Track two MAID isn't about gender
Claims to the contrary aren't supported by the data
In 2022, men made up 51.4 percent of medically assisted deaths in Canada. This slight male bias is consistent with previous years: men accounted for 52.3 percent of assisted deaths in 2021, 51.9 percent in 2020, 50.9 percent in 2019, and so on. This is consistent with other jurisdictions. In Oregon, for instance, men have accounted for 53.1 percent of assisted deaths going back to 1998.
But now consider this: in one Canadian jurisdiction, men accounted for 73.2 percent of MAID deaths. Weird, no? Maybe even cause for concern?
Probably not. That jurisdiction was Prince Edward Island, which had forty-one MAID deaths in 2022. Thirty of the people who chose MAID were male. Eleven were female. But no one, least of all me, is arguing that there’s a problem here or that this type of jurisdictional fluctuation is evidence of anything untoward. This is just how the numbers shake out sometimes.
But here’s Ramona Coelho, family physician and member of the Ontario MAID Death Review Committee, writing in the Globe and Mail about the recently leaked 2023 MAID data from Ontario:
Alarmingly, out of all 116 such deaths, 61 percent were female. Research shows that twice as many women attempt suicide, but then benefit from suicide prevention and do not reattempt.
The 116 deaths Coelho is referring to are so-called track two deaths, which occur when a person has MAID when their natural death isn’t reasonably foreseeable. Last year, there were 4,528 instances of track one MAID, marking an eighteen percent increase from 2022. The number of track two deaths actually went down slightly—there were 121 in 2022—and so made up an even smaller percentage of overall MAID deaths (2.74 percent last year compared to 3.17 percent in 2022).
Others have drawn attention to the gender difference in track two deaths. In a recent article for The Conversation, psychiatrist Sonu Gaind also points to the gender difference as evidence of a problem. Meanwhile, Isabel Grant, a law professor at the University of British Columbia whose work heavily influenced the recent disability-based track-two Charter challenge, thinks the gender difference is evidence of eugenics:
Coelho, Gaind, and Grant aren’t mistaken about the distribution here. Across Canada, women made up 59 percent of track two deaths in 2022, which is an up from 52.5 percent in 2021. In Ontario last year, women accounted for 61.2 percent of track two deaths.
But this isn’t evidence of a problem, let alone genocide, for a couple reasons. First, just as with the PEI data, we’re dealing with small numbers here. In Ontario, we’re talking about twenty-six more women than men accessing MAID. In the 2022 data for Canada, the gender gap amounts to eighty-three more women than men having track two MAID.
The second reason is that the differences, small as they are, are explainable by sex differences in medical conditions. For example, in Ontario last year, chronic pain accounted for 39.7 percent of track two cases, and chronic pain is more prevalent in women. Here’s a recent article called “Sex and Gender Difference in Pain” in International Review of Neurobiology:
Women and girls are disproportionally affected by chronic pain. About half of chronic pain conditions are more common in women, with only 20 percent having a higher prevalence in men.
The Canadian data don’t specify chronic pain, but it would fall under ‘Other Condition’, which was the second most common reason at 37.1 percent. The difference between men and women in that category is substantial.
Neurological conditions made up 37.9 percent of Ontario track two cases. There are many different neurological conditions, so running the numbers is more difficult. Some are more common among men, while others are more common among women. Men are about twice as likely to get Parkinson’s, but women are four times as likely to get multiple sclerosis. ALS is more common among young men than young women, but the difference is smaller post-menopause. The Ontario and Canadian data aren’t specific enough to know the proportions of each condition, but these distributional differences are enough to explain why more women seem to be using track two MAID. In any case, the differences are not enough to conclude that the difference is evidence of gender discrimination or genocide.
Given this, as with my last post, I’m once again led to the conclusion that MAID opponents are making unjustified conclusions from the available data. There’s nothing to indicate that the slightly higher proportion of women among track two deaths is an indication of any kind of problem.
This, however, is only one part of my grievance with this cohort. According to Coelho, “Research shows that twice as many women attempt suicide, but then benefit from suicide prevention and do not reattempt.”
Gaind makes almost exactly the same point in his Globe article:
It should be noted that there is longstanding evidence of a 2:1 gender gap of more women than men attempting suicide when mentally ill, most of whom do not die by suicide and do not try again.
For the sake of argument, I will grant that it’s appropriate to mention traditional suicide in the context of MAID, even though there are important differences between suicidality and requesting MAID. Given this, it’s fine to mention concerning gender gaps, and it’s true that women account for far more hospitalizations following suicide attempts than men do.
But if you write about gender and suicide without mentioning that 75 percent of completed suicides are done by men, you are committing statistical malpractice. This is especially so for Gaind, the chief of psychiatry at Humber River Hospital and former president of the Canadian Psychiatric Association, who’s surely aware of these statistics.
The data we have on MAID doesn’t justify the conclusions reached by Coelho, Gaind, and Grant. In contrast, as I’ve written, that three-quarters of suicides are done by men is evidence of a problem that needs real policy solutions. When people talk about gender and suicide, they should also talk about this. I agree with Gaind that our policies should be informed by evidence. It just turns out that the evidence shows that gender differences aren’t a problem for MAID.
Well stated as always !
There may be another reason why track 2 is used by more women than men. Women live longer, and some men may have died before reaching the age where they may want to use MAIID.