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Not many really ever look into safeguards of these programs and let their imaginations take the reins. Here's the basics of MAID.
The things you need to get the process started is sign off from two doctors or nurse practitioners from two completely independant medical practices who are not directly involved in any long term care planning for the patient and are not experiencing any financial incentive. Doctors are allowed to refuse participation for any reason. They also must have demonstrated expertise in treatment of the condition for which someone is using as their reason for seeking MAID.
In the event of a non terminal illness one also needs a witness to back up your decision to pursue MAID to sign off on all the papers. There are some restrictions about who can count as a witness but in addition to those this person cannot :
-benefit from your death -be an unpaid caregiver -be an owner or operator of a health care facility where you live or are receiving care
The law requires all other potential services and harm reduction strategies be discussed as options and made available and stress is to be put on that you can opt out of the process at any time.
Once the paperwork is signed it begins a 90 day minimum assessment period. Witnesses found to be in violation of any of the witness or doctor restrictions are liable to be criminally charged.
People without decision making capacity are ineligible to apply for MAID. If their case is degenerative they can waive their final consent requirements but people can legally specify under a different program in palliative care a pre-determined termination criteria to pick what level of mental degeneration activates the order and it must be signed off on while the person is of sound mind or else your only choice is a naturally occuring death.
Lastly the final assessment requires active consent and cannot be in a state judged to be mentally incapable of decision making authority unless they previously waived that requirement. The person must be given every opportunity to opt out.
Finally the assessment request now requires a mandatory sign on for data collection for posterity. This is for purposes of determining if the system is being potentially exploited requiring the data in regards to identifying whether race, Indigenous identity and disability seek to determine the presence of individual or systemic inequality or disadvantage in the context of or delivery of MAID. The data regarding everyone who seeks the program, the doctors and the witnesses who signed on and those who decided later not to pursue then is referred to an investigative inquest body and the presence of the program has to be occasionally reviewed by federal Parliament and actively renewed over a predetermined cycle.
So what's stopping two Kevorkian's from just signing off on everything?
You can pretend that safeguards will prevent undesirable deaths (like say patient manipulation, or informed consent which Canada has stopped pretending to care about), but the permissibility alone makes it inevitable.
Backflips and somersaults scenario. How many people in every hospital right now are spending the last week of their lives suffocating? Dozens? Hundreds? Thousands?
You invent scenarios to make MAID unpalatable. The people who want MAID have actually lived through reality.
It's unfortunate that people want to die and they physically can't kill themselves at that moment, but there is no moral obligation to grant desires that people can't fulfill themselves. (There is also the autonomy objection, even if the patient has perfect decision making, killing them now derives then if any future decision making).
We do have an obligation to prevent unreasonable deaths, especially if we are the one's actively killing them as is the case with MAID.
Therefore a system that potentially (or rather inevitably) causes moral bad without any moral good, is not a morally good system and has no benefit to existing.
The reality is that unreasonable deaths will happen, and expanding it (and lowering the thresholds) will increase the percentage of assisted suicides that don't meet some metric of moral permissibility.
There is also the societal harm objection, if illnesses/conditions are treated by euthanasia, and euthanasia becomes a popular way of death (like it is increasingly so in Canada) the incentive to improve treatment of those conditions is weaker. It does not result in a improving society in the long run if euthanasia is an acceptable option to certain conditions (note, this refers to more than just medical health but also living or social conditions).
Part of the system works off of a similar system to triplicate prescriptions which has a cooling effect. Basically every time a single doctor signs off on this it gets flagged in the system along with what other doctor is doing it. Doctors know their data is being tracked by an active investigative body, physical hard copies are required and who their second doctor is is relation to their participation is actively logged and guaged. A two kevorkian system would set up a red flag and cause an in depth investigation with potential criminal persecution.
Not saying that it could not happen but it would create an undue legal risk for any doctors who would try it and doctors are made very aware of the data logging requirements of the program.