MacDonald Laurier Institute
Canada, it’s not racist or xenophobic to talk about immigration

From the MacDonald Laurier Institute
By Joe Adam George
The sustained public antics post-October 7 has caused otherwise pro-immigrant Canadians to question the viability of our current policy
Since 1971, when Prime Minister Pierre Trudeau officially adopted a policy of multiculturalism, Canada has enthusiastically promoted and celebrated cultural diversity as a fundamental element of our national identity.
Perhaps wanting to step out of his father’s shadow and create his own legacy, in 2015, Prime Minister Justin Trudeau upped the multicultural ante by several notches, declaring to the world that Canada would become the “first post-national state”. In a now-infamous interview Trudeau claimed “there is no core identity, no mainstream in Canada.”
Last year, his government announced plans to welcome 500,000 new immigrants per year by 2025 and maintain those numbers annually in the subsequent years. Amidst growing public opposition to high immigration levels, Statistics Canada reported last month that Canada’s population grew by more than 430,000 during the third quarter of 2023 alone, marking the fastest pace of population growth since 1957 and pushing the country’s population past 40.5 million.
PM Trudeau’s pursuit of a post-national vision for Canada – through a blend of substantial hikes in immigration and a systemic push of woke progressivism that has effectively revised and erased Canadian history – has come at a significant cost to Canada’s national unity and security.
Examples of this disunity and lack of social integration have been particularly apparent in recent months. Following Hamas’ October 7 attacks against innocent Israeli civilians, the Jewish community in Canada have been subject to incessant acts of malice and violence by pro-Palestine protestors. Over the last three months, these dissenters have become a nuisance and a threat to all Canadians – from blocking traffic at major intersections and disrupting Christmas celebration events to intimidating businesses and shoppers, and in some extremely worrying instances, plotting to carry out terror attacks on Canadian soil.
Raging antisemitic and anti-Western speeches by controversial Muslim imams like Adil Charkaoui and Sheikh Younus Kathrada have added fuel to the fire (Charkaoui served jail time in 2003 on charges of terrorism and was later allowed a pathway to Canadian citizenship by a judge).
Predictably, questions about uncontrolled immigration and limited social integration have gained considerable prominence in the public square, so much so that the once-taboo topic of immigration could become a hot-button issue in the next federal election. The immigration discourse was already gaining traction on account of joint economic woes and the housing crisis, but the sustained public antics post-October 7 has caused otherwise pro-immigrant Canadians to question the viability of our current policy.
Eric Kaufmann, professor of politics at the University of Buckingham and Senior Fellow at the Macdonald-Laurier Institute, said to me in an interview, “A lot of the talk about integration misses the mark because it only takes into account integration indicators like people getting jobs, learning the language, voting, participating economically and politically, and even feeling a certain attachment to their adopted country, all of which I think are going reasonably well. The main driver for integration problems that we are currently seeing in Western countries is the degree of ethnocultural shifting that is taking place on account of mass immigration. This is bringing a much greater diversity of ethnic identities and religions and results in the importation of overseas conflicts into Western societies leading to inter-communal clashes between groups such as Sikh-Hindu, Muslim-Hindu or Muslim-Jew. The other factor is Islam and its perceived incompatibility with Western culture and values. All this contributes to the rise of populist movements across the globe, particularly in Europe.” Last month, an Angus Reid poll found that more than two-in-five (43%) Canadians believe Islam to be a “harmful presence” to their country.
Out of the over 1.3 million new immigrants who permanently settled in Canada from 2016 to 2021, approximately 1.14 million of them belonged to racialized communities, with most of them coming from South Asian, African and Arab countries. In a 2018 paper, Kaufmann and Matthew Goodwin argue that white Canadians will be a minority around the year 2050. It must be pointed out that this discussion is not about any deranged notion of preserving racial purity but about the effect of quick and massive ethnocultural change. Even with some mixing between cultures, geographic, marital and social patterns remain highly structured by ethnic identity in Canada; this is as true of the majority as of minorities, with white movers avoiding more diverse locations such as Richmond, BC or Brampton, ON. This attachment to one’s own group has been proven in the scholarly literature to be independent of any dislike of outgroups (except at times of violent conflict). Yet any mention of a sense of loss in the disruption of a previously dominant culture is immediately taken as hostility to outgroups and thus racist – a dishonest assessment.
Other countries that have traditionally welcomed a significant number of immigrants are now admitting that their immigration levels are out of control. Leaders (often privately) recognize that while linking immigration to job market needs, infrastructure capacity and economic growth opportunities is vital, greater value ought to be attached to encouraging immigrants to integrate and contribute to advancing a shared national vision. With elections looming in some of these countries, governments are taking belated measures to reduce the overall intake to appease their electorates.
The Danish government has advocated for a “zero refugee” policy. Australia announced new policies that are expected to cut down immigration by 50%. The UK Parliament passed a bill – dubbed “the toughest ever anti-illegal immigration legislation” – which aims to send illegal asylum-seekers to Rwanda. Germany approved legislation that would make it easier for authorities to quickly deport rejected asylum seekers. U.S. lawmakers are negotiating a deal to enforce security along its southern border with Mexico to combat illegal crossings.
It is worth highlighting that Denmark, Australia and Germany are run by left-wing or centre-left governments; mass immigration and social integration can be issues of concern to parties of all political stripes and not limited to “racist right-wing bigots” and “conservatives” as some might lazily portray. When asked which country Canada could take inspiration from to improve immigration controls, Kaufmann mentioned the Social Democrats in Denmark as exemplary.
“I think lowering numbers is absolutely at the heart of any successful immigration policy. I don’t think you can have high [immigration] numbers and not have a problem and you may even have different kinds of problems like antisemitism or anti-LGBTQ sentiments or communal conflicts or radicalization. Essentially, my view is that with high numbers and rapid cultural change, you simply get a loss of social connectedness. You have people in their bubbles moving around and that’s fine but when you get two groups that have an issue with each other, then you’re going to either have a conflict or you tend to get less civic-minded”, he said, citing renowned American political scientist, Robert Putnam’s thesis ‘E Pluribus Unum: Diversity and Community in the Twenty-first Century’. Putnam contends that sharp increases in immigration and ethnic diversity tend to reduce social solidarity and social capital in the short run, meaning social trust (even of one’s own race) would be lower, altruism and community cooperation rarer, and friends fewer, although on the flipside, it is likely to have long-term cultural, economic, fiscal, and developmental benefits.
When asked what continued mass immigration could mean for Canada, Kaufmann said, “I think Canada is moving in the direction of being a low-cohesion society. I mean, if that’s the choice they want to make, that’s fine. I think it’s partly because political correctness is stronger in Canada than almost anywhere else. So, it’s impossible to really have an honest debate about immigration which is one reason why the numbers are so high in Canada compared to other countries. It’s about what the elites will allow you to talk about in a democracy without labeling you a racist, which is completely dishonest, but that’s the way the debate has been conducted in Canada, as some sort of a sacred cow. It’s less sacred in Europe and so there’s more of a real debate around immigration numbers.”
Last month, fueled by concerns over growing antisemitism, the German state of Saxony-Anhalt made it mandatory for applicants wishing to live in the state to recognize Israel’s right to exist. In 2006, the Netherlands made it compulsory for prospective immigrants to watch a film with images of gay men kissing or topless women as part of the civic integration exam to test their readiness to participate in the Dutch liberal society.
When asked if such a values-based test or declaration for prospective immigrants was feasible, Kaufmann said, “People are allowed to have different opinions, even if they may be obnoxious. Even within the citizenry, there are people who don’t recognize the state of Israel and that’s an opinion you’re allowed to have. I think the test should probably focus on subjects like toleration of gays, Jews and women. However, I don’t think Canada is willing to consider qualitative culture-based criteria, such as assimilability to Canadian values, to assess potential immigrants, like they currently do in countries like Denmark, even though I think it would be a good idea. Canadian immigration is completely rooted in voodoo-based reasoning and there’s no economic or demographic rationale to it. The idea that immigration is a sustainable solution to the aging problem, for instance, has been comprehensively debunked. Somehow, it is a religion amongst Canadian elites and to some degree, across political parties. The Conservatives are too scared to touch it out of fear of being branded as racist and anti-immigrant by other parties and the media, even though most of their voters want a lot lower numbers. Regardless, you’ve got a cross-party consensus which is not based in reality.”
In 2016, federal Conservative leadership hopeful Kellie Leitch was heavily criticized, even by members of her own party, for floating the idea of screening out would-be immigrants to Canada, if they were openly intolerant or did not accept Canadian values and traditions such as respect and tolerance for other cultures, freedom of speech and equality.
The systematic dismantling and belittling of Canada’s history by our governments and institutions has left many immigrants seeing very little worth embracing in Canada, often resulting in a retention of their original values– some of which are contradictory to Canadian values and pose a hazard to the safety and security of vulnerable groups like LGBTQ, Jews, women and children.
While Kaufmann does not think Trudeau’s post-national comments have had an impact on the ground on their own, he said they reflect the mindset of the cultural left-dominated or progressive-dominated society.
“The media and the political culture in Canada are dominated by progressivism on any cultural issues, whether that be LGBTQ, religion, ethnicity or immigration. The longstanding narrative in Canadian academia about Canadian identity is that Canada’s just a multicultural country and the only thing it stands for is tolerance and diversity. In a way, multiculturalism is, more or less, a restatement of a post-national country that doesn’t really have a national identity and that’s what the elites want. It is a national identity that claims to have the moral high ground by proclaiming we don’t care about ethnicity or culture because we’re so virtuous and that is really what Trudeau implied. This is still a kind of national identity but based on pride in being holier than thou. His comments reflect an elitist philosophy that has led to record levels of immigration and poor integration.”
The Israel-Hamas war has highlighted the failure of integration inevitably resulting from rapid and uncontrolled mass immigration. Scenes of protestors disrupting Black Friday shopping and Christmas celebrations, or even threatening to kill people in the presence of police officers, were unimaginable in Canada not long ago.
First or second-generation immigrants like me – whether they be permanent residents, students, illegal aliens, or citizens – have immensely benefitted from the magnanimity of Western countries like Canada. In many cases we were offered refuge from the hatred, tyranny, racism, sexism, terrorism, and violence of our home countries. It should not be considered controversial or racist to point out instances of fellow immigrants treating Western generosity and tolerance as weaknesses to be manipulated, bragging about their growing numbers and the political clout they have amassed in liberal democracies (apparently without awareness of the hypocrisy apparent in their support for illiberal tyrannies whose violence drove them to take refuge in the West in the first place). Aaron Wudrick, Director of Domestic Policy at the Macdonald-Laurier Institute, encapsulates this view accurately in his tweet: “The important question isn’t how Canadians identify in terms of ethnicity. It’s whether they identify as *Canadian* and feel any attachment, belonging or commitment to our shared institutions.”
It is dishonest and irrational to label everyone concerned about out-of-control immigration numbers and the need for social cohesion as racist or xenophobic. The sooner we rid ourselves of fallacious name calling, the sooner we can start a serious debate about the best way forward for a compassionate and sustainable immigration policy that prioritizes Canada’s long-term national unity, security and economic interests.
Joe Adam George is a former foreign policy and national security research intern with the Washington, D.C.-based policy think tank, Hudson Institute, and a communications strategist.
Business
Closing information gaps to strengthen Canada’s border security and track fentanyl

By Sean Parker, Dawn Jutla, and Peter Copeland for Inside Policy
To promote better results, we lay out a collaborative approach
Despite exaggerated claims about how much fentanyl is trafficked across the border from Canada to the United States, the reality is that our detection, search, and seizure capacity is extremely limited.
We’re dealing with a “known unknown”: a risk we’re aware of, but don’t yet have the capacity to understand its extent.
What’s more, it may be that the flow of precursor chemicals—ingredients used in the production of fentanyl—is where much of the concern lies. Until we enhance our tracking, search, and seizure capacity, much will remain speculative.
As border security is further scrutinized, and the extent of fentanyl production and trafficking gets brought into sharper focus, the role of the federal government’s Precursor Chemical Risk Management Unit (PCRMU)—announced recently by Health Canada—will become apparent.
Ottawa recently took action to enhance the capabilities of the PCRMU. It says the new unit will “provide better insights into precursor chemicals, distribution channels, and enhanced monitoring and surveillance to enable timely law enforcement action.” The big question is, how will the PCRMU track the precursor drugs entering into Canada that are used to produce fentanyl?
Key players in the import-export ecosystem do not have the right regulatory framework and responsibilities to track and share information, detect suspect activities, and be incentivized to act on it. That’s one of the reasons why we know so little about how much fentanyl is produced and trafficked.
Without proper collaboration with industry, law enforcement, and financial institutions, these tracking efforts are doomed to fail. To promote better results, we lay out a collaborative approach that distributes responsibilities and retools incentives. These measures would enhance information collection capabilities, incentivize system actors to compliance, and better equip law enforcement and border security services for the safety of Canadians.
Trade-off bottleneck: addressing the costs of enhanced screening
To date, it’s been challenging to increase our ability to detect, search, and seize illegal goods trafficked through ports and border crossings. This is due to trade-offs between heightened manual search and seizure efforts at ports of entry, and the economic impacts of these efforts.
In 2024, the Canada Border Services Agency (CBSA) admitted over 93 million travelers. Meanwhile, 5.3 million trucks transported commercial goods into Canada, around 3.6 million shipments arrived via air cargo, nearly 2 million containers were processed at Canadian ports, roughly 1.9 million rail cars carried goods into the country, and about 145.7 million courier shipments crossed the border. The CBSA employs a risk-based approach to border security, utilizing intelligence, behavioral analysis, and random selection to identify individuals or shipments that may warrant additional scrutiny. This triaging process aims to balance effective enforcement with the facilitation of legitimate travel and trade.
Exact percentages of travelers subjected to secondary inspections are not publicly disclosed, but it’s understood that only a small fraction undergo such scrutiny. We don’t learn about the prevalence of these issues through our border screening measures, but in crime reporting data—after it’s too late to avert.
It’s key to have an approach that minimizes time and personnel resources deployed at points of entry. To be effective without being economically disruptive, policymakers, law enforcement, and border security need to strengthen requirements for information gathering, live tracking, and sharing. Legislative and regulatory change to require additional information of buyers and sellers—along with stringent penalties to enforce non-compliance—is a low-cost, logistically efficient way of distributing responsibility for this complex and multifaceted issue. A key concept explored in this paper is strengthening governance controls (“controls”) over fentanyl supply chains through new processes and data digitization, which could aid the PCRMU in their strategic objectives.
Enhanced supply chain controls are needed
When it comes to detailed supply chain knowledge of fentanyl precursor chemicals moving in and out of Canada, regulator knowledge is limited.
That’s why regulatory reform is the backbone of change. It’s necessary to ensure that strategic objectives are met by all accountable stakeholders to protect the supply chain and identify issues. To rectify the issues, solutions can be taken by the PCRMU to obtain and govern a modern fentanyl traceability system/platform (“platform”) that would provide live transparency to regulators.
A fresh set of supply chain controls, integrated into a platform as shown in Fig. 1, could significantly aid the PCRMU in identifying suspicious activities and prioritizing investigations.

Our described system has two distinctive streams: one which leverages a combination of physical controls such as package tampering and altered documentation against a second stream that looks at payment counterparties. Customs agencies, transporters, receivers, and financial institutions would have a hand in ensuring that controls in the platform are working. The platform includes several embedded controls to enhance supply chain oversight. It uses commercially available Vision AI to assess packaging and blockchain cryptography to verify shipment documentation integrity. Shipment weight and quantity are tracked from source to destination to detect diversion, while a four-eyes verification process ensures independent reconciliation by the seller, customs, and receiver. Additionally, payment details are linked to shipments to uncover suspicious financial activity and support investigations by financial institutions and regulators like FINTRAC and FINCEN.
A modern platform securely distributes responsibility in a way that’s cost effective and efficient so as not to overburden any one actor. It also ensures that companies of all sizes can participate, and protects them from exploitation by criminals and reputational damage.
In addition to these technological enhancements and more robust system controls, better collaboration between the key players in the fentanyl supply chain is needed, along with policy changes to incentivize each key fentanyl supply chain stakeholder to adopt the new controls.
Canadian financial institutions: a chance for further scrutiny
Financial institutions (FIs) are usually the first point of contact when a payment is being made by a purchaser to a supplier for precursor chemicals that could be used in the production of fentanyl. It is crucial that they enhance their screening and security processes.
Chemicals may be purchased by wires or via import letters of credit. The latter is the more likely of the two instruments to be used because this ensures that the terms and conditions in the letter of credit are met with proof of shipment prior to payment being released. Payments via wire require less transparency.
Where a buyer pays for precursor chemicals with a wire, it should result in further scrutiny by the financial institution. Requests for supporting documentation including terms and conditions, along with proof of shipment and receipt, should be provided. Under new regulatory policy, buyers would be required to place such supporting documentation on the shared platform.
The less transparent a payment channel is in relation to the supply chain, the more concerning it should be from a risk point of view. Certain payment channels may be leveraged to further mask illicit activity throughout the supply chain. At the onset of the relationship the seller and buyers would link payment information on the platform (payment channel, recipient name, recipient’s bank, date, and payment amount) to each precursor or fentanyl shipment. The supplier, in turn, should record match payment information (payment channel, supplier name, supplier’s bank, date, and payment amount).
Linking payment to physical shipment would enable data analytics to detect irregularities. An irregularity is flagged when the amounts and/or volume of payments far exceed the value of the received goods or vice versa. The system would be able to understand which fentanyl supply chains tend to use a particular set of FIs. This makes it possible to conduct real-time mapping of companies, their fentanyl and precursor shipments and receipts, and the payment institutions they use. With this bigger picture, FIs and law enforcement could connect the dots faster.
Live traceability reporting
Today, suppliers of fentanyl precursors are subject to the Pre-Export Notification Online (PEN Online) database. This database enables governments to monitor international trade in precursor chemicals by sending and receiving pre-export notifications. The system helps prevent the diversion of chemicals used in the illicit manufacture of drugs by allowing authorities to verify the legitimacy of shipments before they occur.
To further strengthen oversight, the platform utilizes immutability technologies—such as blockchain or secure immutable databases—which can be employed to encrypt all shipping documents and securely share them. This presents an auditable form of chain-of-custody and makes any alterations apparent. Customs and buyers would have the capability to verify the authenticity of the originating documents in a way that doesn’t compromise business confidentiality. With the use of these technologies, law enforcement can narrow down their investigations.
An information gap currently exists as the receivers of the shipments don’t share their receipts information with PEN. To strengthen governance on fentanyl supply chains, regulatory policy and legislative changes are needed. The private sector should be mandated to report received quantities of fentanyl or its precursors, as well as suspicious receiving destinations. This could be accomplished on the platform which would embed the receiving process, a reconciliation process of the transaction, the secure upload and sharing of documents, and would be minimally disruptive to business processes.
Additionally, geo-location technology embedded in mobile devices and/or shipments would provide real-time location-based tracking of custody transactions. These geo-controls would ensure accountability across the fentanyl supply chain, in particular where shipments veer off or stop too long on regular shipping routes. Canadian transporters of fentanyl and its precursor chemicals should play an important role in detecting illicit diversion/activities.
Digital labelling
Licensed fentanyl manufacturers could add new unique digital labels to their shipments to get expedited clearance. For example, immutable digital labelling platforms enable tamper-proof digital labels for legitimate fentanyl shipments. This would give pharmacies, doctors, and regulators transparency into the fentanyl’s:
- Chemical composition and concentrations (determining legitimate vs. adulterated versions of the drug)
- Manufacturing facility ID, batch ID, and regulatory compliance status
- Intended buyer authentication (such as licensed pharmaceutical firms or distributors)
Immutable digital labelling platforms offer secure role-based access control. They can display customized data views according to time of day, language, and location. Digital labels could enable international border agencies and law enforcement to receive usable data, allowing legal shipments through faster while triggering closer shipment examinations for those without of a digital label.
International and domestic transporter controls
Transporters act as intermediaries in the supply chain. Their operations could be monitored through a regulatory policy that mandates their participation in the platform for fentanyl and precursor shipments. The platform would support a mobile app interface for participants on-the-move, as well as a web portal and application programming interfaces (APIs) for large-size supply chain participants. Secure scanning of packaging at multiple checkpoints, combined with real-time tracking, would provide an additional layer of protection against fraud, truckers taking bribes, and unauthorized alterations to shipments and documents.
Regulators and law enforcement participation
Technology-based fentanyl controls for suppliers, buyers, and transporters may be reinforced by international customs and law enforcement collaboration on the platform. Both CBSA and law enforcement could log in and view alerts about suspicious activities issued from the FIs, transporters, or receivers. The reporting would allow government personnel to view a breakdown of fentanyl importers, the number of import permit applications, and the amount of fentanyl and its precursors flowing into the country. Responsible regulatory agencies—such as the CBSA and PCRMU—could leverage the reporting to identify hot spots.
The platform would use machine learning to support CBSA personnel in processing an incoming fentanyl or precursor shipment. Machine learning refers to AI algorithms and systems that improve their knowledge with experience. For example, an AI assistant on the traceability system could use machine learning to predict and communicate which import shipments arriving at the border should be passed. It can base these suggestions on criteria like volume, price, origin of raw materials, and origin of material at import point. It can also leverage data from other sources such as buyers, sellers, and banks to make predictions. As an outcome, the shipment may be recommended to pass, flagged as suspicious, or deemed to require an investigation by CBSA.
It’s necessary to keep up to date on new precursor chemicals as the drug is reformulated. Here, Health Canada can play a role, using its new labs and tests—expected as part of the recently announced Canadian Drug Analysis Centre—to provide chemical analysis of seized fentanyl. This would inform which additional chemical supply chains should be tracked in the PCRMU’s collaborative platform, and all stakeholders would widen their scope of review.
These new tools would complement existing cross-border initiatives, including joint U.S.-Canada and U.S.-Mexico crackdowns on illicit drug labs, as well as sovereign efforts. They have the potential to play a vital role in addressing fentanyl trafficking.
A robust, multi-pronged strategy—integrating existing safeguards with a new PCRMU traceability platform—could significantly disrupt the illegal production and distribution of fentanyl. By tracking critical supply chain events and authenticating shipment data, the platform would equip law enforcement and border agencies in Canada, the U.S., and Mexico with timely, actionable intelligence. The human toll demands urgency: from 2017 to 2022, the U.S. averaged 80,000 opioid-related deaths annually, while Canada saw roughly 5,500 per year from 2016 to 2024. In just the first nine months of 2024, Canadian emergency services responded to 28,813 opioid-related overdoses.
Combating this crisis requires more than enforcement. It demands enforceable transparency. Strengthened governance—powered by advanced traceability technology and coordinated public-private collaboration—is essential. This paper outlines key digital controls that can be implemented by global suppliers, Canadian buyers, transporters, customs, and financial institutions. With federal leadership, Canada can spearhead the adoption of proven, homegrown technologies to secure fentanyl supply chains and save lives.
Sean Parker is a compliance leader with well over a decade of experience in financial crime compliance, and a contributor to the Macdonald-Laurier Institute.
Dawn Jutla is the CEO of Peer Ledger, the maker of a traceability platform that embeds new control processes on supply chains, and a professor at the Sobey School of Business.
Peter Copeland is deputy director of domestic policy at the Macdonald-Laurier Institute.
MacDonald Laurier Institute
Rushing to death in Canada’s MAiD regime

By Ramona Coelho for Inside Policy
Canada legalized Medical Assistance in Dying (MAiD) in 2016, encompassing both euthanasia and assisted suicide. Initially limited to those nearing their natural death, eligibility expanded in 2021 to individuals with physical disabilities, with eligibility for individuals with mental illness in 2027. Parliamentary recommendations include MAiD for children. A recent federal consultation explored extending MAiD to those who lack capacity via advance directives, an approach Quebec has already adopted, despite its criminal status under federal law.
Despite its compassionate framing, investigative journalists and government reports reveal troubling patterns where inadequate exploration of reversible suffering – such as lack of access to medical treatments, poverty, loneliness, and feelings of being a burden – have driven Canadians to choose death. As described by our former Disability Inclusion Minister, Canada’s system at times makes it easier to access MAiD than to receive basic care like a wheelchair. With over 60,000 MAiD cases by the end of 2023, the evidence raises grave concerns about Canada’s MAiD regime.
I am a member of Ontario’s MAiD Death Review Committee (MDRC). Last year, the Chief Coroner released MDRC reports, and a new set of reports has just been published. The first report released by the Office of the Chief Coroner, Waivers of Final Consent, examines how individuals in Track 1 (reasonably foreseeable natural death) can sign waivers to have their lives ended even if they lose the capacity to consent by the scheduled date of MAiD. The second, Navigating Complex Issues within Same Day and Next Day MAiD Provisions, includes cases where MAiD was provided on the same day or the day after it was requested. These reports raise questions about whether proper assessments, thorough exploration of suffering, and informed consent were consistently practised by MAiD clinicians. While MDRC members hold diverse views, here is my take.
Rushing to death, Ignoring Reversible Causes of Suffering
In the same-day or next-day MAiD report, Mrs. B, in her 80s, after complications from surgery, opted for palliative care, leading to discharge home. She later requested a MAiD assessment, but her assessor noted she preferred palliative care based on personal and religious values. The next day, her spouse, struggling with caregiver burnout, took her to the emergency department, but she was discharged home. When a request for hospice palliative care was denied, her spouse contacted the provincial MAiD coordination service for an urgent assessment. A new assessor deemed her eligible for MAiD, despite concerns from the first practitioner, who questioned the new assessor on the urgency, the sudden shift in patient perspective, and the influence of caregiver burnout. The initial assessor requested an opportunity for re-evaluation, but this was denied, with the second assessor deeming it urgent. That evening, a third MAiD practitioner was brought in, and Mrs. B underwent MAiD that night.
The focus should have been on ensuring adequate palliative care and support for Mrs. B and her spouse. Hospice and palliative care teams should have been urgently re-engaged, given the severity of the situation. Additionally, the MAiD provider expedited the process despite the first assessor’s and Mrs. B’s concerns without fully considering the impact of her spouse’s burnout.
The report also has worrying trends suggesting that local medical cultures—rather than patient choice—could be influencing rushed MAiD. Geographic clustering, particularly in Western Ontario, where same-day and next-day MAiD deaths occur most frequently, raises concerns that some MAiD providers may be predisposed to rapidly approve patients for quick death rather than ensuring patients have access to adequate care or exploring if suffering is remediable. This highlights a worrying trend where the speed of the MAiD provision is prioritized over patient-centered care and ethical safeguards.
MAiD without Free and Informed Choice
Consent has been central to Canadians’ acceptance of the legalization of euthanasia and assisted suicide. However, some cases in these reports point to concerns already raised by clinicians: the lack of thorough capacity assessments and concerns that individuals may not have freely chosen MAiD.
In the waiver of final consent report, Mr. B, a man with Alzheimer’s, had been approved for MAiD with such a waiver. However, by the scheduled provision date, his spouse reported increased confusion. Upon arrival, the MAiD provider noted that Mr. B no longer recognized them and so chose not to engage him in discussion at all. Without any verbal interaction to determine his current wishes or understanding, Mr. B’s life was ended.
In the same-day or next-day MAiD report, Mr. C, diagnosed with metastatic cancer, initially expressed interest in MAiD but then experienced cognitive decline and became delirious. He was sedated for pain management. Despite the treating team confirming that capacity was no longer present, a MAiD practitioner arrived and withheld sedation, attempting to rouse him. It was documented that the patient mouthed “yes” and nodded and blinked in response to questions. Based on this interaction, the MAiD provider deemed the patient to have capacity. The MAiD practitioner then facilitated a virtual second assessment, and MAiD was administered.
These individuals were not given genuine opportunities to confirm whether they wished to die. Instead, their past wishes or inquiries were prioritized, raising concerns about ensuring free and informed consent for MAiD. As early as 2020, the Chief Coroner of Ontario identified cases where patients received MAiD without well-documented capacity assessments, even though their medical records suggested they lacked capacity. Further, when Dr. Leonie Herx, past president of the Canadian Society of Palliative Medicine, testified before Parliament about MAiD frequently occurring without capacity, an MP dismissed her, advising Parliament to be cautious about considering seriously evidence under parliamentary immunities that amounted to malpractice allegations, which should be handled by the appropriate regulatory bodies or police. These dismissive comments stand in stark contrast with the gravity of assessing financial capacity, and yet the magnitude is greater when ending life. By way of comparison, for my father, an Ontario-approved capacity expert conducted a rigorous evaluation before declaring him incapable of managing his finances. This included a lengthy interview, collateral history, and review of financial documents—yet no such rigorous capacity assessment is mandated for MAiD.
What is Compassion?
While the federal government has finished its consultation on advance directives for MAiD, experts warn against overlooking the complexities of choosing death based on hypothetical suffering and no lived experience to inform those choices. A substitute decision-maker has to interpret prior wishes, leading to guesswork and ethical dilemmas. These cases highlight how vulnerable individuals, having lost the capacity to consent, may be coerced or unduly influenced to die—whether through financial abuse, caregiver burnout, or other pressures—reminding us that the stakes are high – life and death, no less.
The fundamental expectation of health care should be to rush to care for the patient, providing support through a system that embraces them—not rush them toward death without efforts to mitigate suffering or ensure free and informed consent. If we truly value dignity, we must invest in comprehensive care to prevent patients from being administered speedy death in their most vulnerable moment, turning their worst day into potentially their last.
Dr. Ramona Coelho is a family physician whose practice largely serves marginalised persons in London, Ontario. She is a senior fellow at the Macdonald-Laurier Institute and co-editor of the new book “Unravelling MAiD in Canada” from McGill University Press.
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