⭐ PART 2 — The MAiD Expansion: How Eligibility Quietly Grew

⭐ PART 2 — The MAiD Expansion: How Eligibility Quietly Grew

The Hidden Shift Most Canadians Never Saw Coming

By Canadian Citizens Journal

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They Promised Safeguards. What We Got Was Expansion.

When MAiD (Medical Assistance in Dying) was first introduced in 2016, Canadians were reassured it would remain:
• tightly controlled
• restricted to end-of-life cases
• limited to people already dying
• protected by strong safeguards

That promise did not last.

Since 2016, MAiD has expanded faster — and more quietly — than almost any assisted-death framework in the world.

What began as a “rare last resort” has evolved into a system now available to:
• people who are not dying
• people with chronic illness
• people with disabilities
• people suffering due to social or environmental conditions
• and nearly to those with mental illness (delayed, not cancelled)

The public never voted on these expansions.
They were introduced through:
• legislative amendments
• regulatory changes
• judicial rulings
• and policy shifts buried in government documents

This chapter explains how that expansion happened — and why it matters.

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⭐ Phase 1 (2016): “Reasonably Foreseeable Death”

Under Bill C-14, MAiD required:
• a terminal condition
• a “reasonably foreseeable” natural death
• persistent, unbearable suffering
• voluntary, informed consent

Canadians were promised strict limits.

Those limits lasted four years.

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⭐ Phase 2 (2021): MAiD for People Who Are NOT Dying

In 2021, Bill C-7 removed the key safeguard.

The requirement that someone be “near death” was eliminated.

With one legislative change, MAiD eligibility now included:
• long-term disabilities
• chronic pain
• lifelong medical conditions
• conditions that will not cause death
• suffering that may be influenced by care conditions, not disease

This created the most profound shift:

MAiD became available for people whose suffering comes from systemic failure — not terminal illness.

For long-term care residents living in deteriorating environments, this change opened the door to a dangerous overlap between institutional neglect and MAiD eligibility.

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⭐ Phase 3 — Disability-Based MAiD

MAiD reports show a significant rise in requests from:
• disabled Canadians
• people struggling financially
• people unable to access adequate care or housing
• individuals suffering from social, environmental, or structural causes

MAiD was never meant to replace support services.
Yet for many, it is presented as the only available “solution.”

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⭐ Phase 4 — MAiD for Mental Illness (Delayed, Not Cancelled)

The government delayed mental illness MAiD multiple times.
But the legislation remains in place, with a new start date set for 2027.

If implemented, Canada would have one of the broadest mental-health MAiD frameworks in the world.

Many psychiatrists warned:

“People may turn to MAiD because they lack resources, not because they lack hope.”

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⭐ Phase 5 — Advance Requests: The Next Planned Expansion

National studies, expert panel reports, and palliative/MAiD integration documents reveal the next step:

➤ Advance Requests for MAiD — including for dementia.

This would allow:
• requests made while the person still has capacity
• MAiD to be carried out later
• even if the person no longer understands
• even if they resist
• even if their wishes appear changed

This is one of the most controversial expansions in the history of Canadian healthcare.

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⭐ Phase 6 — The Economic Factor Behind the Expansion

Economic modeling published in policy papers estimated that MAiD expansion could reduce healthcare spending by tens of millions annually — and up to $1.2 billion by 2047 due to:
• fewer long-term care costs
• reduced disability payments
• fewer hospitalizations
• reduced need for continuing care services

No one needs to speculate.
These figures were calculated and published.

Systems follow incentives — especially financial ones.

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⭐ Phase 7 — What Frontline Staff Observed After 2021

Across long-term care homes in Canada, workers began noticing:
• faster decline in residents
• worsening mobility
• more infections
• increased palliative classifications
• more MAiD inquiries
• greater emotional deterioration

At the same time, Canada experienced a historic rise in excess mortality, which has not yet been fully explained by federal authorities.

No causal claims are made here — only the documented pattern:

Residents began deteriorating faster, while the systems meant to support them weakened even more.

This matters because MAiD eligibility is built entirely on suffering — and suffering increased dramatically after 2021.

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⭐ Phase 8 — Forced Transitions Inside Care Homes

During this period, many facilities began:

➤ pushing residents with high needs into Assisted Living,

even when their:
• cognitive decline
• mobility loss
• behavioural changes
• inability to weight-bear
• dementia progression

…made Assisted Living completely inappropriate.

Staff repeatedly raised concerns:
“These residents are beyond our scope of care.”

The response?

“We don’t have a choice. You’ll do it or you won’t be working here.”

This was not part of original hiring expectations.
Worker safety declined.
Resident safety declined.
Proper LTC criteria were ignored.

And significantly:

Residents who previously would have been placed in nursing care were now suffering inside a level of care not designed for them.

This forced mismatch led to:
• preventable injuries
• behavioural crises
• falls
• worsening depression
• accelerated decline

And ultimately:

➤ more residents becoming eligible for palliative classification and MAiD.

This systemic trend is directly relevant to the MAiD pipeline.

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⭐ Why the Expansion Matters for Long-Term Care Residents

With MAiD now available even when death is not near, residents living in deteriorating environments increasingly meet MAiD criteria because of:
• unmet care needs
• untreated suffering
• emotional despair
• poor nutrition
• freezing rooms
• understaffing
• loneliness
• lack of proper placement
• institutional conditions
• early cognitive decline
• depression

This is the core issue:

MAiD is being offered in a system where suffering is often created by the institution — not the illness.

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⭐ The Expansion Was Not an Accident — It Was a Funnel

Eligibility widened at the same time:
• LTC conditions worsened
• staffing collapsed
• costs increased
• palliative care merged with MAiD pathways
• social suffering was reclassified as “medical suffering”

This is the foundation of the exposé.

Part 3 begins the next chapter:
what residents actually experience inside Canada’s long-term care homes.

https://open.substack.com/pub/canadiancitizensjournal/p/part-2-the-maid-expansion-how-eligibility