.............................................18
Table 3.1: Total Reported MAID Deaths in Canada by Jurisdiction, 2016 to 2019.......................19
3.2 MAID Deaths as a Proportion of Overall Deaths in Canada.......................................................19
Chart 3.2: Percentage of Total Deaths Attributed to MAID by Jurisdiction, 2019........................ 20
4.0 Profile of Persons Receiving MAID.......................................................................................... 21

4.1 Underlying Medical Conditions of Those Receiving MAID........................................................ 21
Chart 4.1: MAID by Main Condition, 2019............................................................................... 22
4.2 Gender, Average Age and Age Range of Patients who Received MAID.................................... 22
Chart 4.2: MAID by Age Category, 2019................................................................................. 23
4.3 Palliative Care and Disability Support Services........................................................................ 23
Table 4.3: MAID Recipients Who Received Palliative Care
and Disability Support Services, 2019...................................................................................... 24
First Annual Report on Medical Assistance in Dying in Canada, 2019 3

5.0 Delivery of MAID........................................................................................................................ 26
5.1 Reported MAID Deaths by Setting......................................................................................... 26
Chart 5.1: MAID Deaths by Setting, 2019................................................................................ 27
5.2 Number of Unique MAID Practitioners and Frequency of Provision.......................................... 28
Table 5.2: Unique MAID Practitioners in Canada and Frequency of Provision, 2019.................. 28
5.3 Specialty of Practitioners Delivering MAID............................................................................... 28
Chart 5.3: Specialty of MAID Practitioner, 2019....................................................................... 29
5.4 Type of Practitioner Providing the Written Second Opinion (Assessment)................................. 30
6.0 Safeguards and Supplementary Data...................................................................................... 31

6.1 Nature of Suffering of Those Who Received MAID.................................................................. 31
Chart 6.1: Nature of Suffering of Those Who Received MAID, 2019......................................... 32
6.2 Source of the Written Request for MAID................................................................................. 32
6.3 Determination of the Patient’s Request as Voluntary................................................................ 33
Table 6.3: Determination of the Patient’s Request as Voluntary, 2019....................................... 33
6.4 Consultation With Other Health Care Professionals................................................................. 33
Table 6.4: Consultation With Other Health Care Professionals, 2019........................................ 34
6.5 The 10 Clear Day Reflection Period........................................................................................ 34
6.6 Information Received From Pharmacists................................................................................. 35
7.0 Requests That Do Not Result in a MAID Death....................................................................... 36

7.1 Number of Requests and Outcomes...................................................................................... 36
Table 7.1: MAID Requests and Outcomes by Jurisdiction, 2019............................................... 36
7.2 Patient Died of a Cause Other than MAID............................................................................... 37
Chart 7.2: Timing of Death Following Written Request
(Patient Died of Another Cause), 2019.................................................................................... 37
7.3 Ineligibility.............................................................................................................................. 38
Table 7.3: Reasons for Ineligibility for MAID, 2019.................................................................... 38
7.4 Patient Withdraws Their Request For MAID............................................................................. 38
Table 7.4: Reason for Withdrawal of MAID Request, 2019........................................................ 39
8.0 Conclusion................................................................................................................................. 40
8.1 Reflections on the Past Four Years......................................................................................... 40
8.2 Looking Ahead.......................................................................................................................41
Appendix A Profile of Medical Assistance in Dying
by Jurisdiction January 1 to December 31, 2019............................................................................ 43
4 First Annual Report on Medical Assistance in Dying in Canada, 2019

HIGHLIGHTS
This report contains information collected from practitioners and pharmacists for the 2019 calendar year
on written requests for and cases of MAID across Canada. The data presented has primarily been drawn
from the federal monitoring system for MAID, which was launched on November 1, 2018. Prior to that date,
data was provided voluntarily by provinces and territories (June 17, 2016 to October 31, 2018) which has
supplemented some of the analyses presented here.
The report is the outcome of significant collaboration between federal, provincial and territorial levels of
government, and provides the most comprehensive portrait of MAID in Canada to date. Future reports
using data through the federal monitoring system will build on these analyses to provide an understanding
of trends related to requests for, and the delivery of, MAID over time.
The number of medically assisted deaths is steadily increasing

• In 2019, there were 5,631 cases of MAID reported in Canada, accounting for 2.0% of all deaths
in Canada.
• The number of cases of MAID in 2019 represents an increase of 26.1% over 2018 numbers, with
all provinces experiencing a steady year over year growth in the number of cases of MAID since its
introduction into law in 2016.
• When all data sources are considered, the total of number of medically assisted deaths reported
in Canada since the enactment of federal legislation is 13,946.
Profile of MAID recipients1

• In 2019, the proportion of men and women receiving MAID across Canada was nearly equal with only
slightly more cases among men (50.9%) than women (49.1%).
• The average age of persons who received MAID in Canada was 75.2 years; this average age varied
across jurisdictions ranging from a low of 70.4 in Newfoundland and Labrador to a high of 76.9 in
British Columbia.
• Over 80% of MAID deaths occur at age 65 or older.
• Cancer (67.2%) was the most commonly cited underlying medical condition of persons who received
MAID, followed by respiratory (10.8%) and neurological (10.4%) conditions.
The majority of MAID recipients also received supportive services

• The majority of persons receiving MAID (82.1%) were reported to have received palliative care services.
• Of those MAID recipients who did not access palliative care services prior to receiving MAID,
the majority (89.6%) had access to these services but chose not to do so, according to the
reporting practitioner.
• Among the 41.3% of patients requiring disability support services, 89.8% had received them.
1 When all data sources are considered, there were a total of 5,631 MAID deaths in Canada in 2019. This includes 242 MAID deaths
that were reported voluntarily by the provinces and territories. The detailed analysis on requests for MAID (7,336 written requests),
and cases of MAID (5,389 provisions), are available only for the reports collected through the federal monitoring system (for requests
received on or after November 1, 2018).

MAID is most often provided in a home or hospital setting by primary care physicians
• The primary settings for the administration of MAID are hospitals (36.3%) (excluding palliative care
beds/units) and patients’ private residences (35.2%). The remaining cases of MAID occurred in palliative
care units (20.6%) and residential care (6.9%) or other settings (1.0%).
• There were 1,271 unique practitioners who provided MAID in 2019. MAID was provided most
frequently by family medicine physicians (65.0%), followed by palliative medicine specialists (9.1%)
and anesthesiologists (5.0%).
Nature of suffering among MAID recipients

• Practitioners reported that suffering among MAID recipients was closely tied to a loss of autonomy.
• Loss of ability to engage in meaningful life activities (82.1%) followed closely by loss of ability to perform
activities of daily living (78.1%), and inadequate control of symptoms other than pain, or concern about
it (56.4%) were the most frequently reported descriptions of the patient’s intolerable suffering.
One-quarter of written requests for MAID did not result in an assisted death
• There were 7,336 written requests for MAID reported through the MAID monitoring system in 2019.
Of these requests, 26.5% (or 1,947) did not result in a MAID death, because the patients died before
receiving MAID (57.2% or 1,113 cases), were deemed ineligible (29.3% or 571 cases), or they withdrew
their request (13.5% or 263).
• The most frequently reported reasons why a person was deemed ineligible for MAID (7.8% of written
requests) were: lack of capacity to make health care decisions (32.2%); the individual’s natural death
was not reasonably foreseeable (27.8%); and the individual was not in an advanced state of irreversible
decline in capability (23.5%).
• Of those persons who were assessed as eligible for MAID, but did not receive it, the majority died of
another cause prior to administration (15.2%), while a small number (3.6%) of persons withdrew their
request after having been deemed eligible.

MINISTER’S MESSAGE
As Minister of Health, I am proud to present Health Canada’s first
annual report on medical assistance in dying (MAID). This first report
using data collected under Canada’s new monitoring and reporting
system represents the collaborative efforts of federal, provincial
and territorial governments and healthcare professionals to provide
a comprehensive picture of the administration of MAID across
the country.
MAID is being delivered across the country as part of the suite of

publicly available health care services. Provinces and territories
have established information lines and care coordination services
to facilitate MAID requests and connect interested individuals to
participating clinicians. Training and guidance material for health
professionals continue to develop and evolve. The Canadian Association of MAID Assessors and Providers
(CAMAP), the first organization of its kind in North America, has been established and is supporting a
network of health professionals assessing and providing MAID. In addition, bereavement support services
addressing the unique circumstances for family and friends of individuals receiving MAID are emerging.
Academics are collaborating with clinicians to produce much needed research on the MAID experience,
so we know where improvements are required.
MAID is a complex issue on which Canadians have strong opinions that are deeply rooted in personal
values and individual circumstances. I have heard many heart-warming stories from Canadians describing
how MAID granted their loved ones a calm, compassionate and peaceful ending surrounded by family
and friends. Clinicians have expressed how honoured they feel to participate in an experience that is so
intimate and personal, which they often describe as one of the most rewarding aspects of their practice.
I have also heard voices of concern from other Canadians, worried there are insufficient protections
for those who may be vulnerable to coercion or abuse, or who may request MAID out of a sense of
hopelessness associated with their personal situation. Supporting individual autonomy to choose how one
wishes to address intolerable pain and suffering, while ensuring the decision is made freely and not the
result of external pressures or a temporary period of despair, underpins MAID legislation in Canada.
The federal Regulations for the Monitoring of Medical Assistance in Dying came into force on November 1,
2018, setting out new enhanced reporting requirements for standardized data collection across the
country. Since that time, Health Canada has been working in partnership with Statistics Canada,
provinces and territories, as well as physicians, nurse practitioners and pharmacists to support reporting
through this new system. The collection of robust, nationally comparable data not only enables reporting
on MAID’s implementation, but also contributes to an evidence base important to future discussions on
MAID - both in response to recent court cases and through a statutory review of the legislation that is
required under Bill C-14.
As we move forward, I expect this collaborative work to continue in the context of upcoming changes
to the federal MAID legislation. I was pleased to work with the Minister of Justice and Attorney General
of Canada and the Minister of Employment, Workforce Development and Disability Inclusion, in tabling
amendments to Canada’s MAID legislation, in response to the September 2019 Superior Court of Quebec
ruling in Truchon, a challenge to Canada’s 2016 MAID law launched by Nicole Gladu and Jean Truchon.
The changes proposed by our Government were informed by broad consultations, including a series of

roundtable discussions with health care professionals, regulatory bodies and other key stakeholders, as
well as an online survey of Canadians that garnered over 300,000 responses.
In response to Truchon, the proposed legislation (Bill C-7) would see the removal of the requirement for an
individual’s death to be reasonably foreseeable, allowing persons who are suffering intolerably, but who are
not dying, to be eligible for MAID if all other criteria have been met. It would also implement other changes
to address barriers to access noted by healthcare professionals and other experts during the roundtable
discussions. Following passage of the Bill, the MAID monitoring regulations would be amended to align
with the legislative changes to support even stronger monitoring and reporting.
The information released in this first annual report is a critical body of knowledge for Canadians about
MAID. I encourage you to review the data, consider the findings, and continue the dialogue.
The Honourable Patty Hajdu,

Minister of Health

INTRODUCTION
Nearly all countries that permit some form of medically assisted dying consider public reporting to be a
critical component to support transparency and foster public trust in the application of the law. The need
for the consistent collection of information and public reporting also reflects the seriousness of MAID as an
exception to the Criminal Code prohibition against the intentional termination of a person’s life.
Canada’s federal MAID legislation, Bill C-14, An Act to Amend the Criminal Code and to Make Related
Amendments to Other Acts (Medical Assistance in Dying) was enacted on June 17, 2016. In addition to
establishing eligibility criteria for MAID and safeguards for its application, the legislation also required the
federal Minister of Health to make regulations to support data collection and reporting on both requests for,
and the provision of, MAID. The Regulations for the Monitoring of Medical Assistance in Dying came into
force on November 1, 2018.
This document marks the first report using data collected under the new federal monitoring and reporting
system established through these Regulations. This system is contributing to a better understanding
of requests for MAID by providing insight into the circumstances under which MAID is requested and
administered, along with information about the written requests for MAID that do not result in a medically
assisted death.

1.0 THE EVOLUTION OF FEDERAL
MAID LEGISLATION
1.1 PUBLIC DEBATE ON ASSISTED DYING IN CANADA
While Canada’s federal legislation on MAID is relatively new, it is the outcome of years of public dialogue
and debate. The issue of physician assisted dying2 first gained widespread attention in Canada during the
early 1990s, when Sue Rodriguez, a woman living with amyotrophic lateral sclerosis (ALS), applied to the
Supreme Court of British Columbia to have the Criminal Code prohibition on assisted suicide declared
unconstitutional. The case was ultimately appealed to the Supreme Court of Canada (SCC), which
ruled by a narrow (5-to-4) majority that the prohibition against assisted suicide was not in violation of the
Canadian Charter of Rights and Freedoms (the Charter).3 At the time of the decision, no jurisdiction in the
world had legalized medically assisted dying.
Nearly two decades later, in 2011, two family members of Kay Carter (a woman with spinal stenosis
who sought and received an assisted death in Switzerland), William Shoichet (a physician willing to
perform assisted suicide), and Gloria Taylor (a woman with ALS), along with the British Columbia Civil
Liberties Association, once again challenged the federal Criminal Code provisions that prohibit a medical
practitioner from aiding a person to die by suicide by providing them with the necessary medication,
or from directly causing their death at their request. Similar to the Rodriguez case, the plaintiffs
challenged the prohibition based on rights set out in sections 7 and 15(1) of the Charter.
In February 2015, the SCC rendered a unanimous (9-0) judgement in favour of the plaintiffs in the Carter
case, declaring the challenged provisions of the Criminal Code void insofar as:
[T]hey prohibit physician-assisted death for a competent adult person who (1) clearly
consents to the termination of life; and (2) has a grievous and irremediable medical condition
(including an illness, disease or disability) that causes enduring suffering that is intolerable to
the individual in the circumstances of his or her condition.4
The judgement was not prescriptive about eligibility criteria for physician assisted dying beyond the
specifics of the Carter case, and made “no pronouncement on other situations where physician-assisted
dying may be sought”, and found that risks to vulnerable persons could be mitigated through carefully
designed and monitored safeguards.
The SCC suspended the judgement for one year to allow time for the federal government to develop
legislation and regulations. During this period, a federal election resulted in a new government, who
requested a six-month extension of the suspension. An extension of four months was granted.
2 The terms physician assisted death and physician assisted dying were used by the plaintiffs in both the Rodriquez and Carter cases.
The Special Joint Committee on Physician Assisted Dying (2016) recommended changing the terminology to medical assistance in
dying to reflect the participation of a range of health professionals including nurses and pharmacists.
3 Rodriguez v. British Columbia (Attorney General), [1993] 3 S.C.R. 519
4 Carter v. Canada (Attorney General), [2016] 1 S.C.R. 13

At the same time the Carter case was underway, the Government of Quebec had launched a series
of expert panels and reports on end-of-life care, including discussions of physician assisted dying. As
a result of these studies and public opinion research indicating broad support for euthanasia in certain
circumstances, in 2014, the Quebec government passed An Act Respecting End-of-Life Care which set
out the parameters for the provision of medical aid in dying5 to persons at the end of life. It also established
a Commission on End-of-Life Care (la Commission sur les soins de fin de vie) to examine all matters
relating to end-of-life care and oversee the application of specific requirements pertaining to assisted
dying. This provincial legislation came into effect in December 2015.
1.2 THE DEVELOPMENT OF CANADA’S LEGISLATION ON MAID

At the time of the Carter decision in 2015, only a few other jurisdictions permitted assisted dying, including
four U.S. states (Oregon, Washington, Vermont, and California), the country of Colombia, and the Benelux
countries (Belgium, the Netherlands and Luxembourg).
International regimes were studied closely in the development of Canada’s legislation on MAID. There
were a number of similarities in the legislative approaches taken by different jurisdictions, particularly with
respect to safeguards. However, there were also significant differences in terms of which forms of assisted
dying are permitted, and under what circumstances a person may be deemed eligible.
For example, in the U.S. states that permit assisted dying, eligibility is limited to persons who have a
terminal illness (usually defined as being within the last 6 months of life) and only assisted suicide6
(i.e., self-administration) is permitted. In contrast, the Benelux countries determine eligibility, among other
criteria, on the basis of whether the person is experiencing intolerable physical or psychological suffering
resulting from a serious and incurable medical condition, rather than proximity to death. The Benelux
countries also allow voluntary euthanasia (i.e., clinician-administered), which is far more common than
assisted suicide in these jurisdictions.
Following a period of extensive study and consultation,7 in April 2016, the federal government tabled Bill
C-14 which proposed amendments to the Criminal Code to allow physicians and nurse practitioners to
provide a medically assisted death in accordance with specified eligibility criteria and safeguards. While
the legislation drew from other international regimes, it represented a uniquely Canadian approach. Table
1.2 outlines Canada’s current MAID eligibility criteria and safeguards as per Bill C-14.8 Precise wording and
additional details are available on the Health Canada MAID website.
5 Quebec legislation uses the term medical aid in dying rather than medical assistance in dying.
6 Jurisdictions use different terminology in their legislation allowing medical assistance in dying. In Canada, the Criminal Code provisions
on MAID do not employ specific or different terms, but refers only to medical assistance in dying. However, assisted suicide in
other jurisdictions is commonly termed self-administration in Canada, and voluntary euthanasia is commonly termed practitioner
administration.
7 See, for example: the External Panel on Options for a Legislative Response to Carter v. Canada, the Provincial-Territorial Expert
Advisory Group on Physician Assisted Dying and the Special Joint Committee on Physician Assisted Dying.
8 There are currently amendments to the MAID provisions before Parliament, in Bill C-7, including the removal of the requirement that an
individual’s death be reasonably foreseeable. See Section 8.2 for more information.

Similar to the Benelux countries, both assisted suicide and voluntary euthanasia were permitted under
Bill C-14. Under the Criminal Code amendments, medical assistance in dying “MAID” is an umbrella term
which includes:
• the administration by a medical practitioner or nurse practitioner of medication that will cause a person’s
death at their request (clinician-administered); and
• the prescription or provision by a medical practitioner or nurse practitioner of medication that a person
can self-administer to cause their own death (self-administered).
Unlike the Benelux countries, C-14 limited eligibility to competent adults whose “natural death was
reasonably foreseeable”. However, the requirement that natural death be reasonably foreseeable provided
more flexibility than jurisdictions requiring a specific prognosis (i.e., 6 months).
Table 1.2 – Bill C-14 Eligibility Criteria and Safeguards

Eligibility Safeguards
• Request MAID voluntarily (self-request only) • Request must be in writing after the person is informed
• 18 years of age or older of grievous and irremediable condition
• Capacity to make health care decisions • Written request must be witnessed and signed by
• Must provide informed consent 2 independent witnesses
• Eligible for publicly funded health care services in Canada • 2 independent practitioners must confirm eligibility
• Diagnosed with a “grievous and irremediable medical criteria are met
condition,” where a person must meet all of the • Patient must be made aware of all treatment options
following criteria: available, including palliative care, in order to provide
– serious and incurable illness, disease or disability informed consent
– advanced state of irreversible decline in capability, • Practitioner must confirm request has been made freely,
– intolerable physical or psychological suffering, without undue influence
– natural death has become reasonably foreseeable • 10 clear day reflection period unless death or loss
of capacity is imminent
• Final confirmation and consent at time of administration
or provision of the medication or prescription for self-
administration
During the debate on Bill C-14, some Canadians and Parliamentarians voiced support for a more
expansive regime, which would allow advance requests, and expand eligibility to mature minors and
persons whose sole underlying medical condition is a mental illness. Given the complexity of the issues
raised, uncertainty around how such a regime could be implemented in the Canadian context, and the
need to pass legislation under compressed timelines, Parliament agreed to refer these particularly complex
issues for further study, with the findings to be tabled within 2 years of the reviews being initiated.
The Council of Canadian Academies (CCA) was selected by the federal government to undertake
independent reviews on these issues, which were finalized in December 2018. The reports and
a summary are available on the CCA’s website.
The legislation also required that its provisions, as well as the state of palliative care, be referred to one
or more parliamentary committees for review in the fifth year after the Act received Royal Assent (2020).
Finally, the federal legislation on MAID obligated the federal Minister of Health to make regulations to
support data collection and reporting on both requests for, and the provision of, MAID. Federal Regulations
for the Monitoring of Medical Assistance in Dying, which specify reporting requirements for practitioners
and pharmacists, came into force and a new Pan-Canadian Data Collection portal was launched on
November 1, 2018. The majority of the information provided in this report is based on the data collected
under this monitoring system.

1.3 IMPLEMENTATION OF MAID ACROSS CANADA
Following the passage of federal MAID legislation, provinces and territories had the challenging task of
adapting their health care systems within a short time frame to allow for consistent and safe access to
this service. While the Criminal Code, which applies across Canada, establishes the eligibility criteria that
must be met and safeguards that must be complied with before MAID is provided, it is the provinces and
territories that are responsible for the delivery of health care services and the administration of justice. As
such, each jurisdiction has taken its own approach to the organization and delivery of MAID.
For example, in Newfoundland and Labrador, Nova Scotia, New Brunswick, and British Columbia regional
health authorities play a central role in the coordination of MAID, including supporting patients and
providers who need assistance in navigating the service. Meanwhile, some provinces, such as Manitoba,
Saskatchewan, and Alberta have set up province-wide care MAID coordination systems to triage the
intake of MAID requests, support patient information/access, help connect clinicians and streamline
reporting. Smaller jurisdictions (e.g., Northwest Territories) typically have less formal systems set up
primarily to support patients in connecting with a willing MAID provider.
With respect to oversight, some jurisdictions, such as Manitoba, Saskatchewan, Alberta, and British
Columbia have implemented review committees to ensure MAID is being provided in accordance with
federal and provincial rules. In Ontario, all MAID deaths are reported to the Chief Coroner’s Office who is
also responsible for oversight. The regulatory bodies for medicine, nursing and pharmacy in each province
and territory are also responsible for promoting the lawful practice of MAID and ensuring that health
professionals act in accordance with principles of professional conduct and established standards of care.
Several provinces have been reporting publicly on MAID outside of the federal monitoring system.
For example, Nova Scotia, Quebec (through its arms-length commission) and Alberta regularly publish
provincial-level data. Independent groups/research organizations and media have also published MAID
data from across the country which have been obtained directly from provincial, regional or institutional
sources. Health Canada has collaborated with all jurisdictions to support accuracy of reporting and
coherence with provincially published data for the total number of MAID deaths.

2.0 METHODOLOGY AND LIMITATIONS
As noted earlier, the federal legislation on MAID required the Minister of Health to make regulations to
establish a federal monitoring regime to collect data relating to MAID in Canada. Health Canada worked
closely with the provinces and territories, and consulted practitioners, pharmacists and other stakeholders
in the development of the monitoring regime. The objective of this process was to create a reporting
system that captured the elements required under the legislation without placing undue reporting or
administrative burden on practitioners or duplicating existing systems.
2.1 DATA COLLECTED UNDER THE FEDERAL REGULATIONS

Under the Regulations, physicians and nurse practitioners are required to report on all written requests9
for MAID, even if the request does not result in the administration of MAID. There are six possible
outcomes for which a practitioner must provide a report (as per the Guidance for reporting on medical
assistance in dying):
• MAID is provided by a practitioner via administration of a substance
• MAID is provided by a practitioner via the prescribing or provision of a substance to a patient for the
purpose of self-administration
• The patient is referred or transferred as a result of their written request
• The patient is found ineligible for MAID
• The practitioner becomes aware that the patient has withdrawn their request for MAID
• The practitioner becomes aware that the patient has died from a cause other than MAID
Pharmacists are required to report on the preparation and dispensing of substances in connection with
the provision of MAID.
Practitioners also report:

• basic sociodemographic information about the person requesting MAID (e.g., age, gender,
postal code);
• on the assessment of the request and whether eligibility requirements were met (e.g., underlying
medical condition, description of suffering);
• information about procedural safeguards if MAID was provided (e.g., 10-day reflection period,
two practitioners confirm eligibility); and,
• information as to why a request may have gone unfulfilled.
A complete list of the information that must be provided by practitioners and pharmacists under
the Regulations can be found on Health Canada’s website.
9 To trigger an obligation to report, the written request does not have to be in the format required by the Criminal Code as a safeguard
when MAID is provided (i.e., duly signed, dated and witnessed).

Practitioner and pharmacist reporting under the monitoring system occurs in two ways: to a designated
provincial or territorial body, or, directly to Health Canada. Some provinces and territories have a
designated recipient (DR) listed in the Regulations. These are organizations that are responsible for
collecting MAID information directly from practitioners and pharmacists in their jurisdiction and reporting
this information to Health Canada on a quarterly basis. They collect all the information that is required
under the federal Regulations. This approach was put in place to reduce duplicative reporting in those
jurisdictions that had already established MAID data collection systems. These provinces and territories
are Quebec, Ontario (requests resulting in a MAID death only),10 Saskatchewan, Alberta, British Columbia,
Northwest Territories and Nunavut.
Practitioners and pharmacists in the other provinces and territories are required to report directly to
Health Canada through the Canadian MAID Data Collection Portal.11 These provinces and territories
are Newfoundland and Labrador, Prince Edward Island, Nova Scotia, New Brunswick, Ontario (MAID
requests not resulting in a MAID death), Manitoba, and Yukon. The Portal was developed and is managed
in partnership with Statistics Canada and provides a secure, on-line reporting mechanism for MAID data.
Health Canada provides online guidance materials for respondents and manages a MAID Report support
line (phone and email) to assist respondents with questions on completing reports.
2.2 DATA COLLECTED THROUGH INTERIM REPORTS

Prior to November 1, 2018, Health Canada collected and reported on basic data related to MAID requests
by releasing a series of four interim reports12 available on the Health Canada website. These reports were
based on data voluntarily provided to Health Canada by the provinces and territories, and data available
through publicly available information in Quebec. Information in these interim reports included the total
number of reported medically assisted deaths, location where MAID was provided, underlying medical
condition of the person requesting MAID, type of practitioner providing MAID, gender of individual, average
age of persons requesting MAID and general age range. A provincial breakdown of these details was
available for Ontario, Manitoba, Saskatchewan, Alberta, and British Columbia, and in aggregate for the
Atlantic provinces (Newfoundland and Labrador, Prince Edward Island, Nova Scotia and New Brunswick.
Quebec’s data followed a different reporting cycle, and was not available for inclusion in the provincial
breakdown within the fourth interim report.
Health Canada consulted provinces and territories during the preparation of this more comprehensive
report, in order to validate and update historical numbers of cases of MAID from 2016 to 2018, as well as
to validate 2019 numbers.13
10 Ontario has a hybrid reporting system. MAID deaths are reported to the Office of the Chief Coroner of Ontario, which are then reported
to Health Canada quarterly. All other scenarios, specifically referrals, withdrawals, ineligibility and patient death from another cause, are
submitted by practitioners directly to the Canadian MAID Data Collection Portal. Ontario pharmacists also report through the portal.
11 A mail-in / fax-in reporting option is available, especially where internet service may be unreliable.
12 The first update was released on April 26, 2017, providing information on the first six months of medical assistance in dying (June 17
to Dec 31 2016). The second update was released in October 2017 and covered the period Jan 1 to June 30, 2017. The third report
released June 21, 2018, covered the period July 1 to Dec 31, 2017. The fourth and final interim report was released in April 2019 and
covered the 10-month period from Jan 1 to Oct 31 2018.
13 It is accepted practice to publish minor data revisions to a previous year, due to corrections in previously reported data or the addition
of missing data.

2.3 METHODOLOGICAL NOTES
For all years covered in this report, the number of MAID deaths is counted in the calendar year in which
the death occurred, and not in the year in which the request was received or in the year the death
was reported (if they differ). For example, if a request was received in December 2018 and MAID was
administered in January 2019, the reported MAID death is counted in the year 2019. Similarly, a MAID
death that occurred in 2019, but was reported (as per the Regulations) in the first quarter of 2020, will be
counted in the calendar year 2019. For requests not resulting in a MAID death (for example, a finding of
ineligibility, withdrawal, or patient died prior to MAID), the request is counted in the calendar year in which
it is received.
This report presents an updated and verified total number of MAID deaths for the calendar years 2016
to 2018. Combined with the new and more complete MAID data set collected under the authority of the
Regulations, the resulting four-year chart of the number of cases of MAID provided in Canada (Chart 3.1)
contributes to a better understanding of how the uptake of MAID has grown and expanded across
Canada, and in each region. The expanded data collected under the Regulations also forms the basis
of the detailed charts and tables for 2019 presented in this report. As with the previously published interim
reports, data for the Northwest Territories and Nunavut are suppressed in order to protect confidentiality
due to small numbers.14 Data suppression was also applied for other jurisdictions for specific indicators,
as required, to protect the privacy of both patients and practitioners.
Written requests for MAID that were received prior to November 1, 2018, when the regulations came into
force, were not captured, even where the outcome, including the administration of MAID, occurred after
this date. This created a gap in the data of the total numbers of cases of MAID. Provinces and territories
were given the opportunity to update these missing numbers for cases where MAID was provided. As a
result, 2018 aggregate data is based on a combination of three data elements: previously reported data
to October 31, 2018; requests prior to November 1, 2018, where MAID was provided after November 1,
2018; and data collected under the Regulations for the period November 1, 2018 to December 31, 2018.
Similarly, aggregate data for MAID deaths in 2019 is based on two data elements: MAID provisions in 2019
resulting from a written request prior to November 1, 2018, and data collected under the Regulations for
the period January 1, 2019 to December 31, 2019.
Finally, practitioners have the opportunity to include supplementary comments when reporting, either
through their designated recipient or through the Canadian MAID Data Collection Portal. Analysis shows
that this space is typically used to enter additional information to clarify previous responses, or to add
information that did not fit within the standard set of data elements. Of the 5,389 reported MAID deaths in
2019, approximately 25% included additional comments by practitioners. These comments were analysed
to identify common themes or patterns. Some comments that exemplify common themes have been
included throughout this report (Note: names have been changed to protect the privacy of those involved).
14 Numbers under seven are supressed. Other larger cells may also be suppressed to avoid derivation.

2.4 DATA LIMITATIONS
While the federal monitoring system represents the only consistent and comparable national data set
on MAID, and provides the most comprehensive information available, it is not without limitations.
While all cases of MAID are captured under the current monitoring regime, it has become clear since the
implementation of the federal monitoring regime in 2018 that collecting information based solely on “written
requests” for MAID has resulted in data gaps in some key areas.
While the federal legislation on MAID requires a request in writing in order for MAID to be provided, there
is no requirement for a written request to be submitted in order to be assessed for MAID. Since the
implementation of the monitoring system in 2018, practitioners and provincial and territorial officials have
indicated that many assessments for MAID are taking place with the written request only being completed
once a finding of eligibility has been determined or a date for MAID has been established.
The practical effect is that a significant number of cases where the person has made a verbal request,
has been assessed and found to be ineligible, are not being captured.15 The same is true in cases where
a patient makes a verbal request for MAID, but later withdraws the request or dies prior to the completion
of the assessment process. The use of the written request as the “trigger” for MAID reporting has also led
to other inconsistencies in the data. For instance, many individuals who are interested in MAID begin the
process through a verbal request to their primary care provider. This request frequently results in a referral
to another practitioner who is a MAID assessor/provider or to a care coordination service. The patient’s
request may not be formalized in writing until they are found eligible and complete the official, witnessed
request several weeks later. This creates gaps in the reporting of the numbers of requests for MAID and
challenges in understanding the duration of the MAID process between the initial request and the provision
of MAID.
The legislation on MAID, and the supporting regulations for federal monitoring, stipulate that only
physicians and nurse practitioners who receive a written request, or a pharmacist who dispenses
medications for the purposes of MAID, are required to report. However, several jurisdictions have
implemented MAID coordination systems, often staffed by nurses or other allied health providers who
conduct preliminary assessments, to triage the intake of MAID requests. Again, this results in incomplete
data as Health Canada is not authorized to collect information on cases of MAID from these supporting
health providers. In particular, referrals are not captured by jurisdictions with care coordination services.
This gap, along with the reasons outlined above, make the data related to referrals for MAID unreliable.
15 This is not necessarily the case in all jurisdictions. For instance, Quebec’s legislation specifies that requests for assisted dying must be
made in writing.

3.0 CASES OF MAID IN CANADA
3.1 NUMBER OF REPORTED MAID DEATHS IN CANADA (2016 TO 2019)
In 2019, there were 5,631 cases of MAID reported in Canada, bringing the total number of medically
assisted deaths reported in Canada since the enactment of legislation to 13,946.16 The number of cases
of MAID in 2019 represents an increase of 26.1% over 2018 numbers, with all provinces experiencing
a steady year over year growth since the enactment of legislation in the province of Quebec and at the
federal level. A breakdown of the number of cases of MAID by year and jurisdiction is provided in Table 3.1.
Chart 3.1: Total Reported MAID Deaths in Canada, 2016 to 2019
6,000
5,631
5,000
4,467
4,000
3,000 2,833
2,000
1,015
1,000
0
2016 2017 2018 2019
EXPLANATORY NOTES:
1. MAID provisions are counted in the calendar year in which the death occurred (i.e., January 1 to December 31), and are not related to the date of receipt of the
written request.
2. For 2016 - Quebec data begins December 10, 2015 when its provincial Act respecting end-of-life care came into force. Data for the rest of Canada begins June 17, 2016.
3. 2016 – 2018 data includes revisions from previous interim reporting.
4. MAID deaths for 2018 and 2019 include cases whereby the request was received prior to November 1, 2018, with MAID occurring after November 1, 2018. This data
was not captured under the Regulations for the Monitoring of Medical Assistance in Dying. Data was provided voluntarily by the jurisdictions for inclusion in this chart.
For 2019, this represents an additional 242 cases.
5. Cases of self-administered MAID are included in this chart. They are not identified by year or jurisdiction in order to protect confidentiality.
16 This includes data from Health Canada’s four interim reports, data collected through the federal monitoring system, as well as data
voluntarily provided by jurisdictions on MAID provisions where the written request was prior to November 1, 2018.

Almost all cases of MAID reported in 2019 were administered by a practitioner. There were fewer than
7 reported cases of self-administered MAID across the country. This pattern is consistent with other
international jurisdictions that permit both practitioner and self-administered MAID. Prior research17 has
suggested that providers are less comfortable with self-administration due to concerns around the ability
of the patient to effectively self-administer the series of medications, and the complications that may
ensue. As such, some health institutions and regulatory bodies within jurisdictions have developed policies
that discourage self-administration. Of note, Quebec’s legislation on end-of-life care only permits provider-
administered assisted dying.
Table 3.1: Total Reported MAID Deaths in Canada by Jurisdiction, 2016 to 2019
MAID NL PE NS NB QC ON MB SK AB BC YT NT NU Canada
2016 – – 23 7 494 191 24 11 63 194 – – – 1,015
2017 – – 62 47 853 839 63 57 205 677 – – – 2,833
2018 22 8 126 82 1,236 1,500 138 85 307 951 10 – – 4,467
2019 16 17 147 129 1,589 1,788 177 97 377 1,280 13 – – 5,631
Total 2016–2019 55 31 358 265 4,172 4,318 402 250 952 3,102 37 – – 13,946
EXPLANATORY NOTES:
written request.
2. For 2016 - Quebec data begins December 10, 2015 when its provincial Act respecting end-of-life care came into force. Data for the rest of Canada begins June 17, 2016.
3. 2016 – 2018 data includes revisions from previous interim reporting.
4. MAID deaths for 2018 and 2019 include cases whereby the request was received prior to November 1, 2018, with MAID occurring after November 1, 2018. This data was
not captured under the Regulations for the Monitoring of Medical Assistance in Dying. Data was provided voluntarily by the jurisdictions for inclusion in this table. For 2019,
this represents an additional 242 cases.
5. Cases of self-administered MAID are included in this table. They are not identified by year or jurisdiction in order to protect confidentiality.
The steady increase in the number of MAID deaths is likely the outcome of a combination of factors,
including increased awareness of MAID as a legal option, greater acceptance by Canadians and health
care providers and improved data collection and reporting by all jurisdictions.
3.2 MAID DEATHS AS A PROPORTION OF OVERALL DEATHS IN CANADA

MAID deaths accounted for 2.0% of all deaths in Canada in 2019. In other countries that permit some form
of assisted dying, the percentage of total deaths attributed to MAID ranges from 0.3% (in U.S. states where
patients must be at the end of life and only self-administration is permitted) to 4.6% (in Benelux countries
where eligibility is based on suffering rather than proximity to death and clinician-administered MAID
is permitted).
17 Much of the literature on this subject is based in the Netherlands. For example, see: Kouwenhoven, Pauline S. C., Ghislaine J M W van
Thiel, Natasja J H Raijmakers, Judith A C Rietjens, Agnes van der Heide, Johannes J M van Delden. 2012. Euthanasia or physician-
assisted suicide? A survey from the Netherlands. European Journal of General Practice. 20: 25-31.

Chart 3.2: Percentage of Total Deaths Attributed to MAID by Jurisdiction, 2019
3.5%
3.3%
3.0%
2.5% 2.4%
2.0%
1.6%
1.5% 1.6%
1.5% 1.6%
1.4%
1.2%
1.0%
1.0%
0.5%
0.3%
0.0%
NL PE NS NB QC ON MB SK AB BC
Percent of Jurisdictional Deaths Percent of All Deaths, Canada
EXPLANATORY NOTES:
1. MAID deaths include cases whereby the request was received prior to November 1, 2018, with MAID provision occurring in 2019. This data was not captured under the
Regulations for the Monitoring of Medical Assistance in Dying. Data was provided voluntarily by the jurisdictions for inclusion in this chart. For 2019, this represents an
additional 242 cases.
2. Cases of self-administered MAID are included in this chart. They are not identified by jurisdiction in order to protect confidentiality.
3. Given the small population size (and, hence, the small denominator), Yukon’s percentage is sensitive to small increases in case numbers, and is therefore not included in
this chart.
Source: Statistics Canada. Table 17-10-0006-01 Estimates of deaths, by age and sex, annual (2018/19)
As illustrated in Chart 3.2, the percentage of total deaths attributed to MAID varies significantly by province/
territory, ranging from 0.3% in Newfoundland and Labrador to 3.3% in British Columbia. The observed
higher rates of MAID in British Columbia and Quebec are not surprising, considering the evolution of MAID
in Canada and the corresponding socio-political dynamics in those particular provinces. For instance,
British Columbia has experienced a long history of legal and social activism in favour of assisted dying
(both the Rodriguez and Carter cases originated in that province), resulting in a high level of awareness
of MAID.18 Similarly, in Quebec, the Act Respecting End of Life Care (which preceded the federal MAID
legislation), and followed years of study and public engagement in that province (as discussed in Section
1.1 of this report). Varying availability of MAID practitioners across jurisdictions could also be a factor.
18 Robertson, David and Rosanne Beuthin. A Review of Medical Assistance in Dying on Vancouver Island: The First Two Years July 2016
– July 2018. Victoria: Island Health, 2018.

4.0 PROFILE OF PERSONS RECEIVING MAID
As outlined in Section 3.1, when all data sources are considered, there were a total of 5,631 MAID deaths
in Canada in 2019. This includes 242 MAID deaths that were reported voluntarily by the provinces and
territories and not captured through the federal monitoring system as the written request was received
prior to November 1, 2018.19
The subsequent analysis is based only on data collected through the federal monitoring system (N=
5,389) as detailed information was not provided for the additional 242 cases that were not reported
through the federal monitoring system. The alignment of the reporting cycle with the calendar year also
supports improved year over year analysis for future reports.
4.1 UNDERLYING MEDICAL CONDITIONS OF THOSE RECEIVING MAID

Cancer-related illness is the most frequently cited
underlying medical condition associated with “John had metastatic colorectal cancer and
those receiving MAID (cited in 67.2% of cases). gave a long fight. He suffered from pain
This is followed by respiratory (10.8%), neurological despite optimal palliative care and did not wish
(10.4%), and cardiovascular (10.1%) conditions. to go into hospice. He died surrounded by
The full list of reported conditions is outlined in family very peacefully.”
Chart 4.1. Practitioner report
19 These 242 provisions represent written requests for MAID received by practitioners prior to November 1, 2018, and where MAID was
provided to these individuals in 2019. As noted in the Methodology and Limitations section, reporting obligations through the new MAID
regulations began on November 1st, 2018.

Chart 4.1: MAID by Main Condition, 2019
80.0%
70.0% 67.2%
60.0%
50.0%
40.0%
30.0%
20.0%
10.8% 10.4% 10.1% 9.1%
10.0% 6.1% 4.6%
0.0%
Cancer Respiratory Neurological Cardiovascular Multiple Other Condition Other Organ
Comorbidities Failure
EXPLANATORY NOTES:
1. This chart represents MAID data captured under the Regulations for the Monitoring of Medical Assistance in Dying, whereby the written request was received on or after
November 1, 2018. For 2019, this represents 5,389 MAID deaths.
2. The category of “other conditions” includes a range of conditions, with frailty commonly cited.
3. Providers were able to select more than one medical condition when reporting; therefore, the total exceeds 100%.
4.2 GENDER, AVERAGE AGE AND AGE RANGE OF PATIENTS WHO

RECEIVED MAID
In 2019, the proportion of men and women receiving MAID across Canada was nearly equal with only
slightly more men (50.9%) than women (49.1%) receiving MAID. This finding is consistent with previous
interim reports. The gender split differs slightly across the provinces, with a greater number of men
receiving MAID in Saskatchewan, Ontario, Quebec and the Atlantic provinces and more women receiving
MAID in Manitoba, Alberta and British Columbia. Breakdowns by province and territory can be found in
Appendix A.
The average age of persons who received MAID in 2019 is 75.2 years. Across the country, the average
age ranges from 70.4 in Newfoundland and Labrador to 76.9 in British Columbia. The majority (93.4%)
of reported MAID deaths occurred at age 56 and older; 80.6% occur at age 65 and older. This finding is
consistent across jurisdictions.
The greatest proportion of persons who received MAID were in the 65 to 70 age category (16.5%),
followed closely by the 71 to 75 age category (15.0%), and the 76 to 80 age category (14.4%). This is
consistent with trends in cancer deaths,20 which as previously noted was the main underlying medical
condition of patients who received MAID. Overall, there are generally fewer individuals who received MAID
in the youngest (age 18 to 55) and oldest (age 91+) age categories.
20 Statistics Canada. Table 13-10-0142-01 Deaths, by cause, Chapter II: Neoplasms (C00 to D48)

Chart 4.2: MAID by Age Category, 2019
888
811
774
690 704
631
534
254
103
18–45 46–55 56–64 65–70 71–75 76–80 81–85 86–90 91+
EXPLANATORY NOTE:
4.3 PALLIATIVE CARE AND DISABILITY SUPPORT SERVICES

For every case where MAID is provided, practitioners are required to report on whether the patient had
received palliative care and/or disability support services.
While there is no universally agreed upon definition

“Anne was a lovely woman with end-stage
of palliative care, for the purposes of MAID
pancreatic cancer. She fought hard and long
reporting, it has been defined as an approach that
with chemotherapy, extensive surgery, and
improves the quality of life of patients and their
palliative care. By the time of her death she
families facing life-threatening illness, through the
weighed <30kg, was jaundiced and suffering
prevention and relief of pain and other physical
physically and spiritually. She died through
symptoms, and psychosocial and spiritual
MAID in the arms of her loving partner.”
suffering.21 It may be provided in any setting, by
specialists or family medicine physicians with Practitioner report
expertise in palliative care.
21 Canada. Health Canada. Guidance for reporting on medical assistance in dying. Ottawa: Health Canada, 2018.

The majority of persons who received MAID in 2019 were reported to have received palliative care
services (82.1%). Of those who received palliative care services, the majority (60.8%) received these
services for one month or more, 19.9% received services for a duration of two weeks to less than a month,
and 19.4% received services for a duration of less than two weeks. Of those MAID recipients who did not
receive palliative care services prior to receiving MAID, according to the reporting practitioner, the majority
(89.6%) had access to these services.
The above findings seem to suggest that requests for MAID are not necessarily being driven by a lack
of access to palliative care services. Research in this area in Canada has been limited. However, these
findings are consistent with those reported by Quebec’s Commission on End-of-Life Care, as well as
those of a recent Ontario-based study, both of which also found that most MAID recipients had received
palliative care.22, 23 These outcomes are also consistent with international evidence.24 However, it is
important to note that while the data provide insight into whether palliative care has been received, it does
not speak to the adequacy of the services offered. This may be an area for future study.
Table 4.3: MAID Recipients Who Received Palliative Care and Disability Support Services, 2019
Palliative Care Services Disability Support Services
Number Percentage Number Percentage
Persons who received palliative Persons who required disability
4,422 82.1% 2,223 41.2%
care services support services
Persons who did not receive Persons who did not require
874 16.2% 2,262 42.0%
palliative care services disability support services
Unknown 904 16.8%
Unknown 93 1.7% Persons who received disability
1,996 89.8%
support services
Palliative Care—Duration Disability Support—Duration
Less than 2 weeks 854 19.3% Less than 6 months 901 45.1%
2 weeks to under 1 month 880 19.9% 6 months or longer 750 37.6%
1 month or more 2,415 54.6%
Unknown 345 17.3%
Unknown 273 6.2%
Persons who required and did
Palliative care was accessible
783 89.6% not receive disability support 87 3.9%
if needed
services
EXPLANATORY NOTE:
1. This table represents MAID data captured under the Regulations for the Monitoring of Medical Assistance in Dying, whereby the written request was received on or after
22 Downar, James, Robert A. Fowler, Roxanne Halko, Larkin Davenport Huyer, Andrea D. Hill, and Jennifer L. Gibson. 2020. Early
experience with medical assistance in dying in Ontario, Canada: a cohort study. CMAJ. 192: E173-E181.
23 Quebec. Institut national d’excellence en santé et services sociaux (INESSS). Commission sur les soins de fin de vie : Rapport sur la
situation des soin de fin de vie au Québec du 10 décembre 2015 au 31 mars 2018. Quebec: INESSS, 2019.
24 Dierickx, Sigrid, Luc Deliens, Joachim Cohen, and Kenneth Chambaere. 2018. Involvement of palliative care in euthanasia practice
in a context of legalized euthanasia: A population-based mortality follow-back study. Palliative Med. 32: 114–122.

For the purposes of MAID reporting, disability support services could include but are not limited to
assistive technologies, adaptive equipment, rehabilitation services, personal care services and disability-
based income supplements.25 In 2019, 41.2% of MAID recipients were reported to require disability
support services, with the majority (89.8%) having received these services. Only 3.9% of persons who
were identified as needing support services did not receive them (with 6.3% as unknown).
Of those MAID recipients who received disability support services, 37.6% received these services for
six months or longer (including 17.0% who received these services for two years or more) and 45.1%
received these services for less than six months. In the remaining 17.3% of cases, the duration of these
services required by the patient is unknown. Again, while this data does provide insight into whether or
not supportive services are made available to persons seeking MAID, it does not provide insight into the
adequacy of the services offered.
25 Canada. Health Canada. Guidance for reporting on medical assistance in dying. Ottawa: Health Canada, 2018.

5.0 DELIVERY OF MAID
5.1 REPORTED MAID DEATHS BY SETTING
Through the Common Statement of Principles on Shared Health Priorities, endorsed in 2017, Federal/
Provincial/Territorial health ministers have underscored the importance of improving access to home and
community care in light of population aging and increasing chronic disease rates. With respect to end-
of-life care specifically, both Canadian and international evidence suggest a preference towards dying at
home.26, 27 Given the policy importance of understanding where health care is provided, practitioners are
asked to report on the setting (location) where MAID was administered.
In 2019, the primary settings for the administration

“Patient who passed away in her garden, of MAID were hospitals28 (36.3%) and patients’
sitting in her favourite chair, surrounded by private residences (35.2%). As outlined in Appendix
friends and family. Balloons were released A, there were variations across provinces. In Nova
before her death (to help guide her on her Scotia, Ontario, Manitoba and British Columbia,
journey...). She reportedly told her daughter a greater proportion of people received MAID at
that she would not have been able to manage home. This could be due, in part, to having strong
another week.” care coordination services in place and sufficient
Practitioner report distribution of practitioners in the community to
support MAID in this setting.
Conversely, in Quebec, MAID was primarily provided in institutions and hospitals. A recent media report
has highlighted procedural barriers limiting the ability of community pharmacies to prepare MAID drugs,
which has been limiting MAID provision outside of institutions in that province.29 Lower rates of home-
based MAID provisions in other provinces could be attributed to similar barriers, or other factors such as
lack of infrastructure for providing this service in the community, as well as provider/patient preferences.
26 Schou-Andersen, Marianne, Maria P. Ullersted, Anders Bonde Jensen and Mette Asbjoern Neergaard. 2016. Factors associated with
preference for dying at home among terminally ill patients with cancer. Scand J Caring Sci. 30:466-76.
27 Canadian Hospice and Palliative Care Association (CHPCA). What Canadians Say: The Way Forward Survey Report.
Ottawa: CHPCA, 2013.
28 Excludes palliative care beds/units
29 For example, see: Bouchard, Marie-Pier. « Les malades qui veulent recevoir l’aide médicale à mourir à la maison sont pénalisés. »
Radio-Canada, March 11, 2020.

Chart 5.1: MAID Deaths by Setting, 2019
Other
Residential Care Facility 1.0%
6.9%
Palliative Care Facility

20.6%
Hospital
36.3%
Private Residence
35.2%
EXPLANATORY NOTES:
2. Hospital excludes palliative care bed/unit; Palliative care facility includes hospital-based palliative care bed/unit or hospice; Residential Care Facility includes long term
care facility; Private Residence includes retirement homes.
The data further indicate that 20.6% of MAID deaths in 2019 occurred in a palliative care setting, with
a relatively small proportion (6.9%) of MAID deaths occurring in residential care settings (e.g., long-term
care facilities).
There have been a number of media reports emerging across the country over the past several years
highlighting cases where faith-based institutions and palliative care facilities have refused to allow
assessments and/or the provision of MAID on their premises. This has resulted in patients being required
to transfer to another facility if they wish to receive the procedure.30 In the absence of more detailed
information on transfers between facilities, however, it is difficult to conclude how many persons located in
these facilities either chose not to go forward with their request, or needed to move to another setting to
receive an assessment or the procedure.
30 For example, see: Grant, Kelly. “Assisted dying in religious facilities means tough choices for families.” The Globe and Mail, January 5, 2018.

5.2 NUMBER OF UNIQUE MAID PRACTITIONERS AND FREQUENCY
OF PROVISION
Overall, a total of 1,271 unique practitioners provided MAID in 2019.31 This includes 1,196 physicians and
75 nurse practitioners. Roughly half (48.5%) of practitioners provided one MAID procedure in 2019, 41.5%
provided the procedure 2-9 times, and the remaining 9.9% provided the procedure more than 10 times
during that year. It should be noted that there is nothing in the federal MAID legislation that compels a
practitioner to provide or assist in providing MAID.
While several healthcare practitioners have reported anecdotally that providing MAID can be a very
professionally rewarding experience, some challenges remain that could impact the number of willing
MAID providers in Canada. For example, many provinces do not have a specific fee schedule for physician
remuneration for MAID32 and some nurse practitioners (often paid by salary) have reported providing MAID
outside of their regular office hours without compensation.33
Table 5.2: Unique MAID Practitioners in Canada and Frequency of Provision, 2019
Physician 1,196 94.1%
Number of Unique Practitioners Nurse Practitioner 75 5.9%
Total 1,271
1 Procedure 617 48.5%
2-9 Procedures 528 41.5%
Practitioner Frequency
10+ Procedures 126 9.9%
Total 1,271
EXPLANATORY NOTE:
5.3 SPECIALTY OF PRACTITIONERS DELIVERING MAID

As noted above, MAID was provided primarily by physicians (94.1%), while 5.9% of medically assisted
deaths were provided by nurse practitioners. These percentages are consistent with those reported in
Health Canada’s Fourth Interim Report on MAID. While the federal legislation allows both physicians and
nurse practitioners to provide MAID, according to Quebec’s legislation, MAID can only be provided by
physicians. In the rest of Canada, nurse practitioners can provide MAID in Prince Edward Island,34 Nova
Scotia, Ontario, Saskatchewan, Alberta, and British Columbia, but not in Newfoundland and Labrador,
New Brunswick, Manitoba and the three territories.
31 Note: this number only includes healthcare practitioners who provided MAID (i.e., it does not include healthcare practitioners involved
in MAID assessment, but not provision).
32 Reid, Tony. 2019. Reflections from a provider of medical assistance in dying. Can Fam Physician. 64: 639–640.
33 Gemmill, Angela. “Nurse practitioners not always compensated for providing medical assistance in dying,” CBC News, March 23, 2018.
34 While Nurse Practitioners can provide MAID in Prince Edward Island, legislation currently prevents them from signing the
death certificate

The federal monitoring system collects more detailed information about who is providing MAID than was
previously available, namely the specialty of the provider. In 2019, MAID was provided most frequently by
family medicine physicians (65.0%), followed by palliative medicine specialists (9.1%), and anesthesiologists
(5.0%). Chart 5.3 provides a detailed breakdown. This finding likely reflects the traditional role of the family
physician as the primary point of contact with the health care system. The notable number of palliative
medicine specialists providing MAID is consistent with the finding that the majority of patients receiving
MAID had received palliative care services.
Chart 5.3: Specialty of MAID Practitioner, 2019

Psychiatry Other
Oncology 1.2% 4.5%
1.7% Nurse Practitioner
Critical Care and 7.1%
Emergency Medicine
1.7% Internal Medicine
4.7%
Anesthesiology
5.0%
Palliative Medicine Family Medicine

9.1% 65.0%
EXPLANATORY NOTES:
2. Speciality of MAID provider:
Family Medicine includes: Family Medicine, Family and Emergency Medicine
Palliative Medicine includes: Palliative Medicine, Family and Palliative Medicine
Internal Medicine includes: General Internal Medicine, Palliative care and Urology, Hospital Medicine, Gastroenterology, Endocrinology, Pneumology
Critical Care and Emergency medicine includes: Emergency Medicine, Critical Care, Critical Care and Emergency Medicine
Psychiatry includes: Psychiatry, Geriatric Psychiatry
Other includes: MAID, Neurology, Respiratory Medicine, Surgeon, Rehabilitation Medicine, Physical Medicine and Rehabilitation, Nephrology, Cardiology, Geriatric
Medicine, Obstetrician, Otolaryngology
As pictured in Chart 5.3, reporting practitioners had the option or selecting an ‘other’ category. Entries
in this category included a wide variety of specialty medicine groups, including a small number of
practitioners identifying themselves as “MAID Providers.” While this specialty is not officially recognized by
medical certifying bodies in Canada, it may be considered a functional specialty by some providers when
MAID is the primary focus of their practice.

5.4 TYPE OF PRACTITIONER PROVIDING THE WRITTEN SECOND
OPINION (ASSESSMENT)
The federal MAID legislation stipulates that, prior to providing MAID, a practitioner must ensure that a
second physician or nurse practitioner provide a written opinion confirming that the individual requesting
MAID meets all of the eligibility criteria. National data collected on the occupation of the health professional
that provided the second opinion/assessment showed that 92.9% were physicians and 7.1% were nurse
practitioners. This mirrors the proportion of physicians and nurse practitioners who provided MAID, as
outlined in Section 5.3. Information on the specialty of the practitioners providing the second opinion is not
currently collected under the monitoring regime.

6.0 SAFEGUARDS AND
SUPPLEMENTARY DATA
6.1 NATURE OF SUFFERING OF THOSE WHO RECEIVED MAID
One of the eligibility requirements for MAID is that the person’s illness, disease, disability or state of
decline causes them enduring physical or psychological suffering that is intolerable to them and cannot
be relieved in a manner that they find acceptable. This means that persons are not required to undergo
treatments that they do not wish to undertake. This is consistent with prior court decisions in Canada that
have reinforced the right of patients to refuse treatment, even if the treatment is needed to preserve that
person’s health or life.35
Practitioners are required to report on how the person requesting MAID described their suffering.
It is not the practitioner’s interpretation of the intolerability of an individual’s suffering; only the individual
requesting MAID can determine whether their suffering is unbearable. That being said, practitioners must
not provide MAID if they do not feel that the patient meets the eligibility criteria. The MAID recipient’s
description of suffering provides insight into their reason(s) for requesting MAID. When asked to describe
the nature of the suffering prompting their request, patients most often reported “a loss of ability to engage
in meaningful life activities” followed by “loss of ability to perform activities of daily living36” reported in 82.1%
and 78.1% of cases, respectively. A full list of reasons is outlined in Table 6.1.
35 E.g., Starson v. Swayze, [2003] 1 S.C.R. 722, 2003 SCC 32

36 Activities of daily living could include, for example, bathing, food preparation and managing finances.

Chart 6.1: Nature of Suffering of Those Who Received MAID, 2019
Loss of ability to engage in meaningful life activities 82.1%
Loss of ability to perform activities of daily living 78.1%
Inadequate control of symptoms other than pain

(or concern about it) 56.4%
Inadequate control of pain (or concern about it) 53.9%
Loss of dignity 53.3%
Perceived burden on family, friends or caregivers 34.0%
Loss of control of bodily functions 31.9%
Isolation or loneliness 13.7%
Emotional distress/anxiety/fear/existential suffering 4.7%
Loss of control/autonomy/independence 4.1%
No/poor/loss of quality of life 3.7%
Other 0.6%
EXPLANATORY NOTES:
2. More than one can be selected, so the total exceeds 100%.
6.2 SOURCE OF THE WRITTEN REQUEST FOR MAID

When reporting MAID deaths, practitioners are required to identify from whom they received the
individual’s written request for MAID that triggered the practitioners’ reporting obligations. Nationally, almost
half (42.4%) of written requests for MAID originated from a care coordination service, 32.0% originated
from the individual requestor and 23.9% originated from another practitioner, such as a physician, nurse
or social worker. The remaining 1.7% of written requests for MAID originated from another third party, such
as a hospital, long-term care facility or other care setting. These percentages vary significantly across the
provinces, depending upon whether the province has a MAID care coordination service. For example, in
most Atlantic provinces, very few written requests for MAID originated from a care coordination service,37
whereas in other provinces – in particular, the western provinces – the greatest proportion of requests
originated from this source. Provincial breakdowns can be found in Appendix A.
37 With the exception of Nova Scotia where 55.6% of MAID requests originated from a MAID care coordination service.

6.3 DETERMINATION OF THE PATIENT’S REQUEST AS VOLUNTARY
The federal legislation stipulates that an individual’s request for MAID must be voluntary and not made as
a result of external pressure. As part of their reporting obligations when providing MAID, practitioners are
required to specify how they formed the opinion that the patient’s MAID request was voluntary.
In virtually all cases where MAID was provided,

“Patient never faltered in his decision to practitioners reported that they had consulted
proceed with MAID. Wife was laying next to directly with the patient to determine the
him and his son was present. David died a voluntariness of the request for MAID. Other
dignified death.” commonly stated approaches for confirming this
Practitioner report opinion include consultation with family members
or friends (reported in 58.5% cases), review of the
patient’s medical records (reported in 43.9% of cases), and consultation with other health or social service
professionals (reported in 40.7% of cases). A full list is provided in Table 6.3.
Table 6.3: Determination of the Patient’s Request as Voluntary, 2019

Did the patient make a voluntary request for MAID that was not made of a result of external pressure? If yes,
indicate why you are of this opinion.
Consultation with patient 99.1%
Consultation with family members or friends 58.5%
Reviewed medical records 43.9%
Consultation with other health or social service professionals 40.7%
Knowledge of patient from prior consultation (other than MAID) 14.9%
Other 0.3%
EXPLANATORY NOTES:
2. Practitioners were able to identify more than one method they used to arrive at this conclusion, therefore totals exceed 100%.
6.4 CONSULTATION WITH OTHER HEALTH CARE PROFESSIONALS

Before providing MAID, the law requires practitioners to ensure that another physician or nurse practitioner
has provided a written opinion confirming that the person meets all of the eligibility criteria. Beyond this
legal requirement, as part of standard medical practice, practitioners often consult with other health care
professionals to inform their assessment of a patient’s eligibility for MAID.
In approximately half (48.3%) of reported MAID deaths in Canada in 2019, the practitioner providing MAID
had consulted with at least one other health care professional, in addition to the required second opinion
from another practitioner. Nurses were the most commonly consulted health professional (46.7%), followed
by the patient’s primary care provider (33.6%), palliative care specialists (28.4%) and social workers (25.2%).
A full list is provided in Table 6.4.

Table 6.4: Consultation With Other Health Care Professionals, 2019
Nurse 46.7%
Primary Care Provider 33.6%
Palliative Care Specialist 28.4%
Social Worker 25.2%
Other Physician 14.7%
Oncologist 13.5%
Other 9.0%
Psychiatrist 6.2%
EXPLANATORY NOTES:
2. “Other physician” included consultations with a wide range of over 20 medical specialties, the most common being neurologists, hospitalists, and respirologists/
pulmonologists.
3. Examples of entries in “other” included psychologist, speech pathologist, record review, spiritual care, and bio/medical ethicists.
6.5 THE 10 CLEAR DAY REFLECTION PERIOD

Practitioners who provide MAID must ensure that there are at least 10 clear days38 between the day on
which the patient signs the formal written request for MAID and the day on which MAID is provided. This is
frequently referred to as the “reflection period” and is a legislative safeguard intended to ensure individuals
reflect on their intention to proceed with their request for MAID after it is approved.
Practically speaking, the 10-day period can provide practitioners and MAID care coordination services with
the time needed to prepare for the administration of MAID, including communication with the pharmacist,
as well as time for the patient and their loved ones to make necessary arrangements.
The law allows practitioners to waive this safeguard

“I met Lois on November 8, 2019, only 5 days
if both MAID assessors agree that the patient’s
ago. She had recently been diagnosed with
death is imminent, or that the patient might lose
brain tumour, consistent with glioblastoma.
capacity to provide final consent for MAID provision
She was deemed palliative but Lois did not
prior to the completion of the 10-day period.
want any treatment to prolong her life. She
suffered headaches, nausea/vomiting and In 65.7% of MAID deaths, MAID was provided
was admitted with frailty for end-of-life care. following the 10-day reflection period. In the 34.3%
Another physician, the nursing team and of MAID deaths where this period was shortened,
myself were concerned about loss of capacity. most practitioners (84.4%) cited imminent loss of
MAID was accelerated as she had a narrow the patient’s capacity to consent as the primary
window before losing capacity. Lois was reason, with imminent death cited in 45.4% of
relieved that she could die through MAID, these cases.39
surrounded by family and friends.”
Practitioner report
38 In calculating the 10 clear days, the day on which the request was signed and the day on which MAID was provided, are not included.
39 In some scenarios, both circumstances applied, explaining why the total exceeds 100%.

6.6 INFORMATION RECEIVED FROM PHARMACISTS
Under the federal regulations, pharmacists are required to report each time they dispense substances
in connection with the provision of MAID. The information reported by a pharmacist is primarily used to
link the dispensing of the drugs with the MAID death reported by a practitioner for a specific individual.
However, it is also informative about the types of pharmacies dispensing drugs used for MAID.
Based on reports received from pharmacists across Canada, 63.0% of the drugs used for MAID were
dispensed from a hospital pharmacy, 30.4% from a community pharmacy and 6.6% from another type of
pharmacy, such as a compounding pharmacy. The data varies significantly when reviewing the source of
MAID drug dispensing across jurisdictions. Drugs used for MAID have been reported to be dispensed only
from hospital pharmacies in Newfoundland and Labrador, Prince Edward Island, Manitoba, Saskatchewan
and Yukon. Practitioners in New Brunswick and Quebec primarily obtain drugs for MAID provision from
hospital pharmacies. In comparison, practitioners in Nova Scotia, Ontario, Alberta and British Columbia
make approximately equal use of community and hospital pharmacies.
A significant number of MAID practitioners (17.5%) in Ontario also obtained drugs for MAID provision
from other types of pharmacies, such as compounding pharmacies or those that sell speciality medical
equipment (e.g., for intravenous therapy), which could be a feature of pharmacy regulation in that province.
There is an observed correlation between the type of pharmacy dispensing the drugs used for MAID
and the setting for MAID provision. For example, in Quebec and Saskatchewan, where drugs used
for MAID are dispensed from hospital pharmacies, MAID was carried out more frequently in a hospital
setting (48.6% in Quebec and 48.9% in Saskatchewan), as compared to the national average of 36.3%.
In contrast, in Ontario and British Columbia where drugs were more frequently dispensed through
community pharmacies, a greater proportion of MAID occurred in private settings (46.8% and 41.2%,
respectively) compared to the national average of 35.2%.

7.0 REQUESTS THAT DO NOT
RESULT IN A MAID DEATH
7.1 NUMBER OF REQUESTS AND OUTCOMES
As outlined in Table 7.1, there were 7,336 written requests for MAID reported through the federal MAID
monitoring system in 2019. As discussed in greater detail in Section 2.4, collecting MAID information
based solely on written requests received by a physician or nurse practitioner has resulted in some data
gaps, meaning that these numbers do not reflect the full extent of the demand for MAID across Canada.
Given these data limitations a robust analysis on the number referrals for MAID and the reasons why a
referral was made are not possible and this outcome is not presented in Table 7.1.
While the majority (73.5%, or 5,389) of written requests resulted in MAID provision, the remaining 26.5%
(or 1,947) of requests did not result in MAID being administered. Practitioners are still required to report
on the outcomes of these requests if becoming aware of the outcome within 90 days of the date of the
initial request. The reasons why a MAID request did not result in a provision can be attributed to one of the
following three scenarios: the patient died from a cause other than MAID (reported in 15.2% of cases), the
patient was found ineligible (reported in 7.8% of cases), or the patient withdrew their request (reported in
3.6% of cases)
Table 7.1: MAID Requests and Outcomes by Jurisdiction, 2019

NL PE NS NB QC ON MB SK AB BC YT NT NU Canada
MAID requests 24 23 140 134 2,159 2,303 244 136 555 1,603 - - - 7,336
Requests that have

206 125 62 155 571
been declined - - - - - - - - -
(9.5%) (5.4%) (11.2%) (9.7%) (7.8%)
(Ineligible)
Requests that have 134 63 21 35 263

- - - - - - - - -
been withdrawn (6.2%) (2.7%) (3.8%) (2.2%) (3.6%)
Requests where the

273 368 62 31 111 212 1,113
individual died prior - - - - - - -
(12.6%) (16.0%) (25.4%) (22.8%) (20.0%) (13.2%) (15.2%)
to MAID
Requests that
resulted in a 16 17 124 103 1,546 1,747 171 92 361 1,201 11 5,389
- -
medically-assisted (66.7%) (73.9%) (88.6%) (76.9%) (71.6%) (75.9%) (70.1%) (67.6%) (65.0%) (74.9%) (-) (73.5%)
death
EXPLANATORY NOTES:
November 1, 2018. For 2019, this represents 5,389 MAID deaths and an overall total of 7,336 written requests.
2. The total number of requests reported in this table reflects only written requests received by Health Canada under the Regulations for the Monitoring of Medical
Assistance in Dying. These numbers reflect requests received on or after November 1, 2018, and received by a physician or nurse practitioner. It is acknowledged that
jurisdictions may report different numbers of total requests and outcomes for the various scenarios (withdrawal, ineligible or patient) based on their own methodology for
receiving and counting requests.
3. Please refer to Data Limitations (Section 2.4) for an explanation of why referrals are not included in this table
4. Due to small numbers, some data have been supressed to protect confidentiality (represented by dashes).
written request.
6. Cases of self-administered MAID are included in this table. They are not identified by jurisdiction in order to protect confidentiality.
7. All other requests are counted in the year in which they are received
8. It is acknowledged that jurisdictions may report different numbers of total requests and outcomes for the various scenarios (withdrawal, ineligible or patient died) based
on their own methodology for receiving and counting requests.

7.2 PATIENT DIED OF A CAUSE OTHER THAN MAID
In 2019, practitioners reported that 1,113 patients who had submitted a written request for MAID
subsequently died of another cause. This number could include individuals who died before the end of the
10-day reflection period or those who died before their scheduled later date for MAID. It could also include
individuals who no longer intended to pursue MAID, but who did not advise the practitioner of this decision
after submitting the request or after having been approved for the procedure.
As outlined in Chart 7.2, in cases where the date of death was available,40 605 patients (59.1%) died during
the 10-day reflection period,41 235 patients (22.9%) died between 11 and 30 days after submitting their
written request and the remaining 184 (18.0%) patients died more than 30 days following the submission
of their written request. On average, these patients died 8 days after submitting their written request
for MAID. It is important to note that timelines were based on the date of receipt of the official written
and signed request as required in the legislation, and not necessarily from the date of the initial request
or assessment.
Chart 7.2: Timing of Death Following Written Request (Patient Died of Another Cause), 2019
18.0% 59.1%
Less than 10 days

11 to 30 days
> 30 days
22.9%
EXPLANATORY NOTE:
November 1, 2018. For 2019, this represents 5,389 MAID deaths and 1,113 individuals who died prior to the provision of MAID.
Notably, 86.2% of patients who died of a cause other than MAID received palliative care, and of the others,
93.0% were reported as having access to palliative care if it was required. Similar data was observed
among patients who had received MAID, as outlined in Section 4.3. The demographic information and
main underlying condition of patients in this category were also very similar to those who received MAID:
93.0% were age 56 or older, slightly more men (55.5%) than women (45.5%) were reported in this category
and 66.6% were reported as having cancer as their main underlying medical condition.
40 This represents the vast majority (1,024, or 92%) of the 1,113 patients who died of cause other than MAID.
41 Of these patients, 89 (or 8.7%) died within one day of submitting the written request.

7.3 INELIGIBILITY
In 2019, practitioners reported that 571 patients who had submitted a written request for MAID were
deemed ineligible. The law stipulates the eligibility criteria that must be met in order to be approved for
MAID. These criteria were outlined earlier in this report in Table 1.2.
As noted in Table 7.3 below, the primary reasons for finding patients ineligible for MAID, included their lack
of capacity to make health care decisions (32.2%), their natural deaths were not reasonably foreseeable
(27.8%), and their medical circumstances were such that they were not in an advanced state of irreversible
decline in capability (23.5%). The patient demographics of those deemed ineligible for MAID were very
similar to those patients who received the procedure: 92.6% were 56 and older and an equal proportion
of male and female patients were reported in this category.
Table 7.3: Reasons for Ineligibility for MAID, 2019

Not capable of making decisions with respect to health 32.2%
Natural death not reasonably foreseeable 27.8%
Not in an advanced state of irreversible decline in capability 23.5%
Not experiencing suffering that is intolerable to them 17.7%
Could not provide informed consent 17.0%
Did not have a serious and incurable illness, disease or disability 13.3%
Request was not voluntary 1.6%
EXPLANATORY NOTES:
November 1, 2018. For 2019, this represents 5,389 MAID deaths and 571 cases where the individual was ineligible for MAID.
2. Since practitioners could determine that an individual did not meet more than one of these criteria, the total responses exceed 100%.
7.4 PATIENT WITHDRAWS THEIR REQUEST FOR MAID

In 2019, practitioners reported that 263 patients who had submitted a written request for MAID
subsequently withdrew it. The status of a patient’s request for MAID at the time of withdrawal can vary:
the request could have been assessed and approved, been partially assessed, or not yet undergone any
assessment.
The most common reason reported for withdrawing a MAID request was that the patient changed their
mind (reported in 54.0% of cases). This could include instances where a patient decided they were able
to cope with their suffering and elected to delay the procedure to a future date (practitioners have reported
anecdotally that simply knowing that MAID is a viable option can provide some patients with peace of
mind). It could also include circumstances where the patient’s condition stabilized, improved or where they
decided to continue their current treatment course instead of pursuing MAID. A full list of reasons for MAID
withdrawals is outlined in Table 7.4.

Table 7.4: Reason for Withdrawal of MAID Request, 2019
Changed their mind 54.0%
Palliative measures are sufficient 26.2%
Withdrawal immediately before MAID 20.2%
Family members do not support MAID 7.6%
Other 1.5%
EXPLANATORY NOTES:
November 1, 2018. For 2019, this represents 5,389 MAID deaths and 263 cases where the individual withdrew their MAID request.
2. Since practitioners could determine that an individual did not meet more than one of these criteria, the total responses exceed 100%.
The age demographics of patients who withdrew their MAID request were very similar to those who
received MAID, with 89.8% of patients being age 56 or older. A slightly greater proportion of women
(54.4%) than men (45.6%) withdrew their MAID request.

8.0 CONCLUSION
8.1 REFLECTIONS ON THE PAST FOUR YEARS
Over the past four years, as the evidence base on MAID has grown, other places around the world have
implemented legislative changes to permit some form of assisted dying. This includes five additional U.S.
states (Colorado, the District of Columbia, Hawaii, Maine and New Jersey) and the Australian state of
Victoria. New Zealand has also introduced legislation permitting assisted suicide (self-administered MAID),
which will come into force pending a referendum in the fall of 2020.
Recognizing that there are a diversity of views on the topic, public opinion research has consistently
demonstrated strong support for MAID over the past several years.42, 43, 44 To support Canadians who
choose MAID, practitioners and health system administrators across the country have made great
efforts to provide quality of care and access. For instance, the Canadian Association of MAID Assessors
and Providers (CAMAP) has provided a valuable forum for information sharing among health care
professionals, health system administrators, policy makers and researchers. Since its creation in 2017,
CAMAP has hosted an annual conference to discuss emerging issues related to the delivery of MAID
and developed several guidance documents for health professionals to support exiting tools that may
have been developed by provincial health regulators. At the provincial/territorial level, some jurisdictions
have established MAID care coordination services and institution-level MAID teams to manage increasing
numbers of MAID requests, balance the workload and distribution of a limited number of MAID assessors/
providers and minimize disparities in MAID access (e.g., rural/urban).
With respect to monitoring, the reporting requirements set out in the Regulations have contributed to a
better understanding of requests for MAID and associated outcomes. Procedures are being developed
to make the data under the federal monitoring system available to qualified researchers upon request,45
which will help to further inform and enrich the work on MAID in Canada. Future annual reports will also
include an analysis of trends over time. Data linkages which would allow for more in-depth examinations
of the social circumstances of persons requesting MAID (such as geography), are also being considered
to support improved practice and policy decisions for social services and for health care systems. Health
Canada will continue to work with provinces and territories to further improve and refine current data
collection practices.
42 Ipsos. “Large Majority (86%) of Canadians Support (50% Strongly/36% Somewhat) Supreme Court of Canada Decision about Medical
Assistance in Dying.” Ipsos, February 6, 2020.
43 Ipsos. “Most (84%) Canadians Believe a Doctor Should be Able to Assist Someone Who is terminally ill and Suffering Unbearably to
End their Life”. Ipsos, October, 2014.
44 Angus Reid Institute. Social Values in Canada: Consensus on assisted dying & LGBTQ2 rights, division over abortion rights, diversity.
Angus Reid Institute, January, 2020.
45 This access is subject to applicable federal legislation and policies that relate to privacy and protection of personal information.

8.2 LOOKING AHEAD
In June 2017, two residents of Quebec, Jean Truchon and Nicole Gladu, challenged both Quebec’s and
Canada’s MAID legislation on the basis that the federal requirement that an individual’s natural death be
“reasonably foreseeable” and the Quebec requirement that a person be at the “end of life” were in violation
of their Charter rights. On September 11, 2019, the Superior Court of Quebec found these requirements
to be unconstitutional. Neither the federal nor the Quebec government chose to appeal the decision.
The Quebec Court suspended the effect of the
declaration of invalidity for a period of 6 months,
until March 11, 2020, and granted a constitutional
“Patient thanks the government for making it
exemption to the plaintiffs during the suspension
possible for her to get such care. Patient died
period. The suspension of the decision was
very peacefully.”
extended to July 11, 2020,46 and again more
recently to December 18, 2020, in light of the Practitioner report
COVID-19 pandemic.
During January and early February 2020, the Government of Canada launched consultations to inform the
legislative amendments on MAID, consisting of an online public questionnaire and a series of ten cross-
country roundtables with experts and stakeholders. A What We Heard report, summarizing the input
received through these consultations, can be found on the Department of Justice’s website.
On February 24, 2020, the federal government tabled Bill C-7 in Parliament to amend the federal legislation
on MAID. Bill C-7 responds to the Superior Court of Quebec’s September 2019 ruling in Truchon and
introduces other amendments on issues where there was broad consensus. Proposed changes to the
legislation included:
• removing the eligibility requirement for a reasonably foreseeable natural death;
• waiving the requirement for final consent in those circumstances where persons approved for MAID risk
losing capacity to consent before their scheduled date for MAID, and they have an advance consent
agreement with their practitioner;
• adding safeguards to ensure that adequate time and expertise are devoted to the eligibility assessment
of persons whose natural death is not reasonably foreseeable; and,
• enhancing the reporting requirements for the national monitoring regime to allow for data collection
on assessments for MAID where a request has not been put in writing and to collect information on
preliminary assessments that are conducted by other health care professionals.
46 On March 2, 2020, the Court granted the Attorney General of Canada’s request that the suspension of the declaration of invalidity be
extended for four months, until July 11, 2020, to give Parliament sufficient time to consider and enact proposed amendments to the
Criminal Code. The Quebec Superior Court also ruled the end-of-life criterion in the Quebec law invalid. Quebec did not request an
extension to the suspension of the declaration of invalidity.

Bill C-7 does not address the particularly complex issues that were identified for further consideration
and study by the CCA: mental illness as a sole underlying medical condition, expanding access to
mature minors, and advance requests. These issues may be considered during the statutorily required
parliamentary review of the legislation on medical assistance in dying.
As discussed in Section 2.4, collecting data based solely on “written requests” has resulted in data gaps
in some key areas. The proposed legislative changes could provide the Government with the opportunity
to address some of these gaps. For example, as stated above, Bill C-7 proposes to allow the collection of
information on all assessments for MAID, including preliminary assessments undertaken by other health
care professionals. By addressing this gap in the current reporting regime, the monitoring system could
provide a fuller understanding of MAID in Canada. Any amendments to the current monitoring system will
be undertaken in consultation with provinces, territories, and implicated health care providers.
At the time of writing, Parliament was considering Bill C-7. However, the COVID-19 pandemic led to the
disruption of the current Parliamentary session. On June 11, 2020 the Attorney General of Canada filed a
motion requesting a five-month plus one-week extension (December 2020) of the period of suspension
of the Truchon decision to allow parliamentarians to fully consider the proposed bill. This extension was
granted on June 29, 2020, effective until December 18, 2020.

Appendix A Profile of Medical Assistance in Dying by Jurisdiction January 1 to December 31, 2019
Jurisdiction NL PE NS NB QC ON MB SK AB BC YT NT NU
Population 521,542 156,947 971,395 776,827 8,484,965 14,566,547 1,369,465 1,174,462 4,371,316 5,071,336 40,854 44,826 38,780
Total number of medically assisted deaths 16 17 124 103 1,546 1,747 171 92 361 1,201 11 – –
Number of medically Hospital – – – – 46 37.1% 46 44.7% 752 48.6% 456 26.1% 74 43.3% 45 48.9% 169 46.8% 346 28.8% – – – – – –
assisted deaths by
setting Private Residence – – – – 51 41.1% 34 33.0% 295 19.1% 817 46.8% 59 34.5% 19 20.7% 106 29.4% 506 42.1% – – – – – –
Palliative Care Facility – – – – 16 12.9% 23 22.3% 399 25.8% 360 20.6% 26 15.2% 19 20.7% 44 12.2% 218 18.2% – – – – – –
Residential Care
– – – – 11 8.9% 0 0.0% 100 6.5% 114 6.5% 12 7.0% 9 9.8% 42 11.6% 131 10.9% – – – – – –
Facility/Other
Average age of person who received MAID 70.4 73.9 73.3 72.2 73.5 75.8 76.6 76.2 74.6 76.9 68.3 – –
Age range of person 18–45 – – – – – – – – 32 2.1% 29 1.7% – – – – – – 26 2.2% – – – – – –

receiving MAID
46–55 – – – – – – – – 65 4.2% 98 5.6% – – – – – – 42 3.5% – – – – – –
56–64 – – – – 18 14.5% 14 13.6% 218 14.1% 200 11.4% 19 11.1% 16 17.4% 53 14.7% 140 11.7% – – – – – –
65–70 – – – – 20 16.1% 17 16.5% 301 19.5% 275 15.7% 30 17.5% 16 17.4% 55 15.2% 165 13.7% – – – – – –
71–75 – – – – 22 17.7% 30 29.1% 269 17.4% 236 13.5% 29 17.0% 10 10.9% 46 12.7% 162 13.5% – – – – – –
76–80 – – – – 21 16.9% 12 11.7% 247 16.0% 250 14.3% 19 11.1% 13 14.1% 47 13.0% 161 13.4% – – – – – –
81–85 – – – – 15 12.1% 14 13.6% 198 12.8% 226 12.9% 18 10.5% 13 14.1% 46 12.7% 171 14.2% – – – – – –
86–90 – – – – 9 7.3% 7 6.8% 136 8.8% 230 13.2% 18 10.5% 9 9.8% 45 12.5% 174 14.5% – – – – – –
91+ – – – – 9 7.3% – – 80 5.2% 203 11.6% 28 16.4% 12 13.0% 37 10.2% 160 13.3% – – – – – –
Number of Men 7 43.8% 8 47.1% 70 56.5% 65 63.1% 821 53.1% 898 51.4% 77 45.0% 48 52.2% 176 48.8% 571 47.5% – – – – – –
men / women
receiving MAID Women 9 56.3% 9 52.9% 54 43.5% 38 36.9% 725 46.9% 849 48.6% 94 55.0% 44 47.8% 185 51.2% 630 52.5% – – – – – –
Most common Cancer-Related 12 75.0% 10 58.8% 84 67.7% 69 67.0% 1170 75.7% 1087 62.2% 104 60.8% 69 75.0% 238 65.9% 771 64.2% – – – – – –
reported underlying
medical condition Neurological
– – – – 15 12.1% 13 12.6% 149 9.6% 179 10.2% 21 12.3% – – 45 12.5% 126 10.5% – – – – – –
of patients who Condition
obtain a medically
assisted death Chronic Respiratory
– – – – 14 11.3% 12 11.7% 168 10.9% 166 9.5% 15 8.8% 10 10.9% 46 12.7% 143 11.9% – – – – – –
Disease
Cardiovascular – – – – 9 7.3% 8 7.8% 113 7.3% 175 10.0% 14 8.2% 7 7.6% 48 13.3% 166 13.8% – – – – – –
Other Organ Failure – – – – – – – – 68 4.4% 58 3.3% – – – – 19 5.3% 79 6.6% – – – – – –
Multiple
– – – – – – 9 8.7% 86 5.6% 185 10.6% 18 10.5% 9 9.8% 34 9.4% 136 11.3% – – – – – –
Comorbidities
Other Condition – – – – – – – – 37 2.4% 95 5.4% – – – – 25 6.9% 164 13.7% – – – – – –
First Annual Report on Medical Assistance in Dying in Canada, 2019

43
44
Jurisdiction NL PE NS NB QC ON MB SK AB BC YT NT NU
Speciality of MAID Family Medicine 9 56.3% 14 82.4% 55 44.4% 79 76.7% 1,131 73.2% 920 52.7% 92 53.8% 9 9.8% 227 62.9% 962 80.1% – – – – – –
provider
Palliative Medicine – – – – 12 9.7% 24 23.3% 152 9.8% 280 16.0% 0 0.0% – – – – 13 1.1% – – – – – –
Anesthesiology – – – – 25 20.2% 0 0.0% 20 1.3% 173 9.9% 0 0.0% 16 17.4% 9 2.5% 23 1.9% – – – – – –
Internal Medicine – – – – 11 8.9% 0 0.0% 127 8.2% 53 3.0% 0 0.0% – – 13 3.6% 44 3.7% – – – – – –
Critical Care /
– – – – 0 0.0% 0 0.0% 9 0.6% 73 4.2% 0 0.0% 0 0.0% 10 2.8% – – – – – – – –
Emergency Medicine
Oncology – – – – 0 0.0% 0 0.0% 21 1.4% 31 1.8% 0 0.0% 0 0.0% 34 9.4% – – – – – – – –
Psychiatry – – – – 0 0.0% 0 0.0% 0 0.0% 9 0.5% 0 0.0% 39 42.4% 14 3.9% – – – – – – – –
Other – – – – 9 7.3% 0 0.0% 86 5.6% 49 2.8% 79 46.2% 7 7.6% – – 12 1.0% – – – – – –
Nurse Practitioner 0 0.0% 0 0.0% 12 9.7% 0 0.0% 0 0.0% 159 9.1% 0 0.0% 19 20.7% 49 13.6% 145 12.1% – – – – – –
Source of the written Patient Directly – – – – 19 15.3% 56 54.4% 505 32.7% 622 35.6% 53 31.0% 86 93.5% 54 15.0% 312 26.0% – – – – – –
request
Another Practitioner – – – – 37 29.8% 42 40.8% 487 31.5% 442 25.3% 0 0.0% – – 21 5.8% 235 19.6% – – – – – –
Care Coordination
– – – – 68 54.8% – – 530 34.3% 634 36.3% 118 69.0% – – 286 79.2% 640 53.3% – – – – – –
Service
Other – – – – 0 0.0% – – 24 1.6% 49 2.8% 0 0.0% – – – – 14 1.2% – – – – – –
EXPLANATORY NOTES:
1. This table represents MAID data captured under the Regulations for the Monitoring of Medical Assistance in Dying, whereby the written request was received on or after November 1, 2018. For 2019, this represents 5,389 MAID deaths.
2. MAID provisions are counted in the calendar year in which the death occurred (i.e., January 1 to December 31), and are not related to the date of receipt of the written request.
First Annual Report on Medical Assistance in Dying in Canada, 2019

3. Due to small numbers, some data have been supressed to protect confidentiality (represented by dashes).
4. Cases of self-administered MAID are included in this table. They are not identified by year or jurisdiction in order to protect confidentiality.
5. Statistics Canada. Table 17-10-0005-01 Population estimates on July 1st, by age and sex
6. Speciality of MAID provider:
Family Medicine includes: Family Medicine, Family and Emergency Medicine
Palliative Medicine includes: Palliative Medicine, Family and Palliative Medicine
Internal Medicine includes: General Internal Medicine, Palliative care and Urology, Hospital Medicine, Gastroenterology, Endocrinology, Pneumology
Critical Care and Emergency medicine includes: Emergency Medicine, Critical Care, Critical Care and Emergency Medicine
Psychiatry includes: Psychiatry, Geriatric Psychiatry
Other includes: MAID, Neurology, Respiratory Medicine, Surgeon, Rehabilitation Medicine, Physical Medicine and Rehabilitation, Nephrology, Cardiology, Geriatric Medicine, Obstetrician, Otolaryngology
7. Underlying Medical Condition: Providers were able to select more than one medical condition when reporting; therefore, the total exceeds 100%. The category of “other conditions” includes a range of conditions, with frailty commonly cited.
8. MAID By Setting: Hospital excludes palliative care bed/unit; Palliative care facility includes hospital-based palliative care bed/unit or hospice; Residential Care Facility includes long term care facility; Private Residence includes retirement homes.

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First Annual Report on

MEDICAL ASSISTANCE IN DYING

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Publication date: July 2020

1.0 The Evolution of Federal MAID Legislation.............................................................................. 10

2.0 Methodology and Limitations................................................................................................... 14

3.0 Cases of MAID in Canada......................................................................................................... 18

4.0 Profile of Persons Receiving MAID.......................................................................................... 21

First Annual Report on Medical Assistance in Dying in Canada, 2019 3

6.0 Safeguards and Supplementary Data...................................................................................... 31

7.0 Requests That Do Not Result in a MAID Death....................................................................... 36

4 First Annual Report on Medical Assistance in Dying in Canada, 2019

The number of medically assisted deaths is steadily increasing

Profile of MAID recipients1

The majority of MAID recipients also received supportive services

First Annual Report on Medical Assistance in Dying in Canada, 2019 5

Nature of suffering among MAID recipients

6 First Annual Report on Medical Assistance in Dying in Canada, 2019

MAID is being delivered across the country as part of the suite of

First Annual Report on Medical Assistance in Dying in Canada, 2019 7

The Honourable Patty Hajdu,

8 First Annual Report on Medical Assistance in Dying in Canada, 2019

First Annual Report on Medical Assistance in Dying in Canada, 2019 9

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1.2 THE DEVELOPMENT OF CANADA’S LEGISLATION ON MAID

First Annual Report on Medical Assistance in Dying in Canada, 2019 11

Table 1.2 – Bill C-14 Eligibility Criteria and Safeguards

12 First Annual Report on Medical Assistance in Dying in Canada, 2019

First Annual Report on Medical Assistance in Dying in Canada, 2019 13

2.1 DATA COLLECTED UNDER THE FEDERAL REGULATIONS

Practitioners also report:

14 First Annual Report on Medical Assistance in Dying in Canada, 2019

2.2 DATA COLLECTED THROUGH INTERIM REPORTS

First Annual Report on Medical Assistance in Dying in Canada, 2019 15

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First Annual Report on Medical Assistance in Dying in Canada, 2019 17

Chart 3.1: Total Reported MAID Deaths in Canada, 2016 to 2019

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2016 – – 23 7 494 191 24 11 63 194 – – – 1,015

2017 – – 62 47 853 839 63 57 205 677 – – – 2,833

2018 22 8 126 82 1,236 1,500 138 85 307 951 10 – – 4,467

2019 16 17 147 129 1,589 1,788 177 97 377 1,280 13 – – 5,631

3.2 MAID DEATHS AS A PROPORTION OF OVERALL DEATHS IN CANADA

First Annual Report on Medical Assistance in Dying in Canada, 2019 19

Percent of Jurisdictional Deaths Percent of All Deaths, Canada

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4.1 UNDERLYING MEDICAL CONDITIONS OF THOSE RECEIVING MAID

First Annual Report on Medical Assistance in Dying in Canada, 2019 21

4.2 GENDER, AVERAGE AGE AND AGE RANGE OF PATIENTS WHO

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18–45 46–55 56–64 65–70 71–75 76–80 81–85 86–90 91+

4.3 PALLIATIVE CARE AND DISABILITY SUPPORT SERVICES

While there is no universally agreed upon definition

First Annual Report on Medical Assistance in Dying in Canada, 2019 23

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First Annual Report on Medical Assistance in Dying in Canada, 2019 25

In 2019, the primary settings for the administration

26 First Annual Report on Medical Assistance in Dying in Canada, 2019