Ontario Doctor Cautioned After Botched Euthanasia; Informal Coffee Shop MAID Assessment

A London, Ontario doctor was “cautioned” after he was investigated for two separate cases of administering drugs for euthanasia in the Medical Aid In Dying (MAID) program. He will continue practicing but has agreed to six months of supervision and to ongoing review of his patient charts, professional education, consent documentation, professional boundaries, and behavior.

In the first case, Dr. James MacLean assessed a patient named Thomas Dillon outside of the Tim Horton’s coffee shop before driving him to a cadaver preparation room to administer the drugs without communicating with the patient’s family. In the second case, Dr. MacLean did not administer one of the three drugs that are utilized for MAID, which led to the patient spontaneously breathing after the doctor pronounced the patient dead and left the home.

This comes at a time when many US states are launching their own MAID programs, sometimes called “Death With Dignity.” The HighWire has reported about previous cases of concerning behavior by professionals who diagnose and provide death services to patients, including a Colorado patient who was allegedly coerced to end her life as a result of her terminal anorexia.

Dillon did not have a condition where death was imminent, but had incurable Crohn’s disease, depression, and mental health conditions. Canada has a second track that allows individuals who aren’t going to die imminently to get approved for MAID if they have an incurable disease.

The College of Physicians and Surgeons of Ontario (CPSO) conducted an investigation into the two public complaints against Dr. MacLean. An independent assessor assigned to the case concluded that MacLean “did not meet the standard of practice of the profession, displayed a lack of judgment and that his conduct exposes or is likely to expose patients to harm or injury in five out of twenty charts reviewed.”

Dillon was 45 when he died in January 2024. He struggled with financial and housing matters, holding a job, and maintaining personal relationships as a result of his illness. He also had a history of mental illness and substance abuse.

The CPSO committee was troubled by the way MacLean conducted his evaluation in the parking lot of a Tim Horton’s. The committee said, “This reflected a lack of the level of formality and care expected when assessing requests for MAID.”

MacLean sent a large number of text messages with Dillon, including messages about how his family is not supportive of the MAID option for ending his life. Dillon refused to ride to the funeral establishment with his sister, who also arrived at the Tim Horton’s when MacLean conducted his evaluation.

The committee said it was concerned about professional boundaries because of the number of text messages and the fact that MacLean drove Dillon to the site for medication. The committee added, “Taken together, these actions created a risk that (MacLean’s) involvement could be perceived as influencing the patient.”

MacLean decided to drive Dillon to the site “to ensure the patient’s final moments were dignified,” since Dillon did not want to die at home in the presence of his mother, who disapproved of the MAID procedure.

“In this case, the assessment occurred during a single encounter at a Tim Hortons coffee shop,” former committee member Dr. Ramona Coelho said in an email to the National Post. “The family was not engaged in the assessment process, despite being the patient’s primary support and despite the MAID provider being aware they were trying to raise concerns. Collateral information from those closest to the patient is essential to understanding the factors contributing to the desire to die.”

The committee notes state, “these boundary concerns were particularly significant given the inherent power imbalance in the physician-patient relationship. This risk is further heightened where a patient has mental health or substance use issues, as actions intended to be supportive may be experienced or perceived differently.”

The second patient of MacLean was a cancer patient who signed a consent form to have MAID administered to him in the case that natural death is reasonably foreseeable. The man became unresponsive before his scheduled death date with Dr. MacLean, so his family contacted the doctor to have him administer the drugs.

MacLean arrived at the house with a MAID medication kit that he already had on hand since he wasn’t able to get one from the pharmacy on short notice. He administered the first two drugs of the three-drug regimen only to realize he didn’t have the neuromuscular-blocking drug rocuronium, which is the final step to paralyze the body so the patient stops breathing.

MacLean said he believes “the stress of the situation, including the last-minute and urgent request for his attendance and the substantial number of people present with significant tension amongst them, contributed to initial failed provision of MAID.”

The patient’s two sisters were present when their brother received the treatment. They were unaware that MacLean failed to give the third drug as part of the standard protocol, and called MacLean after they realized their brother started breathing again. The funeral home was already called to the residence. MacLean returned to the home about 45 minutes later. The patient’s sister alleges that MacLean tapped the patient on the head and said, “You’re a stubborn one.”

There are concerns about the lack of oversight in the MAID process and about MacLean not receiving a more significant consequence for his failures and alleged unprofessionalism. The Canadian government is expected to issue recommendations at the end of June about a potential expansion of MAID in 2027 to include mental illnesses like depression and personality disorders as a sole qualifying factor for MAID qualification.