Ontario Doctor Put Under Supervision After Assessing Man for MAID Outside Tim Hortons

An Ontario doctor has been placed under supervision for six months by a provincial regulator for two infractions, including assessing a man for euthanasia outside a Tim Hortons and later driving him to the location where he received the fatal injections.

In another case, London, Ont., physician James MacLean failed to administer the medication that paralyzes the body’s muscles, including those involved in breathing, during a medical assistance in dying (MAID) procedure, according to a ruling by the College of Physicians and Surgeons of Ontario (CPSO). The patient began to breathe again after MacLean had declared the patient deceased and left the residence.

Complaints relating to both cases were lodged with the CPSO against MacLean in 2024. The college appointed an independent assessor to review a number of MacLean’s charts, and a ruling for both complaints was issued earlier this year.

The college’s inquiries, complaints, and reports committee concluded that MacLean “did not meet the standard of practice of the profession” and “displayed a lack of judgment,” adding that his conduct “exposes or is likely to expose patients to harm or injury” in 5 of the 20 charts reviewed.

The college has subsequently placed MacLean under supervision after concluding that he did not uphold professional boundaries and that he interacted with patients and families “in ways that can be perceived as coercive or unprofessional.” It also found he made clinical assumptions without adequate corroboration, ignored administration protocols, and kept inadequate records.

MacLean was summoned to appear before the committee to receive a verbal “caution” regarding the MAID complaints.

The doctor, who has been practising since 1980, consented to compulsory clinical supervision for a minimum of six months commencing April 15 as part of an agreement with the college. He will also be subject to frequent supervision meetings, regular assessments of his MAID patient charts, and compulsory professional education pertaining to MAID, consent, documentation, professional boundaries, and professional behaviour.

A CPSO spokesperson told The Epoch Times in an email that the “undertaking” entered into between MacLean and the college “imposes extensive oversight and monitoring requirements” on his practice.

“In accordance with the undertaking, after approximately six months, Dr. Maclean will also submit to an assessment of his practice by an assessor or assessors, which will include chart reviews and may include direct observation of care, interviews with him and colleagues, feedback from patients, and any other tools deemed necessary by the College,” the spokesperson said. “The results of the assessment may form the basis of further action by the College.”

The Epoch Times contacted MacLean for comment but did not hear back by publication time.

Complaint 1

One of the complaints was filed after the January 2024 death of St. Thomas, Ont., resident Thomas Dillon, according to documents first obtained by The Globe and Mail. The 45-year-old suffered from Crohn’s disease.

Dillon’s death was also flagged by the Ontario coroner’s MAID death review committee, although his name was not used in the 2024 report.

The report described the case of “Mr. A,” a man in his 40s who suffered from inflammatory bowel disease. He also had a history of mental health issues, past episodes of suicidal thoughts, and persistent misuse of alcohol and opioids, which resulted in the loss of his driver’s licence.

His condition meant he lacked an active social network, struggled to keep a job, faced challenges in personal relationships, and relied on his family for housing and financial assistance, according to the report.

In its ruling, the college said the patient was assessed by a nurse practitioner after applying for MAID. He was also assessed by MacLean outside a Tim Hortons coffee shop.

Both assessors found him to be eligible for MAID under Track 2, which is designed for people whose death is not reasonably foreseeable but who suffer intolerably from a “grievous and irremediable” medical condition.

The CPSO committee said it found MacLean’s informal parking lot assessment of the man “concerning,” noting that “sensitive MAID-related matters” should be discussed in a professional setting.

“Based on the Respondent’s own account, other locations were not meaningfully explored at the time,” the panel wrote. “In the Committee’s view, this reflected a lack of the level of formality and care expected when assessing requests for MAID.”

The panel also expressed concern about the “quantity and nature” of MacLean’s text messages with Dillon, which contained remarks about the family being against MAID.

The college also questioned MacLean’s decision to drive Dillon to the MAID provision site, which the Globe described as a facility resembling an industrial space where bodies are prepared for funerals.

“Taken together, these actions created a risk that [MacLean’s] involvement could be perceived as influencing the patient,” the committee said, noting the power imbalance between patient and doctor as well as Dillon’s background of mental health and substance use.

Complaint 2

The second complaint concerned a terminal male cancer patient who had signed a “waiver of final consent” that enables individuals whose natural death is reasonably foreseeable to obtain MAID, even if they lose the ability to consent, the committee said in its ruling.

The man became “unresponsive” before the originally planned MAID date, and MacLean was asked by the family to come to the patient’s home to provide the procedure in accordance with the waiver of final consent.

The doctor had placed an order for a MAID medication kit at a pharmacy, but it wasn’t ready when he got there, so he went to the home “with a previously acquired” kit, the college said.

MAID is provided through a series of medications, typically midazolam, propofol, and rocuronium. The first medication is used as a sedative, the second puts the individual into a deep coma, and the third ultimately stops the person’s heart, according to Dying With Dignity Canada.

MacLean did not administer the third medication, which causes paralysis of the muscles, including those responsible for breathing, because he was unable to find it in his briefcase, the decision said. Typically, once this drug is administered the lack of oxygen to the body causes the organs to shut down one at a time until the heart stops beating.

MacLean pronounced the patient dead after administering the propofol because he was unable to hear a heartbeat, the ruling said. But “the patient resumed spontaneous breathing” after MacLean left the home and MacLean had to return to administer additional medication “including the neuromuscular-blocking agent, and again pronounced the patient’s death.”

MacLean told the committee that the stress of the situation, particularly the urgent and last-minute request for his attendance, as well as the large number of people present “with significant tension amongst them,” played a role in the initial failure to provide MAID.

The committee said while MacLean “demonstrated some appropriate reflection” in his responses to both complaints and promised to make certain changes to his practice, it remains concerned that he did not show adequate insight into how particular aspects of his care and conduct required additional improvement.

Canada legalized euthanasia for the terminally ill in 2016 and opened it in 2021 to people whose death is not foreseeable. The procedure may also be opened in 2027 to people whose sole condition is mental illness, though that move has already been delayed due to concerns from health-care providers.