We previously spoke with Sydney Campbell back in 2021 about the topic of mature minors about her academic and research work. You can read the previously published post HERE. 

This post is a follow up to our initial conversation in 2021. Sydney Campbell is now a Postdoctoral Fellow in the Faculty of Medicine at Dalhousie University, having completed her PhD in the Institute of Health Policy, Management and Evaluation at the University of Toronto where she generated conceptual and empirical evidence to inform ongoing discussions related to MAID for mature minors in Canada. Sydney’s work aims to advance perspectives on the participation and engagement of young people in all matters affecting them, rethinking policy action and analysis with a child-inclusive lens, and improving children’s overall health and well-being in several facets of their lives, including in end-of-life contexts. 

This Q&A is designed to be informational and educational, offering evidence-based insights into what “mature minor” means in a clinical context, how capacity is assessed, and what mature minors and their families feel and think about end-of-life care based on Sydney Campbell’s academic work. Our goal is to help readers engage with this topic from a place of understanding rather than assumption, and to provide clear, research-informed answers to questions that frequently arise. 

Background 

In February 2016, Parliament’s Special Joint Committee on Physician-Assisted Dying tabled their report, Medical Assistance in Dying: A Patient-Centred Approach, on the proposed medical assistance in dying (MAID) legislation and what it should address. The Committee recommended a phased approach: the law should be limited to competent adults 18 years or older in the first instance; the government should commit to a study of the moral, ethical, and legal issues relating to the concept of “mature minor” and any appropriate standards to determine the competence of those under 18; and the legislation should then be amended to include mature minors. 

The Council of Canadian Academies completed a comprehensive study of the domestic law regarding mature minors, as well as a comparative study of assisted dying laws as they apply to minors in other countries and submitted their findings to the federal government in December 2018. 

In many jurisdictions across Canada, mature minors already have the right to make important decisions regarding their care. This includes the right to consent to or refuse lifesaving medical treatment. In determining any challenges to the presumption of capacity to make these decisions, the courts look to age, maturity, intellect, life experience and the psychiatric, psychological, and emotional state of the minor. They also consider whether the minor is able to understand the short and long-term consequences of their illness and proposed treatment, and the broader consequences of their decisions such as any impact on others. 

There has been no legislation introduced that would allow mature minors to access MAID. This could only happen if legislation was introduced and passed to change the Criminal Code. In its February 2023 Report, Medical Assistance in Dying in Canada: Choices for Canadians, the Special Joint Committee recommended that mature minors be eligible to access MAID with appropriate protections and safeguards – including that the Government of Canada restrict MAID for mature minors to those whose natural death is reasonably foreseeable. The report indicated that in the case of mature minors, MAID was not appropriate for those suffering solely from a mental illness. 

DWDC position on eligibility for mature minors 

DWDC agrees that the existing eligibility requirement that the person have a grievous and irremediable medical condition should apply to mature minors. DWDC acknowledges that Canadian society will likely expect a minimum age for mature minors in the legislation, even though the emphasis at common law is on capacity and maturity and not chronological age. For this reason, DWDC asks that Parliament amend the existing age requirement of 18 years of age to extend it to persons: “at least 12 years of age and capable of making decisions with respect to their health.” As with adults, there should be a presumption of capacity for these minors. 

DWDC’s position on safeguards for mature minors 

DWDC is of the view that the safeguards that exist now are acceptable for eligible mature minors. DWDC recommends that the informed consent of a competent parent or guardian be required for eligible minors seeking MAID who are 12 to 15 years of age inclusive, and that MAID assessors be required to consult a competent parent or guardian for eligible minors aged 16 and 17. 

DWDC: What does the term ‘mature minor’ mean? How is capacity assessed and determined when it comes to mature minors? 

*Notes regarding terminology: Sydney will use “young person”/” young people” throughout, which refers to children and youth. She will use “mature minor” to reference a sub-population in this group (defined below). 

Sydney Campbell: The term “mature minor” is a legal construct that originated in British common law to grant medical decision-making rights to some individuals below the age of majority, specifically those with competence and capacity to understand what they were consenting to or refusing, and the consequences of this decision. The term has since made its way into Canadian law, evidenced within the notable A.C. v. Manitoba Supreme Court of Canada decision. In sum, then, a “mature minor” (in the Canadian context) is an individual under the age of 18 years who has been deemed capable of providing legally valid consent (or refusal) to medical treatment. 

The process of determining who is a mature minor is somewhat more complex than the definition, alone, makes it seem. This is because there is not a universal standard for meeting a threshold on “maturity” as a minor (i.e. person under 18 years of age in Canada). It often falls onto the shoulders of healthcare professionals (such as physicians) to engage in conversations and assessment protocols (that often differ across institutions and/or locations) and use their discretion to determine which young person is/is not a “mature minor”. Additionally, there is not a standardized set of criteria used across Canada, so provincial and territorial laws play a large role in shaping and defining criteria. For instance, some provinces (e.g., Quebec) use age as one criterion for capacity (such that below a certain age, an individual is automatically seen as incapable), whereas others assess capacity on more of a case-by-case basis (e.g., Ontario, where there is no age included in the Health Care Consent Act). 

In general, though, indicating a level of sufficient understanding of one’s medical condition and treatment options, making a voluntary and informed choice, and appreciating the consequences of one’s decision are key criteria for being deemed a mature minor. Importantly, one’s status as a “mature minor” is often decision and/or context dependent, such that a young person may have legal capacity to make one type of decision in one context, but they may not be considered a “mature minor” in other decisions or contexts. As mentioned, it is quite a complex doctrine to assess. 

DWDC: How important is it for mature minors to be involved in the discussions surrounding MAID legislation?  

Sydney Campbell: To put it simply: incredibly important! 

To date, the engagement of young people (including, but not limited to, mature minors) in conversations and debates about MAID in Canada has been largely overlooked and extremely limited – and here I am talking not just about conversations regarding MAID for mature minors, but even MAID in general. Public engagement in policymaking has been prioritized and situated as crucial part of a democracy, particularly in Canada, yet the reality is that engagement processes often only seek out and include the voices of adults; the same standard of engagement is not consistently or comprehensively applied to young people, even in policy decisions that may affect them (such as MAID deliberations) and even though they have rights to be engaged per the UN Convention on the Rights of the Child—which Canada ratified in 1991. And this is also true for research, where to date there have been only two studies conducted with input from young people in Canada (see Liu et al., 2023 and Campbell et al., 2025). For these reasons, it is incredibly important for this population to be granted space, both in policy and research, to be meaningfully included and heard. 

DWDC: And how important is it for families of mature minors to be involved in discussions about MAID legislation? 

Sydney Campbell: Many childhood studies experts and those working in clinical settings recognize that young people (including mature minors) are often highly relationally embedded, meaning they are impacted by their social circles while also impacting those same circles. For some mature minors, even though they have legal capacity to make their own decisions (i.e., for individual autonomy), they still rely on and seek advice and support from their parents, legal guardians, siblings, and extended family. Of course there are exceptions to this, for instance where a mature minor may be emancipated or may not have a close relationship with their families. And seeking clarity on these relationships to understand whether and how to engage families becomes a task for the care team surrounding the young person – in any end-of-life care context, not just thinking about MAID. 

It is also important to highlight that empirical evidence about family perspectives on MAID for mature minors is missing in literature from the Canadian context too. Thus, while there certainly needs to be more of an impetus to generate evidence that engages directly with young people, generating evidence about family perspectives is also an important area for future research. 

DWDC: What kinds of medical decisions are mature minors currently able to make? 

Sydney Campbell: At present, mature minors can legally make many types of medical decisions ranging from those considered to be more minor though nevertheless important (such as when to take a certain medication), to decisions about fertility and contraception, to decisions about their end-of-life care. In the latter case, a mature minor is (for instance) currently able to make decisions to withhold or withdrawn life sustaining treatment—a decision that will foreseeably result in their death. 

DWDC: Can we talk about the importance talking about death and dying when it comes to mature minors? How should we be approaching this subject? 

Sydney Campbell: I think this is a very important question and one that I am frequently asked about. I will say that many pediatric healthcare providers are already doing an amazing job at including young people of all ages (including mature minors, but not just mature minors) in conversations about death and dying (even when it is the young person, themselves, that is facing a life-limiting or life-threatening condition). I know of many folks working in pediatric hospice and palliative care settings who are true advocates and trailblazers for including young people in discussions about their care, even when guidance on how to do so may be missing or inconsistent. So, leaning into and learning from these professionals is an important step. 

But I usually have a few “bigger picture” pieces that I like to talk about for approaching the topic of having these kinds of discussions with young people. 

• Being open to engaging with young people: The assumption portraying talking about death with all young people as problematic is overly generalized and doesn’t recognize the nuance that exists across this population. A singular, sweeping approach (such as avoidance) can have massive consequences for those who want to be involved in conversations, so the first step requires being open to the possibility that a young person may wish to be engaged (and perhaps, for some, that being meaningfully engaged is in their best interests). 
• Developing death literacy: Moreover, literacy about death and dying is unfortunately not an area of emphasis in school-based curricula nor in many communities, so awareness about what death and dying can look like or involve is missing for most young people. Often, young people only learn about death in a reactive context (e.g., after a family member or pet has died, or when their own prognosis becomes life-limiting or terminal), which makes comprehension a lot more challenging to ensure. So gentle introductions to death and dying (where/when appropriate) throughout childhood present important opportunities to teach about the reality of these natural processes. I love sharing this clip from a Mr. Roger’s Neighbourhood episode as an example of how introducing the topic of death can be done with care. 
• Recognizing that “Grief Matters”: In all conversations related to death (including the anticipation of one’s own death), it is so important to recognize that suffering and grief are intertwined, highly complex, and deserving of support, including for young people. I will plug the work that my current supervisor, Dr. Mary Ellen Macdonald, is doing with “Grief Matters” to better understand and make space for grief through community-based events. There also exists so many resources for helping young people to deal with grief, such as those at KidsGrief.ca and another list put together by Andrea Warnick. And the community-building work that the amazing team at Upopolis is doing for young people with healthcare experiences is very important for supporting this population to navigate things like their own grief (including, but not limited to, grief related to death and dying). 
• Inviting young people’s feedback and guidance: Finally, although there are many resources from experts in this field, it is important to meet each young person where they are at in their experience (as implied in the first point). So, making space for young people to provide feedback on best practices and best approaches can also be incredibly helpful guidance for those who wish to engage with other young people on death-related topics. And by extension, being adaptive and flexible to young people’s needs is a crucial skill to have for these moments. In another national project that I am working on with the VOICE: The Childhood Ethics Project team at McGill University, we are investigating modes through which young people can be engaged in practice, policy, and research, and we are already observing just how important this flexibility is, along with how powerful feedback and guidance from young people can be. 

DWDC: Currently, individuals younger than 18 years are legally permitted to access an assisted death in the Netherlands and Belgium, but not in Canada. What can we learn from those two countries?  

Sydney Campbell: In policy research we talk a lot about the problem of ‘transferability’, where there may be assumptions that what works in one context can or should work in another and be easily transferable, yet in reality this is very rarely the case (due to important sociocultural, economic, and political differences amongst jurisdictions). So, it is important to be cautious in trying to ‘copy and paste’ the approaches of other places in the Canadian context. 

In the context of MAID, I recently completed a comparative analysis examining how other jurisdictions (specifically the Netherlands and Belgium) have addressed assisted dying for (mature) minors, in comparison to Canada, and what similarities and differences exist across policies and discourses in the comparators. And what I found is that dominant coalitions in the Netherlands and Belgium were able to use a different pathway (i.e., through a parliamentary approach) to legalize assisted dying for legally capable minors that was informed by social comfortability with this form of care and a suffering-reduction motivation, while Canada’s MAID decriminalization story was primarily judicial and driven by a rights-based motivation. Additionally, deliberations about MAID for mature minors in Canada tended to emphasize the social uncertainty and limited evidence that exists, leading to hesitation to include this population as eligible. 

I think a lesson for Canada, which has also been mentioned in the 2023 report released by the Special Joint Committee on Medical Assistance in Dying, is that there is a huge need to invest in generating evidence to inform policy for this context and clarifying what the public opinion (inclusive of young people) and clinician opinion is. Doing so will therefore ensure policy sustainability and implementation success, particularly given the decentralized governance structure for health policies in Canada and the heterogenous approaches to understanding concepts like “capacity for consent”. Some of this work is currently being undertaken by a team that I am part of at Dalhousie University, where we are utilizing a youth engagement research model to generate evidence on what young people across Canada, with direct or indirect healthcare experiences, think about palliative and end-of-life care, including MAID. But this is just the start of attempting to clarify these views. 

DWDC: What are your final thoughts? 

Sydney Campbell: I think it is important to know, first and foremost, that mature minors are humans who can and do experience suffering in a variety of forms when they are living with a life-threatening illness – forms that can be similar to adults and others that may be quite distinctive – and grappling with that suffering is always a very personal/subjective experience. In addition, my research and engagement with young people has affirmed that those with experience of a childhood disease or illness hold views that are extremely complex, and they are able to be very reflexive in thinking and talking about MAID.  

I think debates around MAID for mature minors continue for two reasons. First, adults commonly prioritize (most often with good intentions) the protection of young people, particularly in medical settings and even more-so where the prognosis for a young person is poor. Here, this protective ‘nature’ functions as a shielding mechanism and makes discussions about the realities of childhood death challenging to navigate or actualize (as I’ve described above). And then coupled with this, we also have a significant lack of evidence in Canada and internationally on the topic of assisted dying for young people. And these gaps limit our ability to know (a) the state of social perspectives or reactions in this country on MAID for mature minors, (b) the views and recommendations of core interest holders (eg. mature minors, parents, healthcare professionals), and (c) policy-relevant lessons from other contexts that may guide us here in Canada. Therefore, conversation about MAID for mature minors continues because there is still so much that is unknown and that researchers, healthcare providers, policymakers, and society more broadly are grappling with. 

Where possible, I always try to advocate for making more spaces to invite meaningful input for young people, so my encouragement to others would be to listen to and talk more with the young people in your lives on this topic and to avoid excluding them based on your own presumptions about what they can/cannot do or know. Young people are the experts in their own lives, so asking them questions about death, dying, and MAID and really listening to their responses is a task we need to be willing to do and advocate for more often to move the marker forward on this topic in Canada (and elsewhere!). 

Editor’s note: Mature minors, or those under the age of 18, will not be eligible for MAID in March 2027. There has been no legislation introduced that would allow mature minors to access MAID. This could only happen if legislation was introduced and passed to change the Criminal Code. In its 2023 Final Report, the Special Joint Committee recommended that mature minors be eligible to access MAID with appropriate protections and safeguards – including that the Government of Canada restrict MAID for mature minors to those whose natural death is reasonably foreseeable. MAID for mature minors would be limited to those with a grievous and irremediable medical condition (Track 1), not those with a mental illness or whose deaths were not reasonably foreseeable. This recommendation has not been acted upon.