Medical assistance in dying (MAID) became legal in Canada in June 2016. Canada’s Criminal Code now exempts doctors and nurse practitioners who provide, or help to provide, medical assistance in dying.
“Medical assistance in dying” currently includes:
- The use of medication by a physician or nurse practitioner to directly cause a person’s death at their request.
- The prescription or provision of medication by a physician or nurse practitioner that a person can use to cause their own death.
The law currently sets out eligibility criteria for those who wish to apply for MAID. It also sets out safeguards that doctors and nurse practitioners must follow when deciding if a patient qualifies for MAID, in particular to make sure that the patient requesting MAID is fully informed and has given their consent freely.
Visit the Government of Canada’s medical assistance in dying webpage for more information on:
- Eligibility criteria.
- Process for obtaining MAID.
- Roles of the provinces and territories.
- How Health Canada monitors and reports on MAID.
- Independent reviews.
- How Health Canada supports palliative and end-of-life care.
The Evolution of MAID in Canada
During the development and implementation of MAID (Bill C-14) in 2016, many Canadians voiced their support for broader access to MAID. As a result, the Government of Canada committed to study a wider variety of medical circumstances where a person may want to access MAID.
Specifically, the Government of Canada asked the Council of Canadian Academies to study three complex issues including requests for MAID by mature minors, advance requests, and requests for people where mental illness is the only reason for requesting MAID. The reports and a summary are available on the CCA’s website.
As legalizing medical assistance in dying was a significant step for Canada, Parliament committed to reviewing the law five years after it was passed. This review will provide the opportunity to hear from Canadians about how MAID is working, and to see if any changes should be made. It is expected that this review will start in June 2020.
Recent Development with MAID
On September 11, 2019, the Superior Court of Québec found (Truchon v. Attorney General of Canada) that it was unconstitutional to limit access to MAID to people nearing the end of life. The case was brought by two persons living with disabilities, Mr. Truchon, who has lived with cerebral palsy since birth, and Ms. Gladu, who has lived with paralysis and severe scoliosis as a result of poliomyelitis. Practitioners who assessed them were of the view that they met all eligibility criteria for MAID, with the exception of nearing the end of life. The Court declared the “reasonable foreseeability of natural death” criterion in the federal Criminal Code, as well as the “end-of-life” criterion in Quebec’s provincial law on medical assistance in dying, to be unconstitutional.
The Court’s ruling came into effect on March 11, 2020. While this ruling only applies in the province of Quebec, the Government of Canada has accepted the ruling and has committed to changing the MAID law for the whole country. More information on the proposed changes to MAID in Canada can be found here, on the Department of Justice’s Website.
Since MAID was legalized in 2016, more than 6,700 Canadians who were suffering unbearably chose to die peacefully with the help of a physician or nurse practitioner. Over the past four years, our healthcare systems have become more familiar and comfortable with providing MAID, and Canadians have also learned a lot about circumstances where MAID is not allowed.
As part of their preparation for the full review of the MAID law this summer, the Government of Canada released a questionnaire to help inform their response to the Quebec court ruling. This questionnaire offered Canadians the opportunity to share their views on this deeply personal and very important issue. Results for the questionnaire can be viewed here.
The Government introduced their proposals to amend MAID on February 24th 2020. These proposals include:
- Expanded access for patients who aren’t facing a “reasonably foreseeable” natural death.
- Access for patients with serious and incurable illnesses, diseases and disabilities.
- Access for patients in an advanced state of decline in capabilities with no ability to reverse that downturn.
- Access for patients with unbearable physical or psychological suffering.
- New safeguards to protect against undue use of MAID.
The full bill of proposed amendments can be viewed here.