Canada’s Medical Assistance in Dying (MAiD) regime has undergone one of the most rapid expansions of any assisted dying system in the world since it was legalized in 2016. Originally introduced through Bill C-14, MAiD was limited to competent adults suffering from grievous and irremediable medical conditions whose natural deaths were “reasonably foreseeable.” However, successive legislative changes and evolving clinical interpretation have broadened eligibility while reducing procedural safeguards. Today, MAiD accounts for roughly one in every 20 deaths, meaning Canada has the second-highest rate of assisted deaths in the world.
The Netherlands remains the only jurisdiction with a higher proportion of deaths resulting from euthanasia, but it reached that level after more than two decades of legalization. Canada surpassed 3 percent of all deaths within just five years of legalizing MAiD, making it the fastest-growing assisted dying program on record.
Two Tracks and Contested Definitions
The most significant legislative change came with Bill C-7 in 2021, which divided MAiD into two categories. “Track 1” applies to patients whose natural deaths are reasonably foreseeable, while “Track 2” applies to patients whose deaths are not reasonably foreseeable, including many individuals living with chronic illnesses or disabilities. At the same time, Parliament removed several safeguards for Track 1 patients. The mandatory 10-day reflection period was eliminated, the requirement for final consent immediately before the procedure was replaced with the possibility of a waiver of final consent, and the witness requirement was reduced from two independent witnesses to one, who may now be a paid health-care worker.
Although Track 2 includes additional safeguards, concerns remain regarding how they function in practice. Patients are required to be informed about available supports and treatment alternatives, but they are not required to attempt or receive those services before being approved for MAiD. Similarly, while Track 2 assessments normally require a minimum 90-day evaluation period, exceptions allow that period to be shortened under certain circumstances. These provisions weaken protections for vulnerable individuals, particularly when access to disability supports, mental health care, or palliative care remains uneven across Canada.
Another ongoing concern involves the meaning of “reasonably foreseeable death,” which lacks definition. Some clinicians have interpreted foreseeable death as occurring within months, while others have applied the concept to patients who may live many years. Alberta’s recently passed Bill 18 defines reasonably foreseeable death as occurring within 12 months, bringing the province more in line with jurisdictions such as New Zealand, Australia, and several U.S. states, which generally require a prognosis of 6 to 12 months. The proposal would also prevent patients from qualifying for Track 1 simply because they refuse treatment or food and thereby make their own deaths imminent.
Future Expansions and Weak Oversight
Future expansions remain the subject of considerable debate. Following a recent committee report, and amid widespread concern from psychiatrists, suicide prevention experts, disability advocates, and the public, implementation of extending MAiD to individuals whose sole underlying medical condition is mental illness is expected to be indefinitely postponed. Polling cited in these notes found that only about one-quarter of Canadians support psychiatric MAiD, while more than four-fifths believe mental health care should be improved before any expansion occurs.
Advance requests for MAiD represent another unresolved issue. Unlike the current waiver of final consent, which applies only after a MAiD procedure has already been scheduled, advance requests would allow individuals to authorize euthanasia years in advance after losing decision-making capacity. Quebec has already introduced advance requests, while the federal government has studied the issue without announcing further legislation. Opponents argue that advance requests raise difficult ethical questions because patients’ preferences, quality of life, or willingness to continue living may change after they lose capacity—particularly when suffering from conditions such as dementia.
Finally, many observers argue that Canada’s oversight framework remains comparatively weak. Unlike several European jurisdictions, Canada lacks specialized independent review committees to examine compliance with MAiD legislation. Federal monitoring relies primarily on self-reporting by providers, while provincial oversight has been limited. Ontario’s Coroner’s Office identified 178 compliance issues in 2023, yet no providers were referred to law enforcement. More recently, reporting errors were found in half of British Columbia’s 2024 MAiD cases, a total of 2,807 errors ranging from missing information to 353 cases which required ‘education to practitioners’ over legal requirements and practice standards.
How Then Shall We Live?
When I think about medical assistance in dying, I don’t begin with politics, court decisions, or medicine. I begin with Scripture. Before we can answer questions about euthanasia, we have to answer two fundamental questions: Who is God? And who are we?
Genesis tells us that human beings are created in the image of God. That gives every person inherent dignity regardless of health, productivity, independence, or age. We also discover that we were created for relationship. God himself exists eternally in relationship as Father, Son, and Holy Spirit, and human beings are made to live in relationship with God and with one another. The two truths that every person bears God’s image and that we are made for community form the foundation for thinking about life, suffering, and death.
Of course, Genesis doesn’t end with creation. It continues with the Fall. Death, suffering, decay, and brokenness are not part of God’s original design. They are tragic realities of a fallen world. Christians should never minimize suffering or pretend it isn’t real. The question is how we respond to it.
Autonomy vs. Trust
Our culture increasingly suggests that autonomy is the highest good. Euthanasia reflects that assumption. It says that because suffering is undesirable, we should have ultimate control over when and how we die. But the Christian story offers a different hope. Scripture points beyond creation and fall to redemption and restoration. Death and suffering do not have the final word. Christ has overcome death, and one day God will restore all things.
That is why the opening question of the Heidelberg Catechism has always resonated with me: “What is your only comfort in life and in death?” The answer is not that I control my own destiny. The answer is: “That I am not my own, but belong—body and soul, in life and in death—to my faithful Saviour, Jesus Christ.” My deepest comfort is not autonomy but trust. Even the timing of my death ultimately belongs in God’s hands.
That perspective doesn’t mean Christians should prolong life at all costs. Death is natural in a fallen world. Modern medicine can often extend life through extraordinary interventions, but that doesn’t necessarily mean every intervention should be pursued. When someone receives a terminal diagnosis, I encourage them to ask deeper questions. Who do I need to tell “I love you”? Who do I need to thank? What relationships need reconciliation? Who depends on me, and how can I prepare them for my absence? Finally, am I ready to meet my Creator? Those are the questions that give meaning to the time we have left.
Likewise, Christians should embrace compassionate care. Modern palliative medicine can relieve much of the physical suffering associated with dying, yet Canada continues to underinvest in palliative care while expanding access to euthanasia. That imbalance matters. Too often, people are choosing euthanasia in a system where meaningful alternatives—pain management, disability supports, mental health services, or community care—are unavailable or inadequate. Before we present death as a solution, we should ensure that people have every opportunity to live with dignity.
A Social and Linguistic Crisis
I also think we need to recognize that our euthanasia debate reflects a much deeper social crisis. Ours is an increasingly lonely society. Many Canadians lack close friendships, strong families, or supportive communities. We were never meant to face suffering alone. Churches, families, neighbours, and local communities all have responsibilities that government cannot possibly replace. When those relationships weaken, people naturally begin looking to government to solve problems that are fundamentally relational and spiritual. Euthanasia often addresses the symptom rather than the deeper illness.
Language also matters. Over the years, we’ve watched the terminology evolve from “mercy killing” to “assisted suicide” to “medical assistance in dying.” Each change shifts the way we think about what is actually taking place. Words shape our moral imagination. Christians should be careful to describe reality honestly, because clarity of language helps preserve clarity of thought.
Conclusion
Ultimately, this debate raises profound questions about what it means to be human. Do we belong only to ourselves, or do we belong to God? Is human dignity rooted in autonomy or in being made in God’s image? Are suffering and dependence signs that life has lost its value, or are they moments when communities are called to love one another more deeply?
Those are the questions we must continue asking.
Whether public policy moves in directions I support or oppose, my hope doesn’t rest in political victories. It rests in Christ. Christians are called to bear faithful witness through both our words and our conduct, trusting that God remains sovereign over history. We already know how the story ends. Christ has conquered death, and because of that, we can face even life’s hardest questions with confidence, compassion, and hope.
