Canada is one of the few countries permitting Medical Assistance in Dying (MAiD) for individuals with non-terminal chronic pain. While this respects individual autonomy, it also introduces a duty of care: We must ensure that death is not chosen because of inadequate care. Some Canadian advocacy groups, like the British Columbia Civil Liberties Association (BCCLA), have expressed deep concerns over how MAiD is being expanded in Canada.
The BCCLA initially supported MAiD’s legalization, but now says the program has “drifted far from the intentions of Parliament,” raising red flags about its current trajectory. They argue that vulnerable individuals facing disability, mental illness, or social isolation may be inadvertently nudged toward MAiD rather than supported with robust care alternatives. Hence, the BCCLA advocates for stricter oversight, urging clear ethical standards, better data tracking, and stronger informed consent.
In the contemporary era, when access to MAiD has expanded in Canada, there is the potential risk of a surge in requests among vulnerable non-terminal chronic pain patients. A recent three-year study conducted at the Salem Pain Clinic in Surrey, British Columbia, Canada, offers a context-specific narrative: When suffering endures, most chronic pain patients do not choose death, but they prefer dignity, resilience, and multimodal pain management. A multinational team conducted the clinical study. It was published in the SVOA Medical Research journal in June 2025.
The observational longitudinal cohort study reviewed 520 chronic pain patients, recording their age, gender, diagnosis, and SF-36 quality-of-life scores across eight domains. Only five patients (approximately 1 percent) inquired about or requested MAiD. All were males aged 43–80 with neuropathic, non-cancer paraspinal pain. Over three years, SF-36 scores remained remarkably stable, with slight improvements in bodily pain (+1.6), general health, vitality, social, emotional role, and mental health (+0.6 to +0.8), while physical functioning remained unchanged. Despite ongoing discomfort, most patients demonstrated remarkably stable quality-of-life scores, reflecting hope and adaptation rather than despair.
The clinical study concludes that the overwhelming majority (≥99 percent) of chronic pain patients chose ongoing multimodal pain management over MAiD, even when suffering remained significant. This empirical evidence (unlike many opinions) suggests stable quality of life is achievable in chronic pain patients, even when they contemplate MAiD. Patients prefer hope, healing, and hospitality. Indeed, with consistent, value-based care and nonjudgmental listening, many chronic pain patients find pathways through the suffering without resorting to MAiD.
The research publication underscores a crucial message: Value-based, patient-centered pain management can sustain dignity and discourage premature death decisions, even when pain persists. This implies that value-based, multimodal pain care can preserve quality of life and dignity, making the ethical case to continue robust treatment rather than defaulting to MAiD. It reinforces the importance of multimodal, compassionate care and avoiding premature MAiD referral. This is valuable data for policymakers, clinicians, ethicists, and the MAiD process stakeholders.
The ongoing debates emphasize one urgent truth: MAiD must never replace adequate health and social care. For MAiD to remain ethical and compassionate, Canada must ensure accessible, comprehensive mental health, pain management, and social care. Indeed, Canada must ensure rigorous informed consent practices and transparency in the MAiD approval process.
Canada’s MAiD framework was built on the values of autonomy and compassion. But when suffering is rooted in structural gaps like inaccessible care, inequity, or poverty, then autonomy is incomplete. The question before us is not just who can access MAiD, but how we ensure that choosing death does not reflect failed systems. This is not just a clinical issue but a moral one. And if we are to offer dignity in dying, we must first commit to providing dignity in living.
Olumuyiwa Bamgbade is an accomplished health care leader with a strong focus on value-based health care delivery. A specialist physician with extensive training across Nigeria, the United Kingdom, the United States, and South Korea, Dr. Bamgbade brings a global perspective to clinical practice and health systems innovation.
He serves as an adjunct professor at academic institutions across Africa, Europe, and North America and has published 45 peer-reviewed scientific papers in PubMed-indexed journals. His global research collaborations span more than 20 countries, including Nigeria, Australia, Iran, Mozambique, Rwanda, Kenya, Armenia, South Africa, the U.K., China, Ethiopia, and the U.S.
Dr. Bamgbade is the director of Salem Pain Clinic in Surrey, British Columbia, Canada—a specialist and research-focused clinic. His work at the clinic centers on pain management, health equity, injury rehabilitation, neuropathy, insomnia, societal safety, substance misuse, medical sociology, public health, medicolegal science, and perioperative care.
