Is Structural Marginalization Driving Medical Assistance in Dying (MAiD) in Canada? Interpreting Observational Data, Social Context, and Regulatory Reports

Authors

  • James Downar, MDCM, MHSc (Bioethics), FRCPC Division of Palliative Care, University of Ottawa, Clinical Research Chair in Palliative and End-of-Life Care, Adjunct Professor, Queensland University of Technology School of Law Author
  • Kieran L. Quinn, MD, PhD, FRCPC Temmy Latner Centre for Palliative Care, Sinai Health System, Department of Medicine, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada Author

Abstract

This article analyzes current data on Medical Assistance in Dying (MAiD) in Canada, focusing on the interpretation of observational and demographic measures. It explores how structural marginalization is used as a proxy for vulnerability, and considers what this might tell us about decisional capacity and voluntariness in MAiD choices. Drawing on population-based datasets and case reviews, the analysis reveals that by every available measure, MAiD recipients are more socioeconomically privileged, with better service access and a better dying experience than that of the broader population. These findings refute common claims that marginalization and vulnerability drive MAiD requests, and challenge the idea that marginalization is undermining voluntariness in people who request MAiD. This review aims to clarify what current data can and cannot tell us about MAiD in practice, emphasizing the need for nuanced interpretation to guide future MAiD health policy and law.

Author Biographies

  • James Downar, MDCM, MHSc (Bioethics), FRCPC, Division of Palliative Care, University of Ottawa, Clinical Research Chair in Palliative and End-of-Life Care, Adjunct Professor, Queensland University of Technology School of Law

    Dr. Downar is a Critical Care and Palliative Care physician in Ottawa. He graduated from McGill Medical School and completed residency training in Internal Medicine, Critical Care, and Palliative Care at the University of Toronto. He has a Master’s degree in Bioethics from the Joint Centre for Bioethics at the University of Toronto. He is currently Professor and Head of the Division of Palliative Care at the University of Ottawa, where he holds a Clinical Research Chair in Palliative and End of Life Care. He is an adjunct professor at the Australian Centre for Health Law Research at the Queensland University of Technology. He is the current President of the Canadian Critical Care Society and co-chair of the Pan-Canadian Palliative Care Research Collaborative. He has authored more than 170 peer-reviewed publications and was the principal investigator on more than 30 peer-reviewed grants on topics such as medical aid in dying, communication and decision-making for serious illness, palliative care in the critical care setting, grief and bereavement, and the treatment of psychological and existential distress in advanced illness. In 2025, he received the King Charles III Coronation medal for contributions to Palliative Care in Canada, and in 2021 he received the Award of Excellence from the Ontario Medical Association’s Section on Palliative Medicine.

  • Kieran L. Quinn, MD, PhD, FRCPC, Temmy Latner Centre for Palliative Care, Sinai Health System, Department of Medicine, University of Toronto, Toronto, ON, Canada Institute for Clinical Evaluative Sciences, Toronto, ON, Canada Institute of Health Policy, Management and Evaluation, University of Toronto, ON, Canada

    Dr. Quinn is a General Internist and Palliative Care Clinician-Scientist at Sinai Health in the Department of Medicine and Institute of Health Policy, Management and Evaluation at the University of Toronto and a Full Scientist at Institute for Clinical Evaluative Services. His research focuses on using advanced analytic methods, artificial intelligence, and large administrative datasets to accelerate knowledge creation that improves access and delivery of high-quality end-of-life care for people living with advanced illnesses like heart failure, dementia, and cancer. His early research success includes over $36 million dollars in competitive grant funding and more than 120 publications in high-impact journals such as the New England Journal of Medicine, JAMA, and BMJ. He has mentored 19 trainees who have published multiple peer reviewed papers and won several awards for their work together.

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Published

2025-12-16

Issue

Volume 1, Issue 1, Fall 2025

Section

Articles