Organ Donation Increase Through Canadian Assisted Suicide Program – “Strange New Horror”

Deputy Health and Human Services Secretary and acting CDC Director Jim O’Neill called Canada’s Medical Aid In Dying (MAID) program and the subsequent increase in organ donation a “strange new horror” in an interview with the Washington Examiner. Since the implementation of the MAID program, Canada has become the number one in organ donation after euthanasia. O’Neill and HHS have pledged that they will attempt to regain trust in the organ donation program after an HRSA investigation found that at least 28 out 351 organ procurement cases occurred in patients who were not yet deceased.

MAID is a controversial program in Canada, and similar programs have been approved in several states. The HighWire reported in October about a woman named Jane Allen, who was allegedly coerced into completing an assisted suicide procedure. Allen ultimately passed away in 2024 from anorexia complications, but that was years after she was allegedly coerced in Colorado Springs, according to her friends and family. Assisted suicide procedures are legal in 12 states and Washington, DC with Illinois Governor JB Pritzker signing the most recent legislation into law in December.

US states restrict access to euthanasia procedures to only those with a terminal illness, which is usually defined as having a prognosis of death within the next six months. Mental disorders alone cannot qualify a patient for assisted suicide in the US, but it can prevent access if it is determined that the patient has impaired judgment due to a mental disorder.

Canada, however, has a broader definition for who may qualify for assisted suicide. Instead of terminal illness, the MAID law requires the patient to have a grievous and irremediable medical condition. This is defined as having a “serious and incurable illness, disease, or disability” while being “in an advanced state of irreversible decline in capability.”

The definition also states that the “Illness, disease or disability or state of decline causes the person enduring physical or psychological suffering that is intolerable to them and that cannot be relieved in a manner that the person considers acceptable to them.” Lastly, it states that the person’s “natural death” is “reasonably foreseeable,” but there doesn’t need to be a prognosis for a length of time for which that death is foreseeable.

The Canadian law originally had a provision to allow access to MAID solely for mental illness designations beginning March 17, 2023. That was pushed back a year to 2024, and it was pushed back again with the next expiration date set for March 17, 2027.

Claire Brosseau, a Canadian actress and comedian, has made headlines for filing a legal challenge against the continued delay that would otherwise have allowed her access to assisted suicide as a psychiatric-only case. She alleges that she has attempted suicide multiple times and will die in this manner if she is not assisted by the national program.

Brosseau’s doctors disagree on whether this is the right choice for her or whether it is the best option. The Toronto Sun Times reported that Dr. Gail Robinson said she “believes MAID is a reasonable choice for the actress, noting that while she would ‘love’ for the actress to change her mind, she ‘will support her’ no matter what.”

Dr. Mark Fefergrad, Brosseau’s other psychiatrist, believes she can get well and that assisted suicide is not the best option for her. Even Dr. Robinson acknowledges that it comes down to a choice, which implies a hope that Brosseau could recover from the distress caused by her mental disorders.

Brosseau has written several Substack posts about her condition and why she feels her rights are being violated for not having access to a “dignified death.” In December 2024, Brosseau wrote, “I’m asking you- what am I supposed to do? I’m already in palliative care. I’ve already been approved for MAID MI-SUMC. I won’t go through the lists of every treatment I tried and everything I’ve done in order to alleviate the pain. What would you do if you were me? Keep in mind that everyone will think your symptoms are choices.”

The debate about assisted suicide policies for mental health conditions hinges upon what is considered most compassionate – providing freedom of access to the procedure or attempting to provide life-saving care to vulnerable individuals experiencing suicidality.

Raimundo Rojas, with the National Right To Life, wrote an essay about Canada’s MAID program as it relates to the debate about whether Brosseau has a right to access the assisted suicide procedure. “Mental illness attacks judgment,” Rojas wrote. “Severe depression narrows a person’s vision until death seems like the only rational step. Chronic suicidal ideation whispers that everyone would be better off without you. Those thoughts are symptoms of the disease, not explicit expressions of freedom. To build a system that agrees with those thoughts and then carries them out does not honor autonomy. It betrays a sick person at her weakest point.”

Rojas mentioned examples of other interventions in which police, hospital staff, and family act in a way to protect life rather than “cooperation with self-destruction.”

It has been argued that governments have perverse incentives to advocate for programs like MAID, because it reduces health-care costs and provides more healthy organs for patients who need transplants. Dying With Dignity (DWD) is one of the leading advocacy groups for expanding access to MAID and has joined Brosseau in the legal challenge against the Canadian provision that has delayed access for individuals who only have psychiatric disorders. DWD also receives corporate donations from banks, insurance companies, and pharmaceutical companies that stand to financially benefit from expanded MAID access. Pfizer, particularly, donates to DWD and also manufactures three of the drugs recommended to facilitate assisted suicide in the Canadian MAID program.

The United States HHS has not made any specific statements to support or oppose assisted suicide policies, although O’Neill’s recent statements suggest there are deeper ethical concerns the agency would consider before supporting assisted suicide on a federal level.