The federal government may have hit the pause button “indefinitely” on the expansion of MAiD for mental health related issues, but it still has not offered any new help for those that say their mental health crisis is a direct result of living in “legislated poverty.”

For disabled Canadians like Mitchell Tremblay, nothing has changed. 

The Guelph man continues to struggle with mental health issues, poverty, and housing insecurity. Unable to afford to live, he says he’s seriously considered applying for MAiD.

“Rather than go and fight for proper [mental health and disability] support or safe housing here, I was pushing for my own death,” he said. 

Although the expansion has been delayed, Tremblay and others are left feeling discarded by the government’s handling of the issue. The fundamental issues haven’t changed for Canadians with disabilities, who are still living in poverty or being forced into homelessness.

Tremblay’s own mental health worsened from living in unsafe housing administered by an abusive landlord. He eventually developed agoraphobia — there was no way to lock his bedroom doors and he worried about having his belongings stolen, or coming home and being evicted without notice, which happened to him in the past.

“I realized that I was being coerced [due to the lack of supports],” Tremblay told Ricochet. He’s now found safer housing, but is exhausted and burned out from fighting the system. 

Tremblay says part of the problem was that the process itself did not consider the most marginalized people. 

The special committee that convened to determine the fate of the MAiD expansion didn’t speak with any advocates or disabled individuals impacted by these policies. The committee also did not include ministers of health, mental health and addictions, or persons with disabilities, nor their shadow cabinet or NDP critic counterparts.

The committee’s final report only mentioned poverty once — which experts and advocates say has been a key issue with MAiD and the criticism of its expansion. 

Disability advocate Sarah Colero says the Canadian government is failing disabled Canadians by forcing them to live in a constant state of escalating poverty. 

Colero calls the financial support that is available to people with disabilities — ranging between $800 and $2000 depending on the province, well below the poverty line — legislated poverty. “This isn’t viable. I’m not getting money to feed myself. I’m not getting money to shelter myself. The only viable option there is MAiD.”

And, Colero says, getting on disability supports in the first place is very challenging. “Not only is it hard to get on, it’s hard to maintain your position as a recipient of a disability program.”

The Federal government recently introduced a disability benefit set to be implemented in 2028. The benefit has been widely criticized by disability advocates, as it would only provide an extra $2,400 per year. 

Every month, she has to report that she hasn’t left the province. If she forgets, her account is put on hold. “We are really on a tight leash. Not only is it legislative poverty, but we have to go through all these checks and balances repeatedly to stay destitute.”

Colero said that people are not being offered the treatments, support, housing, or healthcare that they need. 

Increasingly, Canadians are turning to food banks and other frontline organizations, some increasingly desperate for support. The CEO of Food Banks Mississauga told Macleans that people are barely surviving. “Clients are telling us they’re considering medically assisted death or suicide because they can’t live in grinding poverty anymore.” 

Krista Carr, executive vice president of Inclusion Canada, told Ricochet that her organization receives about 10 calls per month. “Situations have gotten so desperate that they are wondering if there’s any other choice. It’s a lot cheaper for the system to end people’s lives than it is to support them to live well.”

Tremblay says he’s connected with many other Canadians considering MAiD due to poverty or housing insecurity.

“In my circle, it’s in the hundreds,” he said.

In an online document, the federal government states that it recognizes structural barriers and systematic biases like race, disability, and socioeconomic status as factors that affect people’s access to healthcare. However, MAiD “practitioners must work to keep systemic biases out of their assessment.”

“On the one hand, providing MAiD might lead the practitioner to believe they are complicit with societal failures. On the other hand, not providing MAiD to a person who wishes to access it and fulfills the eligibility criteria might lead the practitioner to believe they are forcing the requester to live in a state of intolerable suffering,” the site states.

Scott Kim, a psychiatrist and bioethicist at the National Institutes of Health, who studies MAiD, told Ricochet Media there are deep flaws in the system.

“The document suggests in very artful and lawyerly language that a provider who declines to perform MAiD is ‘forcing’ the requestor to suffer unbearably. That is a very perverse way of manipulating the public and the providers, to suggest that a caring clinician who would rather work with a patient to help them regain their will to live is doing something cruel,” he said.

MAiD instead of healthcare access and a social safety net

The link between socioeconomic factors, mental health, and expanding MAiD aren’t complicated, Kim said. Most health professionals know that poverty only exacerbates a range of health issues. “I don’t think you need an expert to see the obvious connections,” he said.

The number of Canadians ending their lives through medically assisted death has grown at a speed that it now outpaces every other nation in the world.

Assisted deaths accounted for four per cent of all deaths in Canada in 2022 — up from one per cent in 2017, the first full year the legislation was in place. In 2022, the total number hit 13,000 nationwide.

MAiD officially became legal in Canada in 2016 under the requirement that death was reasonably foreseeable. The eligibility to apply expanded in March of 2022 to include people with disabilities, or those suffering pain even if they are not close to death.

Since then, there have been numerous cases across the country of people with manageable disabilities or chronic illnesses applying for MAiD because ultimately they are too poor to live. They have come to represent Canada’s failure to care for its most vulnerable citizens, and have raised serious questions about how assisted-suicide laws are applied.

People like 54-year-old Amir Farsoud from St. Catharines, who told CityNews in 2022 that he was unable to make rent on the Ontario Disability Support payments he gets. “I don’t want to die, but I don’t want to be homeless more than I don’t want to die.”

In December, a 52-year-old grandfather in need of cancer treatment opted for MAiD because of long chemotherapy wait times in British Columbia. Last year a Cape Bretan woman applied because she’s been waiting more than a decade to receive workers’ compensation. “I can’t live with this type of pain and I’m disintegrating to nothing, and the options that I have for quality of life are there, but workers’ comp is refusing to provide them, so I have no option really but to apply for MAID,” she told CTV.

Last summer in Ontario, a disabled woman applied because she said it’s easier to access than the province’s disability support program. “It’s not what I want,” she told CBC. “But if I don’t receive the support that I need, the outcome is the same.”

In August, a Vancouver-hospital even went as far as suggesting MAiD to a woman seeking help for suicidal thoughts. Then there was a Veterans Affairs employee who was investigated for pressuring at least four veterans to use MAiD. 

And recently, in May, Stéphanie Lavoie, a Quebec woman with Lyme disease, accessed MAiD as a last resort. Her family claims she was denied at home care because she didn’t meet Quebec’s healthcare system criteria. “Is it ethical to let someone die because they do not fit into one of the famous checkboxes?” she told Global News.  

Both Health Canada and the Canadian Association of MAiD Assessors and Providers told Ricochet that people cannot access MAiD solely due to poverty. 

However, Madeline, a woman living with a disability who previously spoke with Ricochet, provided documentation that she was approved for MAiD. She explained that her health has deteriorated as a direct result of poverty and an inability to afford the treatments she needs to live — treatments that exist and the government refuses to pay for.  

The promise of federal disability payments

The U.N and the Canada Human Rights Commission have both noted that Canada is using MAID as a result of their failure to fulfill human rights obligations, Colero points out. 

“The same obligations Canada committed to when they ratified the UNCRPD (United Nations Convention on the Rights of People with Disabilities),” she said. “There’s something seriously wrong when a country as wealthy as Canada continues to deny basic human rights to disabled people while simultaneously claiming to have ratified the UNCRPD 14 years ago.”

In 2020, the federal government announced a plan to provide a disability benefit that would top up provincial benefits to help pull some disabled people out of poverty, allowing them to afford safe housing and medical treatments. 

The benefit was even mentioned on the government’s website answering questions about MAiD, under a section that explained the ways that the government was working “to better meet the needs of disabled communities in Canada.” That was in March of 2021, in time for the federal election. This was removed from the website by February 2023. 

A spokesperson from Health Canada declined to answer why this section was removed. 

In 2021, MAiD legislation expanded to allow people without terminal conditions to access assisted death. 

“The reality is, the federal Liberals promised disabled people financial help to coincide with the MAID expansions,” Colero said.

Finance minister and deputy prime minister Chrystia Freeland was asked in November why no money has been earmarked for the benefit, but she offered no concrete answer.

In April, the Federal government announced the Canadian Disability Benefit in their 2024 budget, amounting to an extra $200 per month in support. The benefit can only be accessed by going through the Disability Tax Credit, which both the Senate and Canadian Revenue Agency’s disability advisory committee acknowledge is in need of reform. And the benefit was widely criticized by persons with disabilities, and only about 40 per cent of disabled Canadians living in poverty would even qualify, according to Inclusion Canada.

A failure to respond to public concerns about MAiD

Colero and Tremblay note that there have been no substantial changes in policy to improve healthcare access or disability support since MAiD expansion for mental illness was delayed the first time.

Documents obtained through access to information requests reveal that similar concerns have also been raised internally. 

In a document dated January 11 2023, Maureen Denison, a senior policy advisor for Veteran Affairs Canada, provided her feedback on MAiD practice standards to Health Canada and the chair of the federal expert panel on MAiD. 

“There is no acknowledgement that in Canada, timely access to needed care is not given across all types of medical, specialist, surgical, and nursing care, in particular mental health support. This lack of access and subsequent lack of treatment could cause a person to ‘give up’ and seek MAiD,” the document states. 

The Ministry did not respond to specific questions about this document. Ricochet was also unable to contact Denison.

During the question period for the report of the special joint committee on MAID in June, 2023, a note provided to the Minister of Health provided recommended responses to questions about MAiD expansion and media stories surrounding MAiD.

A section titled: “If pressed on the government’s reaction to media stories alleging that people are seeking MAiD due to lack of needed services” suggests ways to dodge the question without actually engaging with the examples provided in the media while also stating that “improving access to social and health services remains a priority” and mentioning the proposed Canadian disability benefit.

An internal memorandum written by Health Canada in 2022 stated that the ministry was taking extra steps to improve data collection, including looking at income tax data, collected by the Canadian Revenue Agency (CRA), of MAiD applicants to obtain more background information. According to an access to information request filed by Ricochet, the CRA has no record of any documents or email communications about the topic.

A spokesperson for Health Canada declined to answer whether people can be approved for MAiD when the driver of their health deterioration is poverty. The spokesperson also declined to comment on the many individual cases of people seeking MAiD because they are too poor to live. 

“I have been deeply troubled by some people in the bioethics community and in the legal community suggesting that there is no social injustice in the fact that we offer MAiD to disabled persons who are living in poverty, that it’s better than nothing,” Trudo Lemmens, a professor of Health Law and Policy at the University of Toronto told Ricochet. 

“People are dying because we are facilitating their death rather than facilitating their living.”

“I think that it’s wordplay and that the connection is obvious when you become homeless,” Tremblay said. “There’s a high chance that you begin developing a mental illness.” 

As much as 50 per cent of the homeless population consistently suffer from mental health illness. It is well-documented that people who are unhoused are more likely to develop chronic health conditions, substance abuse issues, and are at increased risk of abuse and violence, in the shelter system or on the street, which can leave lasting traumatic scars.  

Treatable conditions are offered MAiD instead of healthcare

According to the fourth annual report on Medical Assistance in Dying, 13,241 people accessed MAiD, accounting for 4.1 per cent of all deaths in Canada in 2022, an increase of 30 per cent from the previous year. There were 463 people with non-fatal disabling health conditions who accessed MAiD, double the amount from 2021. Of that, 59 per cent were women. 

“A disproportionate number of women have disabilities, but a disproportionate number of women with disabilities are even more marginalized than men,” Carr said. “It’s the multiple and intersecting layers of discrimination that women face.”

Many common complex chronic illnesses — such as myalgic encephalomyelitis (ME/CFS) or Long-COVID — are more likely to affect BIPOC women, who are also more likely to be ignored or gaslit by their doctors, making access to actual care difficult. But detailed information about race, Indigenous identity, and disability has only begun being collected in 2023. There are no immediate plans to incorporate information about socioeconomic status.

Eleanor Stein, a retired psychiatrist and former MAiD assessor, has worked with patients who have complex chronic illnesses for decades. “Many people with chronic diseases are living below the poverty line and can’t access the medical care, home care or social support that they need. And that experience, in my opinion, contributes a lot to their considering death.”  

According to Stein, doctors might misdiagnose complex chronic conditions that present with pain and fatigue as anxiety or depression because they have a “total lack of understanding of the diagnostic criteria.”

In her experience, this is also less likely to happen to men: “They’re much more likely to have had a family doctor that really went to the wall for them and ordered all kinds of tests.”

Sabrina Poirier, a Canadian advocate and research partner who also lives with ME told Ricochet that there are many individuals within their community pursuing MAiD. “The relentless suffering our ME patients endure, and the lack of access to knowledgeable and compassionate clinical care certainly plays a role in the decision.”  

The problems are compounded by the lack of resources according to Poirier: 

“What is rarely acknowledged is that the lack of appropriate financial, social and disability support, means that many of our ME patients are also dealing with neglect, poverty, a lack of safe and affordable housing, food insecurity and isolation on top of the illness. 

“They are being forced to end their lives due to systemic failures and that should be something that the Canadian government wants to address immediately and effectively.”

‘We’re not getting to the root cause’

When patients die of MAiD, it is unclear what information is collected and how it is recorded, specifically the factors that led to the patient applying. 

The key issue, Carr points out, is all the information is collected by forms filled out by doctors, nurses, and pharmacists, but not from the person dying of MAiD. “We’re really not getting down to the root cause of what the individual feels is the reason for the death.” 

During the November 28 evidentiary hearing, Dr. K. Sonu Gaind, chief of psychiatry at Sunnybrook Hospital and professor at the University of Toronto, also notes that “we’re not collecting the data properly” pointing to the large increase of MAiD deaths where “other” was reported as one of the underlying conditions. “That went up to 15 per cent — and that’s 15 per cent of 13,000 deaths,” he said. “It is now the third most reported category.”

The “other” category is used to lump together a variety of different conditions like frailty, diabetes, chronic pain, autoimmune conditions. Some of these conditions are not an exact diagnosis for example there are many different types of autoimmune conditions or diseases that cause chronic pain. The way these conditions are recorded are not standardized and differ by province.

Even though 4.1 per cent of all deaths in Canada occur due to MAiD, the sixth leading cause of death in Canada, they aren’t being recorded accurately. Statistics Canada only records the underlying condition and does not indicate that someone died of medically assisted death. 

The federal government has not collected key information about socioeconomic factors, disability supports, or race. Health Canada and individual provinces do not collect and report data on the reasons people requested MAiD, erasing the health conditions of patients. 

Statistics Canada said that the way deaths are coded is in line with the World Health Organisation. This strategy of recording deaths has been criticized by researchers who say that these codes fail to accurately capture the underlying conditions affecting people who apply for MAiD. 

“Not only is that lying to us about MAiD, they [Statistics Canada] don’t want to say MAiD is the sixth leading cause of death in Canada. That in itself is an insult to science and medicine,” Colero said.

The reality is that the federal government could help improve the lives of disabled people very easily by actually providing these benefits. 

“Send money out to disabled people. So that they can eat, so that they can pay for therapy, so that they could pay rent,” Colero said. “Is it really that hard?”