The Link between Poverty and Medical Assistance in Dying Applications

By Keza Uwitonze, University of Manitoba, Faculty of Law Student

With the cost of living soaring rapidly, a number of people suffering under the weight of economic disparity have turned to medical assistance in dying (MAID) as a solution to poverty.

While the scope of this problem requires comprehensive examination. Lives have ended incomplete, lives still yet to be lived, extinguished for the inability to pay for housing or home care. And it’s the vulnerable who suffer the consequences: those with disabilities and those who are sick are often left with no resources and turn to MAID for an answer. Dying with dignity, when you’ve been denied a life lived with dignity, offers a form of control in the face of turbulent life circumstances. 

History was made in 2015 with the Supreme Court’s decision in Carter v Canada, where sections 241(b) and 14 of the Criminal Code were found to “unjustifiably infringe s.7 of the Charter[1] thereby being “of no force or effect to the extent that they prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”[2]

In response to these monumental changes, the federal government issued Bill C-7, An Act to amend the Criminal Code (medical assistance in dying). The Bill legislatively entrenched the Supreme Court’s judgment from Carter, while also outlining some key requirements for those who seek medical assistance in dying. The most obvious requirement is that an individual must be of age (18 or older), “capable to make decisions with respect to their health and…[t]hey must make a voluntary request for MAID that is not the result of external pressure and must give informed consent, after having been informed of the means available to relieve their suffering.”[3]

Even with a more understanding government and legislative protection of the right to die with dignity, the trouble now is that we’re seeing a rise in applications from people who cannot afford housing or home care to help them with their illnesses. In an article from October 2022, CBC News wrote about a woman named Sathya Dhara Kovac who opted to die with medical assistance due to her worsening ALS diagnosis. Even though “she felt she had more life to live [she] just [didn’t have] enough home care support to do so,”[4] suggesting that this was a choice that Kovac made to assert her autonomy. It was recommended to her that as her condition progressed, she might find adequate care elsewhere, but she “lived alone at home with her dog [and] did not want to give that up to live in a facility.”[5] In this situation it seems as though MAID was a chance for independence denied everywhere else in Kovac’s life. She wanted to live on her own terms but that wasn’t a financially viable option.

But this autonomy and independence, and the reasons for asserting them could not be expressed, as the article goes on to reveal that Kovac did not disclose her true reasons for her MAID application: “that she was driven to seek MAID due to a lack of adequate home care support, fearing that if she shared her full rationale [the application panel] would deny her.”[6]

It is a terrible loss for society when people feel obliged to choose death over a life of financial struggle. While MAID was a government approved opportunity to die with dignity, one might ask if the government is capable of providing a place where everyone has the gift of living with dignity. Parliament has expanded the qualifications for MAID applications. Starting on March 17, 2024, the “grievous and irremediable condition” requirement will include individuals whose sole underlying condition is a mental illness.

The benefit of this expansion is that it gives autonomy to those experiencing mental illness when there is often an infantilizing or villainizing of their existence. Having power over their own lives is a confirmation that they understand themselves better than anyone else around them. But in light of MAID being used by those who cannot afford to live, and acknowledging that the rising cost of living affects the vulnerable much more (i.e. those with disabilities, mental illnesses), there is a fear that we’ll continue to see more stories like that of Sathya Dhara Kovac. People who are resigned to end their lives for lack of resources which could keep them alive. The access to justice to the courts in Carter is proving to have unintended consequences.

In a perfect world, homelessness and poverty would not and could not be reasons for MAID. Despite the government approved autonomy, it should be a startling revelation to find that Canadians are considering an application to die with dignity in light of drastic economic disparity.

[1] Carter v Canada (Attorney General), 2015 SCC 5 at para 147 [Carter].

[2] Ibid.

[3] “Bill C-7: An Act to amend the Criminal Code (medical assistance in dying)” (last modified 19 June 2023), online: Government of Canada, <,and%20have%20decision%2Dmaking%20capacity > [].

[4] Bryce Hoye, “Winnipeg woman who chose to die with medical assistance said struggle for home care help led to decision” (4 October 2022), online: CBC <> [].

[5] Ibid.

[6] Ibid.

The views expressed in these blogs do not necessarily reflect the views of the Faculty of Law at the University of Manitoba and should not be construed as legal advice or endorsement.

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