Disability & MAID: Three-in-five concerned lack of adequate care may push vulnerable to consider assisted dying

About ARI

The Angus Reid Institute (ARI) was founded in October 2014 by pollster and sociologist, Dr. Angus Reid. ARI is a national, not-for-profit, non-partisan public opinion research foundation established to advance education by commissioning, conducting and disseminating to the public accessible and impartial statistical data, research and policy analysis on economics, political science, philanthropy, public administration, domestic and international affairs and other socio-economic issues of importance to Canada and its world.

About Cardus

Founded in 1974, Cardus is a non-partisan think tank dedicated to clarifying and strengthening, through research and dialogue, the ways in which society’s institutions can work together for the common good.

INDEX

Part One: Disability experiences in health care

• Half of those living with moderate or severe disabilities report barriers to health care

• Health care workers divided over quality of care PWD receive

• Two-in-five health care workers say they feel/felt unequipped to help PWD

Part Two: Increasing MAID use and concerns for the vulnerable

• Is increased use a good thing or bad thing?

• Three-in-five concerned about socially, financially vulnerable populations

• Support for MAID rises

Part Three: Canadians’ personal connection to MAID

• How many have had experience?

• One-in-three who received unsolicited offer said yes

Part One: Disability experiences in health care

Canada’s legalization of medical assistance in dying (MAID) has raised a significant amount of concern among disability advocates. A coalition of disability rights organizations have filed a Charter challenge against the so-called “track two” of Canada’s MAID law, enacted in 2021, which allows for individuals to seek MAID when death isn’t reasonably foreseeable. They argue that people living with disabilities are applying for MAID due to “lacking essential supports”.

Meanwhile, the proportion of Canadians living with disabilities has risen from 2017, according to Statistics Canada, to 27 per cent of the population older than 15 from 22 per cent. Mental health is a growing issue for Canadians, as Statistics Canada reported in 2023 that mental health-related disabilities are on the rise.

Approaching three-in-ten (28%) Canadians say they are living with a long-term mental health issue. One-in-five (22%) say they are living with chronic pain, while other serious concerns such as mobility issues (8%), hearing disability (8%) and vision disability (6%) are experienced by at least one-in-20 or more Canadians:

Half of those living with moderate or severe disabilities report barriers to health care

Poor health care access has been one of the symptoms of the health care crisis that has gripped the country in recent years. Data released by the Angus Reid Institute in 2022 found 29 per cent of Canadians, or nine million, had chronic difficulty access health care.

Related: Access to Health Care: Free, but for all? Nearly nine million Canadians report chronic difficulty getting help

These challenges have extended to Canadians living with disability. A majority (57%) of those living with disabilities which severely impact their day-to-day life have experienced some sort of barrier, including worse access to health care in general (31%), worse quality care (24%), difficulty finding a primary care doctor (21%), or inaccessible treatment or testing locations (12%).

A more detailed explanation of how disability was assessed in this survey is included in the methodology section at the end of this report.

Health care workers divided over quality of care PWD receive

As Canadians living with health challenges say they’ve experienced difficulties with access to health care, those within the system offer mixed assessments as to how those living with disabilities are treated.

To assess opinions of Canadian health care workers, this survey included an additional sample of 468 of those who worked in health care in various capacity.

Among health care workers, more than two-in-five (45%) say they believe people living with disability receive poor or terrible care in their province:

Approaching two-in-five Canadian health care workers say those living with disabilities receive worse speed of access in the health care system (38%), quality of care (36%) and attentiveness to their health concerns (42%) than most Canadians:

Two-in-five health care workers say they feel/felt unequipped to help PWD

Many health care workers say they perhaps didn’t have the tools needed to address issues of those living with disabilities. Two-in-five (40%) health care workers say they weren’t really or not at all equipped to deal with the needs of their patients living with disabilities, which perhaps suggests that there is a gap in training in the system which could alleviate some of these issues:

Part Two: Increasing MAID use and concerns for the vulnerable

Use of medical assistance in dying has expanded rapidly since it was initially introduced in 2016. That year, just over 1,000 Canadians used it to end their life. In 2022, the most recent year for which data is available, more than 13,000 Canadians chose to use it, accounting for four per cent of deaths in Canada. Indeed, Canada’s MAID program is considered the fastest growing in the world.

Is increased use a good thing or bad thing?

The number of MAID deaths in Canada per year has increased ten-fold since it was introduced in 2016. Quebec leads the nation in proportion of use, with 6.6 per cent of deaths in the province attributable to MAID. Overall, half of Canadians feel that the increased usage of MAID is a good thing in that it gives Canadians more control over their end-of-life decisions. This rises to two-thirds in Quebec (67%). For one-in-five, this is a bad trend and a sign of overuse, while the same number say it’s neither good nor bad, it just is.

Political and religious views are also illuminating. Those who are more religious along the Angus Reid Institute and Cardus’ Spectrum of Spirituality (see details here) are most likely to say that MAID is being overused.

There is also notably very little difference in opinion among the three groups of respondents in this survey – the general population, health care workers, and those living with disabilities which impact their day-to-day life. In each case, half or more say that increasing use is a good thing, while one-in-five push back:

Three-in-five concerned about socially, financially vulnerable populations

Some of the concerns about MAID being overused coalesce in the finding that three-in-five Canadians are worried that the financially or socially vulnerable may consider MAID because of the lack of access to adequate care. Given the above data regarding the reportedly poor access to care for people with disability, and the lower than ideal levels of confidence among health care workers that adequate care is available, this is a key takeaway from the data:

Concern for the vulnerable is highest among those living with a disability that severely impacts their day-to-day life. Half (49%) in this group strongly agree they’re worried financially or socially vulnerable people would consider MAID because of a lack of access to care:

Support for MAID rises

Through the years, the criteria to be approved for MAID has changed.

In 2016, when MAID was initially introduced, the criteria were as follows:

• be capable of making decisions about their own health;
• have a medical condition where death was reasonably foreseeable;
• not be pressured by anyone else into asking for MAID;
• give consent only after being informed of all other options available.

Considering this context, Canadians are largely supportive and have become more supportive over the years. Three-quarters (76%) now say they’re supportive of MAID under the 2016 criteria. Levels of uncertainty in earlier polling have diminished:

Notably, those living with more severe disability which affects their day-to-day life are stronger in their support of the 2016 criteria for MAID than the general population:

In 2021, the criteria for MAID approval were altered. The biggest difference was that MAID became available to people with serious, incurable illness or disability whose death is not reasonably foreseeable. People seeking MAID must wait at least 90 days (with exceptions if they lose the ability to consent) before they can receive it and must be assessed by two doctors before it can be approved. Support for MAID under these criteria is lower – three-in-five (63%) support it, compared to 76 per cent for the former version – but support is also rising. In 2022, all but 3.5 per cent of cases of MAID in Canada were those where natural death was reasonably foreseeable.

Health care workers (36%), and those living with more severe disabilities (37%), are more likely to strongly support the 2021 criteria than the general population (29%) or those who report no mental or physical health issues which pose day-to-day challenges for them (27%):

Part Three: Canadians’ personal connection to MAID

How many have experience with MAID?

With instances of MAID increasing, the proportion of those who know a close friend or family member who received MAID has reached one-in-five (18%). This is higher among those older than 54 (24%) and those in Quebec (26%), the province which has seen the most medically assisted deaths since 2016. Exposure is close to evenly divided between close friends or family members.

Notably, six per cent of Canadians say that they had a close friend or family member who was offered MAID unsolicited, something opponents have been concerned about.

From 2016, when it was first legalized, to 2022, the last year data is available, there have been 44,958 medically assisted deaths in Canada. In aggregate, one-quarter of Canadians report they have had some exposure to MAID either by knowing friends or family who requested it or were offered it unsolicited:

One-in-three who received unsolicited offer said yes

The increasing availability of MAID has concerned some advocates that those suffering from mental and physical health issues could be pressured into MAID. Although those who support MAID argue there are enough guardrails in the process to prevent someone who didn’t want MAID from being coerced into it, stories such as the veterans who were offered MAID by Veteran Affairs Canada caseworkers have raised the alarm that MAID is being brought up unsolicited to some who weren’t even considering it.

As noted above, six per cent of Canadians say they know a friend or family member who was offered MAID without requesting it. Among those who say someone close to them received this offer, one-in-three (37%) say that this offer was accepted while two-in-three (63%) say it was rejected:

Survey Methodology

The Angus Reid Institute, in partnership with Cardus, conducted an online survey from Oct. 2-7, 2024 among a representative randomized sample of 1,652 Canadian adults who are members of Angus Reid Forum. For comparison purposes only, a probability sample of this size would carry a margin of error of +/- 2 percentage points, 19 times out of 20. Discrepancies in or between totals are due to rounding. The survey was self-commissioned and paid for jointly by ARI and Cardus.

This survey estimates two-in-five (43%) of Canadians live with a disability or health condition that poses at least some difficulty for their daily activities.

In order to ascertain this categorization, Canadians participating in the survey were first asked if they live with one or more disabilities or health conditions, including those more officially associated with disability — such as chronic pain, mobility issues, vision/hearing impairment, or mental health — but also some other potentially debilitating conditions that may not traditionally be thought of under the definition of disability — such as an auto-immune disorder or other chronic health conditions. The broader list of conditions offered produces a somewhat higher proportion of Canadians qualifying as living with disability in this survey when compared to official Statistics Canada stats. According to Statistics Canada, 27 per cent of Canadians aged 15 and older had one or more disabilities that limited them in their daily activities.

Further probing on the frequency and extent to which their disability/condition interferes with or limits their daily activities was used together to assign a level of “severity” for analysis purposes. See the full set of questions in the questionnaire.

This survey includes an additional sample of 468 current or former Canadian health care workers who are members of the Angus Reid Forum.

For detailed results by age, gender, region, education, and other demographics, click here.

For detailed results by the Spectrum of Spirituality and the health care workers sub sample, click here.

For detailed results by those living with disability, click here.

For the full release including methodology, click here.

For questionnaire, click here. 

Image – ID 93535719 | Kreangkrai Indarodom | Dreamstime.com

Dave Korzinski, Research Director, ARI: 250.899.0821 dave.korzinski@angusreid.org

Daniel Proussalidis, Director of Communications, Cardus: 613.899.5174 dproussalidis@cardus.ca