Kiano Vafaeian in an undated handout photo.Mching/Courtesy of family
An Ontario woman is calling for a moratorium on medical assistance in dying for those without terminal conditions after her mentally ill son flew to Vancouver last month to end his life.
Margaret Marsilla said her 26-year-old son, Kiano Vafaeian, received MAID after being denied it by doctors in his home province in recent years. She alleges that he “shopped around” until he could find the two physicians needed to approve the procedure.
Her son had long battled substance abuse, depression associated with his Type 1 diabetes, and blindness in one eye, according to Ms. Marsilla, who is from Caledon.
People with terminal conditions can qualify for MAID under what is referred to as Track 1. Mr. Vafaeian’s condition didn’t meet those requirements, according to Ms. Marsilla.
Undated handout photo of Margaret Marsilla, of and her son Kiano Vafaeian, who flew to Vancouver to receive medical assistance in dying after being denied by doctors in Ontario.Mching/Courtesy of family
But she argued that her son should not have been eligible under the Track 2 option, which allows patients to qualify for the procedure if they endure intolerable suffering because of chronic diseases and disabilities.
Ms. Marsilla said her son had a bit of numbness but had never complained of nerve pain, and could get around well enough because he had sufficient eyesight in one eye. She added that he took a three-day trip to Mexico’s Yucatán Peninsula before returning to Vancouver shortly before Christmas last year.
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Ms. Marsilla said his death also underscores the need to permanently stop the expansion of MAID to people whose sole condition is mental illness, a practice that was initially slated to be legal in 2024 but has been postponed until 2027.
“People go through deep holes, and it takes time for them to come out,” she in a telephone interview. “During that deep hole, they can go through that [MAID] application process.”
Track 2 has expanded rapidly since it was legalized five years ago. However, it represented only 4.4 per cent of the 16,499 people who died via MAID in 2024, the last year for which Health Canada has published data.
A committee of the United Nations last spring reviewed Canada’s treatment of disabled people and called on Ottawa to end MAID for anyone without a terminal illness. It said the procedure is offered as state-sanctioned relief from suffering to people who are failed by governments that don’t properly fund access to health care or accessible housing.
Dr Ellen Wiebe at the Willow Women’s Clinic in Vancouver in March, 2016.John Lehmann/The Globe and Mail
In October, 2024, a B.C. judge granted an injunction halting the MAID death of an Alberta woman suffering from bipolar disorder and akathisia, which is an underlying feeling of horror coupled with an inability to sit still that is linked to certain types of medication.
Her common-law husband argued in his application for the injunction that the woman could not get her own doctors to support her MAID application, so she turned to doctors in British Columbia. The injunction lapsed and she returned to Alberta, but it’s not clear what happened to her.
Mr. Vafaeian’s approval for the procedure by two Ontario doctors was the subject of a CBC documentary in 2023. But Ms. Marsilla said that approval lapsed, and in recent years he had been denied MAID by doctors in that province. She said she is not clear on how he came to be approved in British Columbia.
She said her son’s death certificate says he died of MAID because of blindness, severe peripheral neuropathy and diabetes. Ms. Marsilla argued that all those conditions were very treatable.
His death certificate was signed on Dec. 31 by Ellen Wiebe, a MAID provider who was also at the centre of the Alberta case from 2024.
Dr. Wiebe said in a statement to The Globe and Mail on Wednesday that every one of her patients was capable of consenting to MAID and that in each Track 2 procedure she ensured her assessment of their eligibility took the requisite 90 days.
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“As with all my colleagues, I carefully assess each patient and each individual for whom I provided MAID had a grievous and irremediable medical (not psychiatric) condition causing unbearable suffering and causing an advanced state of decline in capability,” Dr. Wiebe’s statement said.
Trudo Lemmens, a University of Toronto professor and Scholl Chair in Health Law and Policy, said Mr. Vafaeian’s death raises serious questions about Track 2 cases in general, including whether doctors who are not the patient’s main physician can approve MAID when the person is clearly battling mental health issues for which they may not be getting adequate treatment.
“I’m interested in knowing how was that respected here,” he said.
Isabel Grant, a law professor at the University of B.C. who has been critical of Canada’s MAID framework, said this case raises clear questions about why people are flying for hours to seek a procedure that is readily available, but they did not qualify for.
“That’s not what out-of-province care is supposed to be,” she said.
B.C’s Ministry of Health issued a statement saying it is committed to providing MAID in a manner that is respectful and supportive of patients, families and providers. The statement said the ministry would not discuss Mr. Vafaeian’s case.
The ministry has said previously that each MAID death is reviewed by a special unit to ensure that doctors and nurses are complying with all the laws and rules. This unit does not conduct potential misconduct investigations. That is left to police or the regulatory colleges for nurses and doctors.
The College of Physicians and Surgeons of BC, the self-regulating professional body that has the task of investigating complaints against doctors accused of violating MAID rules, did not immediately respond to a request for comment about Ms. Marsilla’s concerns.
Last year, the college issued a statement to The Globe saying that it had never disciplined a doctor in relation to medically assisting someone’s death.
When asked whether it was legal for a doctor in Vancouver to assess whether a patient calling in from another province is suitable to die by MAID, the college referred to its guidelines on virtual care. That guide states that prescribing any care to such a patient is fine for B.C.’s doctors as long as they are also abiding by the licensing rules in the “jurisdiction where the patient is located.”