The Cost of Certainty

How narrative control is narrowing Canada’s MAiD debate

Canada’s Medical Assistance in Dying (MAiD) regime was built on a promise that has become central to public trust: that those seeking an assisted death may do so within a framework of careful safeguards designed to protect the vulnerable while respecting autonomy.

I came to this issue not through ideology, but through experience. In October 2021, my mother died by MAiD in British Columbia after a rapid decline marked by severe weight loss, chronic pain, psychiatric deterioration, disordered eating, and profound hopelessness. My family believed these circumstances raised serious questions about vulnerability, capacity, and whether her desire to die reflected enduring autonomy or the distortions of untreated mental suffering.

The questions we asked in the aftermath changed the course of my life. What began as a daughter’s attempt to understand how this could happen evolved into years of investigation involving Freedom of Information requests, regulatory complaints, and what became Canada’s first police investigation into a MAiD death. That work eventually led me to testify before parliamentary committees on two separate occasions and to discussions with policymakers in the United Kingdom and Scotland. It also became the foundation for my forthcoming book, The Other Side of the Straitjacket: A Daughter’s Story of Mental Illness and Assisted Dying.

What has struck me most over these years is not simply the polarization surrounding MAiD, but the increasingly narrow boundaries of acceptable discourse around it.

Every ethically serious medical practice should be able to tolerate scrutiny, especially one involving the intentional ending of human life. Yet in Canada’s MAiD debate, criticism is often treated less as a contribution to oversight than as a threat to the legitimacy of the system itself. Questions about safeguards are reframed as attacks on autonomy. Concerns about psychiatric vulnerability are dismissed as ideological opposition. Scientific uncertainty is presented to the public with a confidence that the underlying evidence does not always justify.

One of the clearest examples of this is the debate over the physiological effects of MAiD medications. Public discussion of this issue gained momentum following the work of Dr. Joel Zivot, an American anesthesiologist and expert in lethal injection pharmacology, who raised concerns during testimony before the Canadian Senate in 2021 as Canada was considering the expansion of its MAiD regime to include individuals whose natural death was not reasonably foreseeable. Zivot questioned whether the drug protocols used in assisted dying may, in some cases, lead to rapid fluid accumulation in the lungs—a condition known as pulmonary edema, which impairs oxygen exchange and, in severe cases, may produce a dying process he described as more akin to drowning.

His testimony raised an important question: how much do we actually know about the physiological effects of MAiD medications during the dying process?

Recently, I came across a Substack article from a MAiD advocacy platform criticizing military veteran and MAiD critic Kelsi Sheren for raising concerns about pulmonary edema during assisted dying. In dismissing those concerns, the authors wrote: “Perhaps the most common and harmful example is her claim that the MAiD medications cause fluid to build up in the lungs and cause the person to drown—which is completely untrue.”

I found that statement deeply troubling—not simply because I disagree with it, but because I possess evidence that directly challenges it.

Through Freedom of Information records, I obtained documentation of the precise medications and dosages administered to end my mother’s life. The protocol was neither unusual nor experimental. It matched the standard intravenous drug regimen recommended by the Canadian Association of MAiD Assessors and Providers (CAMAP).

I also possess something extraordinarily rare in a MAiD case: an autopsy.

Because MAiD deaths are generally classified as expected deaths with a known cause, autopsies are seldom performed. As a result, post-mortem evidence examining the physiological effects of MAiD medications in real-world settings remains remarkably limited.

My mother’s autopsy documented pulmonary edema.

Whatever conclusions one draws from a single case, it leaves little room for absolutism.

I am not suggesting this proves pulmonary edema occurs in every MAiD death, nor that every patient experiences conscious respiratory distress. It does, however, establish an important point: pulmonary edema can occur after the administration of standard MAiD medications.

That makes the assertion that such concerns are “completely untrue” difficult to defend.

A more intellectually honest position would be to acknowledge that we do not yet know how often pulmonary edema occurs during MAiD, under what circumstances it develops, or what clinical significance it may carry, largely because the research simply has not been done.

I have attempted to engage directly with the authors of this Substack on this issue. I approached them in good faith, outlining the evidence in my possession and raising what I believe are legitimate questions about the physiological effects of MAiD and the troubling lack of meaningful clinical research in this area.

What I encountered was not curiosity, but defensiveness. And that, in many ways, captures the deeper problem.

Increasingly, I see advocacy groups, institutions, and stakeholders responding to questions about MAiD not by openly examining potential flaws in the system, but by protecting the system from scrutiny. The impulse is not to ask what might be missing from our understanding, but how confidence in the existing narrative can be preserved.

This is a pattern I know intimately. My family experienced it repeatedly after my mother’s death. Over time, I came to recognize this pattern as a form of institutional gaslighting. Not overt manipulation, but something subtler: selective framing, strategic omission, and unwavering certainty in areas where meaningful uncertainty remains.

The effect is profound. People begin to question what they witnessed, what they know, and whether their observations are legitimate—not because the evidence disproved them, but because the dominant narrative leaves no room for competing truths.

That principle matters profoundly in medicine, where progress has never depended on the defence of existing assumptions, but on the willingness to question them. Medicine advances because clinicians and researchers remain open to anomalies, willing to investigate uncomfortable evidence, and humble enough to acknowledge the limits of current knowledge. Ethical systems should demand no less of themselves.

That is why the growing defensiveness surrounding MAiD concerns me. Any system empowered to intentionally end life carries an extraordinary burden of accountability. Public trust in such a system cannot rest on polished messaging or categorical reassurance; it must be earned through transparency, rigorous scrutiny, and a genuine willingness to examine where safeguards may fail.

What concerns me most is not disagreement, nor even criticism. It is the gradual normalization of a culture in which difficult questions are treated as threats rather than as necessary components of ethical oversight. Once that happens, the goal subtly shifts. The priority is no longer understanding what is true, but preserving confidence in what is already believed.

That is a dangerous place for medicine—or for any institution entrusted with irreversible decisions—to operate.