Canada reports the largest number of deaths by medical assistance in dying (MAiD), surpassing all other countries for yearly assisted deaths.
Salina Pirzada, a PhD candidate at the Max Rady college of medicine, is conducting a study which investigates the implications of evolving MAiD practices and policies on vulnerable Canadians.
Pirzada is supervised by Dr. Harvey Max Chochinov, a distinguished professor of psychiatry at the U of M and a pioneer in dignity therapy for end-of-life patients, and Dr. Christine Kelly, an expert in Canadian disability movements.
Pirzada said “as the federal government continues to broaden access to MAiD, there is an urgency to understand the gravity and impact of evolving MAiD policies on vulnerable populations who may experience disempowerment, stigmatization and inequities in health outcomes and access to services.
“Though assisted dying may be appropriate in select patients, timely and accessible state-supported health care and community support should be available to all Canadians, especially in response to severe and intolerable suffering.”
According to Pirzada, given the rapid uptake of MAiD in Canada and the fact that the country is on track to have one of the world’s most expansive assisted dying programs, she wanted to examine the link between social determinants of health and the construct of dignity in the context of MAiD.
She explained that patients requesting MAiD in Manitoba continue to be an understudied population. This study amends for this by being the first Canadian study examining motivations for MAiD from patients themselves in the context of social determinants of health and dignity related distress. She continued that this patient-oriented, integrated knowledge translation approach ensures that knowledge is relevant to the lives of patients and addresses the “know/do” gap of health research.
“Again, the study is not yet complete, but we are seeing that factors like living in chronic poverty or suffering from a mental illness may contribute to this feeling of no longer wanting to continue living,” said Pirzada. “Patients have described a type of psychosocial suffering that might be remedied with access to appropriate and timely supports and services.”
Pirzada stated that determining whether MAiD is ethically right or wrong is subjective, “but what can perhaps be agreed on is that at present, several safeguards — many of which were intended to prevent avoidable and wrongful deaths for those who met initial criteria — are being lifted, making it imperative to examine whether MAiD puts vulnerable Canadians at risk. And if so, create policies to ensure MAiD is not the answer to systemic inequality.”
She added that MAiD for mental illness, which will be legal in 2027, continues to be a topic of heated debate.
“Those living with mental illnesses are often at an increased risk of experiencing inequalities such as socio-economic hardship, discrimination and stigma, violence and abuse,” stated Pirzada. “As such, it is critical to understand whether expanding eligibility is respecting their autonomy or increasing the risk of harm. The Canadian healthcare system does not have equitable access to clinical services for all patients, questioning whether a MAiD request for ‘irremediable’ psychiatric suffering is primarily due to a lack of available supports and resources.”
She said that a patient’s inability to access timely support could also be a contributing factor for a MAiD request, as MAiD continues to become more accessible and can be obtained within 90 days or less. Pirzada stated that “other supports such as home care is often not as easily accessible as MAiD.”
She disclosed that she received over $40,000 in grants and scholarships for the study, with her primary funder being Research Manitoba who awarded her $35,000. The remaining funds came from various departmental awards. This funding has enabled her to make the study more patient-oriented, addressing a gap in previous MAiD literature that has not been focused on patients’ experiences in the context of social determinants of health and dignity related distress.
Pirzada stated that her research, in particular the mental illness component, will provide critical insight for policymakers, healthcare providers, researchers, patients and their families, given the legislative changes in 2027. She is focused on publishing her findings before MAiD for mental illness is in practice in hopes that the knowledge she acquires will inform decision-makers on how to improve equitable access to care for societies’ most vulnerable.
Sharing her thoughts about the impact her research will make, she said she hopes that her research as a whole can protect vulnerable Canadians, help healthcare providers better understand their patient’s motivation for MAiD and impact health policy at the national level.
