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The Doctor Behind One of Canada’s First MAID Deaths Speaks Out
Ian Ball was among the earliest to administer the procedure. He recalls the anxiety ten years later
According to the most recent federal figures, of the 326,230 deaths registered in Canada in 2024, 16,499 were medically assisted. That year, Ontario reported 4,944, and British Columbia 2,997. Quebec registered the highest rate of medical assistance in dying, or MAID, by any jurisdiction in the world, contributing 36.3 percent of medically assisted deaths that occurred in the country.
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If one were to classify MAID as a cause of death in Canada, in 2024 it would have been the fourth after cancer, heart conditions, and accidents, and ahead of cerebrovascular diseases. Consistent with previous years, the vast majority of medically assisted deaths in 2024 were for people of a median age of seventy-eight whose natural deaths were considered reasonably foreseeable, with 4.4 percent for people of a median age of seventy-six who might otherwise live indefinitely (albeit intolerably).
In Canada, how people die with medical assistance varies legally: legislation defined eligibility criteria but not how the death was to occur. Trends emerged: 99.99 percent of medically assisted deaths in Canada have been instances of active euthanasia—for obvious reasons. Whereas assisted suicide usually involves an anti-nauseant, the passage of an hour, and drinking half a cup of lethal liquid with or without observation, active euthanasia—directly administered by a medical or nurse practitioner—consists of the three-drug cocktail midazolam (an anxiolytic), propofol (a coma-inducing sedative), and rocuronium (a paralytic) injected in this sequence. It has a near-zero failure rate, and death typically occurs within minutes.
Born in Ottawa, Ian Michael Ball is an associate professor in the Division of Critical Care Medicine and the Department of Epidemiology and Biostatistics at Western University, a trauma physician with the London Health Sciences Centre Trauma Program, and the Critical Care Medicine lead for Southwestern Ontario. He was among the first physicians in Canada to administer MAID. With an LHSC ethicist, Ball was instrumental in developing a step-by-step procedural guide for hospitals across the country establishing MAID programs.
The interview has been edited for length and clarity.
Was euthanasia a component of your education?
Yeah, absolutely. I was interested in bioethics right from the beginning and remain so. I took some religion and philosophy courses with a bioethics focus. After I finished my clinical training at Western, I went back to Queen’s, joined the faculty, and completed a master’s in clinical epidemiology at the University of Ottawa. But I don’t have any formal training in ethics per se. I can tell you how I got involved with MAID, which I think is what you’re getting at. As a clinician, my job is to take a practical approach while being aware of complexity.
I was at a meeting with an LHSC ethicist probably in 2015. They were working extremely hard to prepare LHSC for MAID. I was there to ask, “Well, what would happen if we had an organ donor who wanted MAID?”
At the end of the meeting—there were four or five of us—almost everyone left, except for just the ethicist and I. I asked him, “How did you find providers, people willing to do MAID?” He said, “Well, people just kind of hang around after talks, just like you are now, and volunteer.” I said, “How many do you have?” He said, “A few.” Without having given the matter a whole lot of thought, I said, “If you’re ever stuck, and you need somebody, maybe add me to the list,” not thinking I would ever hear from him again about........