Canada is among the limited countries allowing Medical Assistance in Dying (MAiD) for individuals suffering from non-terminal chronic pain. While this upholds personal autonomy, it also imposes a duty of care: We must ensure that the choice of death is not a consequence of insufficient care. Some Canadian advocacy organizations, such as the British Columbia Civil Liberties Association (BCCLA), have voiced significant concerns regarding the expansion of MAiD in Canada.

Initially, the BCCLA supported the legalization of MAiD; however, they now indicate that the program has “drifted far from Parliament’s intentions,” raising alarms about its current direction. They contend that vulnerable individuals dealing with disability, mental health issues, or social isolation may be unwittingly pushed towards MAiD instead of being provided with strong care alternatives. Thus, the BCCLA calls for tighter regulations, advocating for clear ethical guidelines, enhanced data tracking, and more robust informed consent.

In today’s context, where access to MAiD has broadened in Canada, there exists the potential for an increase in requests from non-terminal chronic pain sufferers. A recent three-year study carried out at the Salem Pain Clinic in Surrey, British Columbia, provides a localized perspective: When suffering endures, most chronic pain patients do not opt for death but instead seek dignity, resilience, and multimodal pain management. A multinational team executed this clinical study, which was published in the SVOA Medical Research journal in June 2025.

The observational longitudinal cohort study examined 520 chronic pain patients, cataloging their age, gender, diagnosis, and SF-36 quality-of-life scores across eight dimensions. Only five patients (around 1 percent) expressed interest in or requested MAiD, all of whom were males aged 43–80 with neuropathic, non-cancer paraspinal pain. Over the course of three years, SF-36 scores showed remarkable consistency, with minor enhancements in bodily pain (+1.6), general health, vitality, social involvement, emotional role, and mental well-being (+0.6 to +0.8), while physical functioning remained stable. Despite ongoing pain, most patients exhibited remarkably stable quality-of-life scores, signifying hope and adaptability rather than hopelessness.

The clinical study concludes that an overwhelming majority (≥99 percent) of chronic pain patients opted for continuous multimodal pain management instead of MAiD, even under significant suffering. This empirical evidence (in contrast to many perspectives) indicates that a stable quality of life can be attained for chronic pain patients, even when considering MAiD. Patients favor hope, healing, and compassion. Indeed, with consistent, value-driven care and nonjudgmental listening, many chronic pain patients navigate their suffering without resorting to MAiD.

The research article highlights an essential message: Value-driven, patient-focused pain management can maintain dignity and deter premature death decisions, even amid persistent pain. This suggests that value-oriented, multimodal pain care has the potential to uphold quality of life and dignity, making a compelling ethical argument for continued robust treatment instead of defaulting to MAiD. It emphasizes the necessity of multimodal, compassionate care and the importance of avoiding premature referrals to MAiD. This data is invaluable for policymakers, healthcare providers, ethicists, and stakeholders involved in the MAiD process.

The ongoing discussions underscore a critical truth: MAiD must never be a substitute for appropriate health and social care. For MAiD to remain ethical and compassionate, Canada must guarantee accessible, comprehensive mental health, pain management, and social care. Indeed, Canada must ensure stringent informed consent practices and transparency within the MAiD approval process.

Canada’s MAiD framework was established on the principles of autonomy and compassion. Yet, when suffering stems from structural deficiencies such as inaccessible care, inequity, or poverty, autonomy remains incomplete. The issue at hand is not solely about who qualifies for MAiD, but how to ensure that the choice of death does not signify a failure of systems. This transcends clinical concerns and delves into moral implications. If we are to offer dignity in death, we must first pledge to provide dignity in life.

*Olumuyiwa Bamgbade is a prominent health care leader dedicated to value-based health care delivery. A specialized physician with extensive training from Nigeria, the United Kingdom, the United States, and South Korea, Dr. Bamgbade offers a global perspective on clinical practice and health systems innovation.*

*He serves as an adjunct professor at various academic institutions across Africa, Europe, and North America and has authored 45 peer-reviewed scientific papers published in PubMed-indexed journals. His international research collaborations extend to 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 the Salem Pain Clinic in Surrey, British Columbia, Canada—a specialty and research-oriented clinic. His focus at the clinic is on pain management, health equity, rehabilitation from injuries, neuropathy, insomnia, societal safety, substance misuse, and medical sociology.*