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MacDonald Laurier Institute

Toronto’s “Sankofa Square” – The terrible folly and historic injustice of erasing the legacy of abolitionist Henry Dundas

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From the Macdonald Laurier Institute

By Lynn McDonald

Canadians’ keenness to repent for the misdeeds of the past has its merits, but has also led to gross errors of judgment.

Mayor Olivia Chow and Toronto City Council went even more over-the-top in their choice of “Sankofa Square” for Yonge-Dundas Square. Other renamings in the city have either substituted a banal name, like substituting Toronto Metropolitan University for Ryerson University, or, more frequently, selected an Indigenous name as a substitute for “colonizer” monikers. The Ghanaian word “Sankofa,” however, was selected for its meaning: “learning from the past.” But what can we learn about slavery in Ghana?

Slavery was rife both throughout Africa and much of the world in centuries past. Under its previous name, the Gold Coast, Ghana was a prime place for the sale of slaves to European slave traders. As well, its version of slavery included the horrible practice of executing the slaves of a chieftain who died, so that they could serve him in the afterlife.

In 1847, a Methodist missionary, the Rev. George Chapman, sent an account of this practice from his mission post in Kumasi, the second-largest city in Ghana. In an article in the Toronto Christian Guardian titled “Horrid Treatment of Infants in Ashanti,” Chapman explained that both men and women slaves, of all ages, were executed. When a woman slave with a nursing infant was beheaded, her baby fell to the ground “with her headless body.” Such an infant was regarded as an “abomination.” It gets worse:

“The body of the mother may remain in the street all day exposed to the gaze of every passer-by, and by her side may remain her helpless, living infant exposed to, not only the heedless foot of the multitude, but suffering intensely from the direct rays of a tropical sun. Seldom does any eye pity; no one would ever think of taking away that child and thus saving its life—it remains in the street until evening, and then, as the individual whose business is to drag away the bodies of these victims, takes away the mother; he may at the same time take away the child, not to pity and save it, but to cast both mother and child into the cell where these wretched victims are thrown, and they both remain to putrify [sic] or to be devoured by swine or carnivorous birds.”

In the same article, Chapman described being alerted to the beheading of a female slave in a nearby village. The dead mother’s baby, still alive, was left by her side. Starving, it had crawled up to his mother’s body to lick the blood from her bleeding neck. The missionary hastened to the execution site to try to save it, but he was too late: a bystander saw Chapman coming and prevented rescue by standing on the infant’s neck to kill it.

Ghana abolished slavery only in 1874, roughly 100 years after it was abolished, through court cases, in 1772 in England, and in 1778 in Scotland. For Scotland, it was Henry Dundas, as a lawyer, who won over the Scottish law lords on the appeal case he headed of an escaped enslaved man, Joseph Knight. They not only freed him, by a solid 8-4 majority, but ruled that there could be no slavery in Scotland, and thus freed all other slaves in the country.

This was Henry Dundas’s first achievement as an abolitionist.

Ontario, thanks to John Graves Simcoe, the first lieutenant-governor, has the merit of being the first jurisdiction in the British Empire to abolish slavery, albeit gradually, in 1793, about 80 years before Ghana got around to it. Simcoe, it should be noted, was an appointee of Henry Dundas, a fellow abolitionist.

Yet Mayor Chow called the renaming of Yonge-Dundas Square “beautiful,” and even claimed that she could not “think of a better a name for a gathering place at the heart of our city” than Sankofa Square. To Chow, Henry Dundas’s actions were no less than “horrific.”


Dundas and Ryerson: the Christian Guardian connection

Rev. Chapman sent his story to the Christian Guardian, a weekly Methodist magazine based in Toronto, for which Egerton Ryerson was the founding editor. He was no longer the editor when this story appeared, but he had himself written on abolition in the British Empire and the United States. Ryerson, notably, was a visitor in the British House of Commons on May 14, 1833, for the last debate and adoption of the law to abolish slavery in the British Empire. He gave a superb report on it in the Christian Guardian titled “House of Commons: Colonial Slavery.”

Ryerson also happened to be in Boston, en route to England in 1850, when the United States Congress passed the draconian Fugitive Slave Act. This required the return of slaves caught in free states, where they previously would have been safe. That law meant that escaped slaves from the American South would have to make it to Ontario to be safe, which sparked the development of the “Underground Railroad.” In a report written for the Christian Guardian, Ryerson condemned the law as an attempt to “trample under foot” the “rights of man,” adding that it was “incredible to me” that slavery was being championed in Boston, “the cradle of liberty.”


The abolition of slavery in Africa

The British law of 1833 that abolished slavery in the “British colonies” effectively meant in the West Indies; it also included Canada, which by comparison, had very few slaves. It would take decades more for slavery in Africa itself to be abolished, as well as the slave trade on the continent’s east coast. Recall journalist Henry Stanley’s “Dr. Livingstone, I presume?” on finding missionary doctor David Livingstone alive, but ill, on the coast of Lake Tanganyika in 1871. Livingstone had himself witnessed the beheading of 400 local slaves by slave traders from Zanzibar.

Given Ghana’s significant role in the transatlantic slave trade, and Dundas’s clear opposition to slavery, it makes little sense to strike Dundas’s name off of Toronto’s most famous public square. But so far, Chow is sticking by her assertion that Dundas’s legacy with regards to slavery is “horrific.”


The inconvenient truths about slavery and its abolition

Canadians, and especially Torontonians, are keen to repent of the misdeeds of the past, both against Indigenous people and enslaved Africans. This new humility has its merits, but has also led to gross errors of judgment, especially false accusations against supposed “colonizers” or “colonialists.” Ryerson himself was accused of responsibility for the “colonialist” past, although he himself was born in Ontario, on a farm north of Lake Erie. Neglected is the documented fact that Indigenous societies themselves were slave societies. The losers of wars between Indigenous societies could be killed, mutilated, and/or enslaved, and even sold as slaves. Those more fortunate were adopted by the conquering group, in other words, assimilated – another no-no in today’s world.

No Indigenous society is known to have actually abolished slavery. Indeed, Indigenous slaves were among those freed by the abolition laws of Britain and Upper Canada.

Nor did any African state ever abolish slavery or the slave trade of its own accord. It took decades of pressure from Great Britain, and sometimes bribes from it, to achieve its abolition. Again, Dundas had some understanding of the key role of African leaders in slavery and the slave trade. As he stated in 1792 in the House of Commons when defending his amendment to William Wilberforce’s motion for abolition of the slave trade, to make it “gradual”:

“If once a Prince of an enlightened character should rise up in that hemisphere, his first act would be to make the means of carrying off all slaves from thence impracticable. What reason had they to suppose that the light of Heaven would never descend upon the continent of Africa? From that moment there must be an end of African trade. The first system of improvement, the first idea of happiness that would arise in that continent, would bring with it the downfall of the African trade, and that in a more effectual way than is done by regulations of this country.”

Dundas had a much better understanding of the complications of abolishing slavery and the slave trade than other abolitionists, certainly more than Wilberforce, the Parliamentary abolition leader. But even Dundas had no idea that it would take nearly a century to get rid of it everywhere, and that until it was abolished everywhere, with thorough enforcement measures as well as the adoption of laws, it would remain in force, and many would be its miserable victims.


A better name than “Sankofa Square”

There is good reason not to go back to “Yonge-Dundas” Square, for Sir George Yonge, when governor of Cape Colony, South Africa, made money on the slave trade. Yet neither Mayor Chow, nor Toronto’s previous mayor, John Tory, ever condemned him. This is not to suggest renaming Yonge Street, for too much Ontario history has passed along it. The Rebels of 1837 marched down Yonge Street from Eglinton Street, only to be stopped at Maitland Street. Egerton Ryerson, in his first post as a Methodist minister, had his start as an itinerant preacher riding the “Yonge Street Circuit.”

Reasonable titles would be “Dundas Square,” or, better, “Slavery Abolition Square.” “Ryerson Square” would suit, but only when the anti-Ryerson people come to realize that they fell for false accusations. The square is close to where he developed such great educational reforms as free schools for all, teacher training, and free public libraries, initially for Ontario, in time adopted throughout the country.

Lynn McDonald, CM, Ph.D., is a former Member of Parliament, a professor emerita of University of Guelph, and a fellow of the Royal Historical Society.

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Closing information gaps to strengthen Canada’s border security and track fentanyl

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Macdonald-Laurier Institute

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.

Fig. 1. Canadian purchasers and transporters would authenticate packaging, documentation, and contents for shipments of fentanyl and its precursor chemicals in a live tracking system. They would provide  transparency into shipments, and share discrepancies, payment intermediaries, and payment recipients with regulators. Banks would share payment information for fentanyl shipments with regulators. Figure provided by the authors.

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.

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MacDonald Laurier Institute

Rushing to death in Canada’s MAiD regime

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Macdonald-Laurier Institute 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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