MAiD
MAiD (medical assistance in dying) is legal throughout Canada.
Canada’s first MAiD legislation came into force on June 17, 2016.
Amendments to this legislation came into force on March 17, 2021.
What is MAiD?
MAiD is assistance provided by a doctor or nurse practitioner to a person, at that person’s request, that causes the person’s death. MAiD can happen in one of two ways:
- a doctor or nurse practitioner gives a drug to the patient that causes the patient’s death; or
- a doctor or nurse practitioner prescribes a drug for a person, at the person’s request, that the person can swallow and cause their own death.
Who can access MAiD?
To access MAiD in Canada* you must:
- be eligible for health care services in Canada (or you would be eligible but for a minimum period of living in a province or territory or a waiting period for eligibility)
- be at least 18 years old
- be capable of making decisions with respect to your health
- have asked for MAiD yourself and no one is pressuring you to ask for it
- have been told about other available ways to relieve your suffering, including palliative care
- have given informed consent to receive MAiD
- have what is called a “grievous and irremediable medical condition”
Having a “grievous and irremediable medical condition” means:
- you have a serious and incurable illness, disease or disability**
- you are in an advanced state of irreversible decline in capability
- your illness, disease or disability or that state of decline causes you enduring physical or psychological suffering that is intolerable to you and that cannot be relieved under conditions that you consider acceptable
* For an exception specific to Quebec, see below
**For the purpose of this legislation, until March 17, 2027, “mental illness” is not considered to be a “serious and incurable illness, disease or disability.
What are the key procedural safeguards for MAiD?
All persons who want MAiD must meet the criteria set out above and follow the steps set out below.
- A request for MAiD must be signed by one witness
- Two medical or nurse practitioners independent of one another must confirm that the eligibility criteria have been met
If a person’s natural death has become reasonably foreseeable, then they proceed along “Track One” with respect to additional procedural safeguards.
Track One
For a person on Track One, their medical or nurse practitioner must:
- be of the opinion that they meet the eligibility criteria set out above
- ensure that the person’s request for medical assistance in dying was signed and dated by the person – or if the person requesting medical assistance in dying is unable to sign and date the request, another person — who is at least 18 years of age, who understands the nature of the request for medical assistance in dying and who does not know or believe that they are a beneficiary under the will of the person making the request, or a recipient, in any other way, of a financial or other material benefit resulting from that person’s death — may do so in the person’s presence, on the person’s behalf and under the person’s express direction
- ensure the person’s request for MAiD was signed and dated after the person was informed by a medical practitioner or nurse practitioner that the person has a grievous and irremediable medical condition
- ensure that the person has been informed that they may, at any time and in any manner, withdraw their request*
- ensure that another medical practitioner or nurse practitioner has provided a written opinion confirming that the person meets all of the eligibility criteria
- be satisfied that they and the other medical practitioner or nurse practitioner conducting assessments are independent
- if the person has difficulty communicating, take all necessary measures to provide a reliable means by which the person may understand the information that is provided to them and communicate their decision; and
- immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request and ensure that the person gives express consent to receive medical assistance in dying*
There is no minimum waiting period between the day the request was signed and the day MAiD is provided.
* There are two exceptions to the requirement that a person give express consent to receive MAiD immediately prior to its provision: 1) “advance consent”; and 2) “final consent waiver”. See explanations of these below.
If a person’s natural death has not become reasonably foreseeable, then they proceed along “Track Two” with respect to procedural safeguards.
Track Two
If a person’s natural death has not become reasonably foreseeable, then they proceed along “Track Two” with respect to additional procedural safeguards.
For a person on Track Two, their medical or nurse practitioner must:
(a) be of the opinion that the person meets all of the eligibility criteria set out above
(b) ensure that the person’s request for medical assistance in dying was made in writing and signed and dated by the person– or if the person requesting medical assistance in dying is unable to sign and date the request, another person — who is at least 18 years of age, who understands the nature of the request for medical assistance in dying and who does not know or believe that they are a beneficiary under the will of the person making the request, or a recipient, in any other way, of a financial or other material benefit resulting from that person’s death — may do so in the person’s presence, on the person’s behalf and under the person’s express direction
(c) be satisfied that the person’s request for MAiD was signed and dated after the person was informed by a medical practitioner or nurse practitioner that the person has a grievous and irremediable medical condition
(d) ensure that the person has been informed that the person may, at any time and in any manner, withdraw their request
(e) ensure that another medical practitioner or nurse practitioner has provided a written opinion confirming that the person meets all of the eligibility criteria set out above;
(e.1) if neither they nor the other medical practitioner or nurse practitioner referred to in paragraph (e) has expertise in the condition that is causing the person’s suffering, ensure that they or the medical practitioner or nurse practitioner referred to in paragraph (e) consult with a medical practitioner or nurse practitioner who has that expertise and share the results of that consultation with the other practitioner
(f) be satisfied that they and the medical practitioner or nurse practitioner referred to in paragraph (e) are independent
(g) ensure that the person has been informed of the means available to relieve their suffering, including, where appropriate, counselling services, mental health and disability support services, community services and palliative care and has been offered consultations with relevant professionals who provide those services or that care
(h) ensure that they and the medical practitioner or nurse practitioner referred to in paragraph (e) have discussed with the person the reasonable and available means to relieve the person’s suffering and they and the medical practitioner or nurse practitioner referred to in paragraph (e) agree with the person that the person has given serious consideration to those means
(i) ensure that there are at least 90 clear days between the day on which the first assessment under this subsection of whether the person meets the eligibility criteria set out above begins and the day on which medical assistance in dying is provided to them or — if the assessments have been completed and they and the medical practitioner or nurse practitioner referred to in paragraph (e) are both of the opinion that the loss of the person’s capacity to provide consent to receive medical assistance in dying is imminent — any shorter period that the first medical practitioner or nurse practitioner considers appropriate in the circumstances
(j) if the person has difficulty communicating, take all necessary measures to provide a reliable means by which the person may understand the information that is provided to them and communicate their decision and
(k) immediately before providing the medical assistance in dying, give the person an opportunity to withdraw their request and ensure that the person gives express consent to receive medical assistance in dying.
Are advance requests for MAiD legal in Canada?
“Advance request” for MAiD refers to a request for MAiD made by a person before all of the eligibility criteria for MAiD, as defined by the Criminal Code, are met. Advance requests for MAiD are not currently legally permissible in Canada..
“Advance consent” for MAiD refers to a consent given before the loss of capacity to consent to receiving MAiD. Advance consent for MAiD is legal in Canada only through one of two mechanisms: a “final consent – waiver” and “advance consent – failed self-administration.”
“Final consent – waiver” (sometimes called a “waiver of final consent” or “final consent waiver”) is a mechanism that allows for the waiving of the requirement that express consent be given by the person immediately prior to the provision of MAiD. A final consent – waiver may only be acted upon when all of the following are true:
- the person’s natural death has become reasonably foreseeable
- prior to losing capacity, the person met all of the eligibility criteria
- the person has lost capacity
- all of the other procedural requirements for a valid “final consent – waiver”, as set out in the Criminal Code, have been met
“Advance consent – failed self-administration” is a mechanism that allows for the waiving of the requirement that express consent be given by the person immediately prior to the provision of MAiD in the specific context of a failed self-administration (i.e., the person has self-administered the oral medications but has not died within a specified time period). An advance consent – failed self-administration agreement may only be acted upon when all of the following are true:
- prior to losing capacity, the person met all of the eligibility criteria the person self-administered MAiD but has not died within a specified time period and has lost capacity
- all of the other procedural requirements for a valid “advance consent – failed self-administration” set out in the Criminal Code have been met.
Only patients on Track One are eligible for final consent waivers. Patients on either Track One or Track Two are eligible for advance consent for failed self-administration.
Who is accessing MAiD and how often?
The most recent official data on MAiD in Canada can be found here.
The most recent official data on MAiD in Quebec can be found here.
How is MAiD in Quebec different from MAiD in the rest of Canada?
An additional legal framework for MAiD applies in Quebec and is set out in An Act respecting end of life care.
The key differences between the federal and Quebec legislation re: MAiD are the following:
- The Canadian exclusion of MAiD for a person whose sole underlying medical condition is mental illness is temporary – until March 2027. The Quebec exclusion of MAiD for a person whose sole underlying medical condition is mental disorder is permanent.
- Canada allows provider- and self-administered MAiD while Quebec only allows provider-administered.
- Canada does not allow advance requests for MAiD. Quebec has passed legislation to allow advance requests for MAiD. This legislation will come into effect by June 2025.
How is MAiD in Canada different from MAiD in other parts of the world?
The key differences between Canada and other places that allow MAiD are:
- unlike anywhere else (other than some Australian states), nurse practitioners are allowed to provide MAiD
- unlike the American states, provider-administered MAiD is allowed
- unlike the American states, access to MAiD is not limited to those who are terminally ill
- unlike the European countries, whether suffering is intolerable is assessed entirely by the person
Links to legislation, case law, data, and other sources of information on MAiD in other parts of the world are available here.
A Deeper Dive into MAiD in Canada
Much more detailed information about MAiD in Canada is available by clicking on the links below:
Major MAiD Court Cases
Charter challenges to federal and Quebec MAiD legislation
Freedom of religion/conscience cases
Third parties trying to prevent someone from accessing MAiD
Provincial/Territorial MAiD Legislation, Regulations, Programs
Health Professional Regulatory Body Guidelines, Standards, and Disciplinary Decisions
