London doctor reprimanded after MAID care breaches, including informal assessment setting and procedural failures during patient death.
Newsroom (29/05/2026 Gaudium Press ) A London, Ontario physician has been formally reprimanded following two separate incidents involving the provision of Medical Assistance in Dying (MAID), raising concerns about professional boundaries, procedural adherence, and patient safety.
The disciplinary action stems from investigations by the College of Physicians and Surgeons of Ontario (CPSO) after complaints were filed regarding the care of two patients. In both cases, the college concluded that Dr. James MacLean’s conduct fell short of the standards expected in what it described as a “highly regulated area of medical practice.”
Although the reports do not specify when the incidents occurred, they outline detailed concerns about MacLean’s decision-making and methods while assessing and administering MAID.
Informal Assessment Raises Ethical Concerns
The first case involved a patient with a complex medical history that included inflammatory bowel disease, multiple surgeries, and mental health challenges. After applying for MAID, the patient underwent eligibility assessments by MacLean and a nurse.
However, the CPSO found that MacLean conducted part of his evaluation in an unusual and inappropriate setting—outside a coffee shop. The patient was ultimately deemed eligible under “Track Two” provisions, which apply to individuals whose death is not reasonably foreseeable but who experience intolerable suffering from a grievous and irremediable condition.
The committee criticized the choice of location, stating that discussing sensitive end-of-life matters in a public, informal environment fell below expected standards of care. It noted that alternative, more appropriate settings were not meaningfully explored.
Concerns extended beyond the assessment setting. The committee found that MacLean’s communication with the patient, including extensive text messaging, exceeded what was necessary for clinical purposes. His decision to personally drive the patient to the MAID provision location also drew scrutiny.
Regulators warned that such actions risked blurring professional boundaries and could be perceived as influencing the patient’s decision-making. This risk was considered particularly significant given the patient’s mental health background, which may have heightened vulnerability in the physician-patient relationship.
Procedural Failures During MAID Provision
The second case highlighted more serious issues related to the technical and procedural aspects of MAID delivery.
In this instance, the patient had been assessed and approved for MAID and had signed a waiver of final consent to allow the procedure in the event of losing decision-making capacity. Before the scheduled date, the patient became unresponsive, prompting a request for MacLean to attend their home and proceed in accordance with the waiver.
However, complications arose when a prepared MAID medication kit was not available at the pharmacy. MacLean instead used a previously acquired kit. During the procedure, he administered the anesthetic propofol but failed to administer a required neuromuscular-blocking agent because he could not locate it.
Believing the patient had died, MacLean pronounced death after failing to detect a heartbeat. He subsequently left the residence. Soon after, however, the patient resumed spontaneous breathing.
MacLean returned and, upon observing renewed cardiac and respiratory activity, administered additional medication—including the neuromuscular-blocking agent—before again pronouncing death.
The CPSO described this sequence of events as deeply concerning. The committee pointed to inadequate preparation, failure to follow the full medication protocol, and an overemphasis on urgency at the expense of established procedures.
According to the report, these actions raised “serious concerns” about judgment, adherence to medical protocols, and overall patient safety in the provision of MAID.
Concerns About Communication and Professionalism
In addition to clinical issues, the second complaint included concerns about MacLean’s interactions with the patient’s family members. While accounts differed on some details, the CPSO concluded that the physician’s communication was not consistently effective or professional.
The situation at the patient’s home was described as stressful, with multiple individuals present and heightened emotional tension. MacLean acknowledged that these pressures contributed to the initial failed provision of MAID, but regulators emphasized that such circumstances require heightened—not reduced—adherence to protocol.
Regulatory Response and Supervision
In its ruling, the CPSO underscored that MAID remains subject to strict legal and professional standards, even as the regulatory framework evolves. Physicians, it noted, must adhere carefully and consistently to these requirements to ensure patient safety and maintain public trust.
While the committee acknowledged that MacLean demonstrated some reflection and committed to making improvements, it found that his insight into the seriousness of the issues was insufficient.
As a result, the physician has been formally cautioned and will undergo a period of supervision. The disciplinary measures include three months of moderate supervision followed by three months of low-level oversight. He is also required to review multiple MAID cases with a supervisor to improve compliance and clinical judgment.
MacLean remains licensed to practice medicine during this period.
Broader Implications
The cases highlight the complexities and sensitivities involved in MAID, particularly under Track Two provisions, which often involve patients with chronic conditions and mental health considerations rather than imminent death.
They also underscore the importance of maintaining clear professional boundaries and strict adherence to protocols, especially in emotionally charged situations.
For regulators, the incidents serve as a reminder that even experienced practitioners may require oversight when standards are not fully met. For the medical community, they reinforce the need for rigor, consistency, and ethical clarity in one of healthcare’s most consequential areas.
Ultimately, the CPSO’s decision illustrates its commitment to accountability in MAID practice while allowing for corrective measures aimed at improving future care.
- Raju Hasmukh with files from CTV News
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