Canada’s Track 2 MAiD system presents challenges for assessors
As Canada’s medical assistance in dying (MAiD) system evolves, new UBC research sheds light on the difficult realities of Track 2 cases, where people may live for years while enduring chronic suffering.
Led by nursing professors Dr. Barbara Pesut (BP) and Dr. Sally Thorne (ST), the study reveals key obstacles for physicians and nurse practitioners assessing those who apply for Track 2 MAiD, including interpretation of eligibility criteria, obtaining specialist consultation on alternative options to relieve suffering, and managing the impact on patients found ineligible.
Because these decisions can significantly reduce years of life, assessments are deliberate, resource-intensive and high-stakes. This study offers new insights, drawing on first-hand experiences from 23 MAiD assessors across four provinces to identify system-level barriers.
Why are Track 2 assessments complex?
BP: Track 2 applicants differ from those under Track 1 because they may live for years—even decades—while coping with chronic suffering. That makes these decisions especially complex. Clinicians look beyond symptoms, reviewing medical history, prior treatments, support systems and decision-making capacity. It’s not a tick-box exercise; it’s a series of meaningful conversations to understand the patient and why they’re making this request now.
Why do Track 2 assessments take so long, and what are the biggest barriers?
ST: Track 2 cases may involve multiple visits, detailed record review and coordination with specialists, all of which can take considerable time. While the law requires a minimum 90-day safeguard, assessments often extend beyond that to ensure all eligibility criteria are met. Because the stakes are so high, assessors say the work is stressful and best done with a supportive consultative team.
Accessing consultation, including specialists in the patient’s specific medical condition, can be a challenge if some refuse to participate, which can stall the process. Complete medical records can also be difficult to obtain, especially for patients with fragmented care histories. Social and geographic factors—including rural location, housing instability and financial constraints—add to the complexity, especially if patients have struggled to access care that could ease their suffering.
Do Track 2 experiences vary by location?
BP: Yes. While MAiD legislation is federal, each province has created its own approach to providing Track 2 assessment, in some cases adding barriers to access. B.C. has done fairly well with this; early on, government and health authorities created MAiD coordinating centres, reducing barriers to access and encouraging collaboration. Quebec has moved ahead of the rest of the country in some respects, with advance requests in circumstances such as dementia, which adds to the legal complexity.
How are ineligibility decisions handled, and what could improve Track 2 assessments?
ST: Declaring a patient ineligible is one of the most challenging parts of the work. Assessors are concerned about risks to patients when they are found ineligible, and they try to provide support wherever possible. If assessors feel unsupported, some may opt out of providing care, which raises equity concerns. We don’t want a system where people have the option of MAiD under Canadian law but no one is willing to provide it.
To improve assessments, we need structured consultation systems for all assessors, team-based coordination centres and remuneration that reflects the time and complexity of these cases. Sharing knowledge across regions can help standardize decision-making and clarify what counts as reasonable safeguards.
What’s next from UBC’s research program?
BP: We will continue studying Track 2 systems and patient experiences, following persons through their application process and interviewing bereaved families over time. We expect to share our findings within a year. We hope this work will inform policy improvements and clinical guidance.
