I had the opportunity to explore these questions with Dr. Dirk Huyer, Ontario’s Chief Coroner and chair of the province’s MAiD Death Review Committee (MDRC). With his office tasked with reviewing every MAiD death in Ontario, Dr. Huyer provides a rare, unfiltered view into the practice—beyond the headlines and heated takes.

Looking Beyond the Headlines

Dr. Huyer stressed that the role of the coroner’s office is not to pass judgment, but to understand the full context of each death and make recommendations to improve MAiD practice. However, what surprised him most wasn’t necessarily what they found in their reviews—it was how parts of those reviews have been selectively used to push particular narratives.

“Some people have taken snippets of the reports to support their positions,” he said, “rather than looking at the context.” And context matters deeply, especially when discussing the very end of someone’s life.

The Complexity of Track Two

Canada is unique in having two MAiD pathways: Track 1 for individuals whose death is reasonably foreseeable, and Track 2 for those suffering intolerably from chronic but non-terminal conditions. Track 2 is where many of the most difficult ethical questions emerge.

According to Dr. Huyer, while Track 2 accounts for a small fraction of overall MAiD cases, it tends to attract disproportionate public attention—often due to its complexity. Factors like long-term unemployment, lack of access to adequate housing or healthcare, and social isolation can all shape someone’s suffering. This, in turn, affects their eligibility for MAiD.

The challenge, as Dr. Huyer explained, is that while the legislation has safeguards, the real world is messier: “Sometimes the service that could help is simply not available. That doesn’t make it right. But it’s the reality for that person at that moment.”

Are People in Marginalized Communities Choosing MAiD?

One of the most important points we discussed is the link between socioeconomic marginalization and MAiD requests. A recent MDRC report showed that individuals receiving MAiD under Track 2 were more likely to live in materially deprived neighbourhoods. However, Dr. Huyer was clear: “It’s a correlation—not necessarily causation.”

This doesn’t mean that people are choosing MAiD because they’re poor. But it does mean we need to ask: are we offering people the support they need to not choose MAiD?

Other countries offer interesting contrasts. In California, for instance, wealthier individuals are disproportionately represented in MAiD cases. Could it be that suffering looks different when it’s compounded by anxiety, depression, and unmet expectations—regardless of income level?

Autonomy Under Pressure

Autonomy is the legal and ethical backbone of MAiD. But as I asked during the episode—can a decision really be autonomous if it’s made in the context of social isolation or lack of support?

Dr. Huyer was careful to avoid broad generalizations. “It’s an important consideration,” he said, “but we can’t assume someone’s decision is invalid just because they’re isolated. Each case needs to be evaluated fully.”

Still, the concern lingers. If someone is completely alone, with no access to mental health support, no family, and no meaningful social interaction—are they choosing to die, or simply choosing what seems like the only option left?

Supporting Assessors and Practitioners

Beyond the patients, we also need to consider the assessors. MAiD assessors are often working in emotionally draining environments, with complex cases and limited resources. Dr. Huyer pointed to the need for more “communities of practice” and care coordination, especially in Ontario.

Other provinces, like Nova Scotia and British Columbia, have adopted centralized care coordination models. Ontario, with its decentralized health system, is lagging in this regard. A more consistent framework could better support both practitioners and patients.

What Comes Next?

As MAiD becomes more normalized in Canadian healthcare, Dr. Huyer remains hopeful—but realistic. “We’re seeing an overall maturing of MAiD practice,” he said. “But we need to keep improving. That means more holistic assessments, more transparency, and more conversations.”

Conversations like this one.