Despite concerns surrounding the implementation of Medical Assistance in Dying (MAiD) for Canadian federal prisoners, the Correctional Service of Canada (CSC) is confident the process is fool proof.

On June 18, The Catholic Register published a story that outlined the multiple weaknesses in the system as detailed by Correctional Investigator Ivan Zinger.

“There is no requirement for CSC to convene an investigation or mortality review process following death. There is no requirement to inform this office of a MAiD procedure. Though the guidelines assume that MAiD will be completed in the community, they still provide, in exceptional circumstances, for the procedure to be performed in a CSC treatment centre or regional hospital,” Zinger told the Register.

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On June 20, Esther Mailhot, senior advisor media relations for CSC, contacted the Register with a written statement saying, “MAiD is a complex and deeply personal matter and CSC ensures a robust and compassionate process for those who may wish to access these services.”

Mailhot affirmed that 11 federal prisoners have ended their lives through MAiD from the time medical homicide was legalized in 2016 until March 31, 2024. Over that same period, the Corrections Service received 40 MAiD requests. In 2022, four MAiD deaths were granted of eight requests received. In 2023, one prisoner was medically killed out of 11 requests for medical death. 

An Access to Information document obtained by the Register indicates the 2023 MAiD death was the first to be approved according to “track two” guidelines where “natural death is not reasonably foreseeable.” No medical rationale was listed.

Mailhot said MAiD provision within the Corrections Service is consistent with its top priority of “ensuring that those who are incarcerated in Canada’s federal institutions have access to quality, safe, patient-centred and culturally-responsive care.”

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The CSC’s legislative mandate, and the Corrections and Conditional Release Act (CCRA), require providing “essential health care and reasonable access to non-essential health care to federal inmates, in keeping with professional standards. As part of this, CSC is responsive to the needs of offenders, including quality and compassionate palliative and end-of-life care,” she added.

“The eligibility requirements within CSC follow the legislative requirements that apply to all Canadians. Once an individual makes such a request, a physician or nurse practitioner will meet with them to discuss relevant information, offer referrals to support services (such as mental health professionals, chaplains, elders, etc.), and schedule the individual for an eligibility assessment,” she said.

Reflecting the recently updated guidelines reported in the June 18 story, Mailhot noted that “CSC’s guidelines require that an external physician or nurse practitioner perform the second eligibility assessment, and that the procedure be completed externally to CSC, namely, in a community hospital or health care facility, other than in exceptional circumstances.”

The CSC concluded “the process related to the provision of MAiD is comprehensive and contains numerous safeguards to ensure that federally incarcerated individuals are afforded the same rights as all other Canadians.”

Zinger reiterated his concerns about the absence of transparency and mechanisms.

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“Not conducting investigations of MAiD cases remains a serious concern. That is, making sure that CSC met its health care obligations and provided professionally accepted standards of care leading up to the MAiD request and procedure, and investigating if all was done to transfer the person ASAP into the community, including promptly pursuing compassionate release or parole.  The CSC investigation report should be sent to us by law as any other death in CSC custody — ensuring external oversight.”

Once again, Zinger noted that “the exception of performing the procedure inside penitentiaries is outrageous. The most humane way to deal with palliative and end-of-life cases is to transfer them to the community ASAP and allow them to freely choose MAiD if that is their wish.”