Since the legalization of medical assistance in dying (MAiD) in 2016, the federal government has created certain safeguards and regulatory mechanisms – including data collection – to ensure that people don’t request death because they lack access to care, including palliative care.
Health Canada itself has acknowledged that “information about access to palliative care and disability supports is important to ensure that MAiD is not being sought because of a lack of options for end-of-life-care or support services.”
Given just how routine euthanasia and assisted suicide have become, it is essential that Health Canada’s annual reports on MAiD include robust data on palliative care – especially regarding the adequacy of the care provided. However, the most recent annual report, presenting 2024 data, leaves much to be desired on this front.
This has important implications. The lack of adequate data raises questions about how meaningful the choice of MAiD really is for many people.
Take, for example, the report’s claim that 74.1 per cent of MAiD recipients in 2024 received palliative care, whereas only 2.5 per cent of recipients required but did not receive palliative care services. Of those who did not receive palliative care, “91.2 per cent confirmed that services were accessible to them.” The report concludes that “consistent with previous years, most MAiD recipients who required either palliative care or disability support services received these services.”
This conclusion simply cannot be made convincingly based on the data collected.
Critically, the annual report provides little detail on the timing, intensity, quality and location of care. Palliative care should be delivered early in the disease process, in sufficient intensity and quality, with the continuity of care required to meet a person’s needs, and, as the natural end-of-life approaches, at a person’s home if they prefer.
Yet research continues to show that only a minority of Canadians receive palliative care in keeping with these standards. Instead, much of palliative care is delivered close to death, with little intensity and often reflexively in acute-care settings. This mismatch is important since palliative care aims to relieve the suffering that often leads patients to seek MAiD. Yet a significant proportion of MAiD recipients likely don’t receive quality palliative care.
Assessment of care issues
Even if we were to take the numbers at face value, they would still be cause for concern. According to the report, there were 14 cases in 2024 where palliative care was required but not accessible to MAiD recipients and, for an additional 22 cases, it was unknown if the required palliative care was accessible.
We should ask questions about the assessment process since Health Canada reports that for 2 per cent of those dying via MAiD (or 327 people) it is unknown if they needed palliative care. In addition, in 0.6 per cent of MAiD deaths (99 people), palliative care was required, but it is unknown if they received it.
Palliative care is intended to address not only physical symptoms and pain, but also the relational, emotional, psychological and spiritual needs of people living with serious illness. Palliative care is ideally suited to address the sources of suffering the annual reports mention. It is likely that many of the 20.9 per cent of MAiD recipients in 2024 who “did not require” palliative care reflect issues in MAiD assessments, where assessors did not accurately identify who would benefit from palliative care or perhaps were unaware of the full nature and potential benefits of these services.
Given that palliative care should be provided at the point of diagnosisof a life-limiting or life-threatening condition, everyone who is assessed to be eligible for MAiD – at a minimum, everyone in Track 1 whose death is “reasonably foreseeable”– should receive palliative care.
As previously argued in Policy Options, a lack of palliative care and untreated suffering leading to MAiD should be considered medical error.
Inequities across Canada
Health Canada’s annual reports also do not highlight the downward trend that appears over time. The proportions of MAiD recipients who received palliative care – regardless of its quality – decreased to 74.1 per cent in 2024 from about 82 per cent in 2019 and 2020 (see Figure 1).
There are also disconcerting findings in the 2023 and 2024 annual reports, which show disparities in that some provinces have significantly lower percentages of MAiD recipients receiving palliative care (see Figure 2). Saskatchewan, for instance, reported 53.1 per cent of MAiD recipients required and received such care (compared to 74.1 per cent nationally) and 15.5 per cent required but did not receive it (compared to 2.5 per cent nationally). These variations reflect inequities in access to palliative care in Canada.
The critical missing piece: adequacy
As experts have warned, this palliative care data means little without meaningful assessment of the adequacy or qualityof these services. The annual reports provide no information regarding what qualified as palliative care, who provided it or with what qualifications. And they contained no information regarding frequency or duration of contact.
Health Canada acknowledged its data does not speak to “the adequacy or quality of the palliative care services that were available or provided” in their 2019 and 2021 annual reports. Otherwise, it isn’t noted as a limitation.
What data we do have about the duration of palliative services also raises serious concerns about the timeliness of palliative care. About one-third of those who required and received palliative care only had it for less than a month prior to MAiD, according to the 2024 annual report.
What’s more, studies show that many Canadians who would benefit from palliative care are not referred early enough, if at all, and lack the needed palliative care to die in their community rather than a hospital.
If palliative care is only provided after someone requests MAiD due to what they consider unbearable suffering, then palliative care is too little, and too late in many cases.
Other research suggests this is indeed the case. A study of patients requesting MAiD at an Ontario hospital found that prior to requesting MAiD, just 27.4 per cent of patients had a community palliative care physician and 59.5 per cent had some palliative care involvement. Another Ontario study found that only about one in five received palliative care in their home and, looking across all health sectors, for half of those who received palliative care, it started less than two months before death and with less than 18 days of care.
The scarcity of beds in hospices – which offer a more homelike and peaceful setting than hospitals and more specialized end-of-life care – also compromises palliative care accessibility. Canada is far off the target of seven hospice beds per 100,000 people. According to one study, it had only 3.97 beds per 100,000 people in 2022. Analyses of Alberta, Ontario and B.C. found that the number of palliative care beds was likewise inadequate.
According to the World Health Organization, palliative care is recognized as part of the human right to health. But access to palliative care in Canada is neither equitable nor universal, in spite of repeated calls to address this. Research has shown how palliative care access varies across and within provinces, across urban and rural settings, across local health regions and across primary care providers, with only a minority of family physicians delivering home visits for palliative care. Palliative care also varies across disease groups, with those dying of frailty (e.g., dementia) and organ failure (e.g., heart failure) having much less access – and worse outcomes – than those dying of terminal illness (e.g., cancer).
Health Canada’s annual report data provides an illusory and unfounded conclusion about adequate palliative care received by MAiD recipients. Instead, the lack of accessibility to quality palliative care raises questions about how meaningful the choice of MAiD even is for many.
