Despite recent revisions to guidelines for Medical Aid in Dying (MAiD) in Canadian prisons announced in March, correctional investigator Ivan Zinger remains concerned about a process that remains opaque to public scrutiny. 

Last year, Zinger drew attention to the fact that, though his office has the mandate to investigate all deaths in custody, MAiD cases are exempt from the ombudsman’s oversight.

Zinger told The Catholic Register that his office was never informed or consulted during the recent review process.

“There was no formal consultation with our office on them, despite all of our reporting over the years on this issue,” said Zinger.

Zinger provided the only statistics Correctional Service Canada (CSC) has thus far afforded his office. The list of MAiD cases begins with two in 2018 and stops in 2022. The count is nine, with nearly half taking place in 2022. Zinger suggested that any further questions about more up to date numbers be directed to CSC.

Zinger concedes the revisions introduce some important safeguards.

“One independent witness must sign; the requirement for voluntary and informed consent, that is, no compulsion/no pressure; provisions for family/next of kin to attend procedure if security requirements are met; second eligibility assessment; and the procedure to be normally conducted by external provider.”

Zinger is unequivocal in his opposition to prisoners being administered MAiD within prison walls and outlined three outstanding issues with the revised guidelines.

“There is no requirement for CSC to convene an investigation or mortality review process following death. There is no requirement to inform this office of a MAiD procedure. Though the guidelines assume that MAiD will be completed in the community, they still provide, in exceptional circumstances, for the procedure to be performed in CSC treatment centre or regional hospital.”

Zinger has consistently targeted that last concern as being particularly problematic given the complexities of prison management and how incarceration might interfere with the exercise of “voluntary and informed consent.” And it has led Toronto Deacon Mike Walsh, co-founder and director of the Friends of Dismas, in a recent email to fellow members of the Canadian Catholic Prison Ministry Network, to ask the underlying and troublesome question, “Is MAiD made for prisoners?”

In his 2019-2020 Annual Report, Zinger reported on the first case of a person receiving MAiD within prison. The man in question was a “non-violent recidivist” diagnosed with a terminal cancer.

“The decisions to deny parole and then provide MAiD in a prison setting seem out of step with the gravity, nature and length of this man’s sentence. With no other alternative available, the decision to deny full and day parole was almost certainly a factor in shaping his decision to seek MAiD.”

Prison chaplains and others who work as volunteers in the prison system have increasing concerns about the susceptibility of prisoners to the message that MAiD is a way out of suffering. With an aging prison population, those pressures are only going to increase.

Deacon Paul Bar, president of the charity that supports the Dismas Fellowship, an organization that provides support to former and current prisoners and those “touched by crime,” said his “concern is that prisoners would look at MAiD as being a pretty viable alternative to dying alone in prison or on the streets.”

Chaplain Juliane Martin, director of spiritual care at a group of Toronto transitional homes for former federal prison inmates, has now accompanied two men in the last days of their life. 

“I never thought when I started the chaplaincy journey a while ago that I would be involved in palliative care. But just in the past couple of years, I've walked that journey with two individuals. Both were contemplating MAiD at one point, because somebody had whispered in their ear that it would be a good option,” said Martin.

Martin stresses the need for Christian organizations to offer real alternatives to prisoners at the end of their life.

“The idea of coming out leads them to question what they are coming out to. They don't have family members that are waiting for them, either because their family has passed away or they're completely disenfranchised from their family and friends. I think what ends up happening is they stay in prison longer than they should, and then there aren't options for them. I think some people might choose MAiD because they really believe that's the best choice.”