A study examining the potential of Canada’s Medical Assistance in Dying (MAiD) programme estimates that expanding it to include “vulnerable groups” could generate state savings of as much as CAD 1.273 trillion (approximately NOK 1.05 trillion) by 2047.

The study, entitled “Government Economics of Expanding Canada’s Medical Assistance in Dying to Vulnerable Populations and the Ethical Implications of Allowing the State to Control Death”, examined both voluntary and non-voluntary scenarios across several population groups. It was written by researchers Uzair Jamil and Joshua M. Pearce at Western University and was first published in the journal OMEGA – Journal of Death and Dying in February 2025. It models both voluntary and non-voluntary euthanasia scenarios and has attracted renewed attention in connection with the debate over further expansions of the MAiD programme.

– A “limited option” for terminally ill patients

The researchers examine groups that cost society more than their economic contribution, including people with severe mental illness, elderly pensioners, the homeless, drug addicts and Indigenous peoples.

In the voluntary scenario, savings are estimated at between CAD 59 and 65 billion. In the non-voluntary euthanasia scenario, where consent is unclear or absent, savings could amount to between CAD 1.24 and 1.27 trillion by 2047 if such a regime were legalised. For pensioners alone, the researchers estimated economic gains of more than CAD 1.2 trillion in scenarios involving involuntary participation.

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The savings derive primarily from reduced expenditure on healthcare services, care provision and pension payments.

The researchers raise concerns that substantial financial incentives could lead the state to prioritise euthanasia over care. They use formulations such as “a deeply troubling ethical dilemma” and “a mentality that gives free rein”, and point to the danger of economics becoming a hidden source of pressure.

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The study is not official policy; rather, it is an analysis illustrating the potential inherent in an aggressive expansion of MAiD.

The Liberals, a driving force behind euthanasia

Canada has one of the world’s most liberal euthanasia programmes. Since the country, under Prime Minister Justin Trudeau, legalised euthanasia in June 2016, the eligibility criteria have repeatedly been relaxed. What was originally presented as a limited option for terminally ill patients has been transformed into one of the world’s most permissive assisted-dying programmes.

In 2021, the requirement that “natural death must be reasonably foreseeable” was removed, and MAiD was expanded to include people with non-terminal conditions such as chronic illnesses and disabilities. This laid the groundwork for the inclusion of mental illness as the sole qualifying condition, something that was planned for introduction in 2023/2024 but has been postponed until March 2027.

The Liberals have been the driving force behind both the introduction of the programme and all major subsequent expansions. They have consistently argued on the basis of “personal autonomy”, “compassion” and “dignity”.

In 2023, MAiD accounted for around five per cent of all deaths in Canada, and the proportion has increased steadily since legalisation.