Learn more about Canada’s assisted dying law.
As of March 17, 2021, when Bill C-7 received Royal Assent, the law no longer requires a person’s natural death to be reasonably foreseeable to access medical assistance in dying (MAID).
On Wednesday, March 17, 2021, after a year of debate, discussion and delays, Bill C-7 received Royal Assent and became law. This was an important milestone in medical assistance in dying legislation. Much like the original passage of Bill C-14 in 2016, which formally legalized assisted dying in Canada and laid out rules for how it could be accessed, this bill will be remembered as one of enormous change, driven by compassion, an end to suffering and discrimination, and a desire for personal autonomy.
Read the full text of Bill C-7, Canada’s new assisted dying law.
To qualify, a person must satisfy all the following criteria
* To have a “grievous and irremediable medical condition,” a person must:
Other health providers who assist with the process of assessing eligibility or administering MAID are also protected from liability. These practitioners include, but are not limited to, pharmacists, social workers, psychologists, therapists, hospital lawyers and nurses.
Several provincial regulatory authorities have, however, issued guidelines that strongly encourage medical practitioners who are unwilling or unable to provide MAID to refer their patients to other institutions or providers. Others require a transfer of care or referral. In Ontario, for example, objecting providers must make an “effective referral” to an available, accessible physician or agency willing to facilitate a request for assisted dying.
Unlike assisted dying laws in some other jurisdictions, you do not need to have a fatal or terminal condition to be eligible for medical assistance in dying in Canada.
As of March 17, 2021, there are different safeguards depending on which track you fall under. See below for more details.
Any request for medical assistance in dying must be assessed by two independent practitioners. Both physicians and nurse practitioners can assess your eligibility based on the listed criteria. They must be independent from one another and confirm your eligibility in writing.
A request for MAID must be made in writing. The written request must include your signature. If you cannot write, another adult can sign on your behalf under your clear direction.
A written request for MAID must be signed and dated in the presence of one Independent Witness, who must also sign and date the request.
You can withdraw your request for medical assistance in dying at any time and in any manner. Even if you are found eligible for MAID, you are not obligated to proceed. You will be given an opportunity to withdraw your request right before the MAID procedure.
Immediately before the MAID procedure, you will be given the opportunity to withdraw consent. You must confirm that you consent to receive medical assistance in dying UNLESS you have signed a waiver of final consent. See below.
The waiver of final consent is only available to individuals whose death is reasonably foreseeable. This is an agreement you enter into with your MAID provider, after being assessed and approved.
The waiver of final consent allows someone who has already been assessed and approved for MAID to receive it on or before their chosen date even if they do not have the capacity to consent at the time of the MAID procedure. This would be based on a signed and dated agreement with their provider. This amendment is named after Audrey Parker, a Nova Scotia woman who was forced to access MAID earlier than she would have liked, because she was afraid that she would lose capacity and not be able to provide consent at the time of the MAID procedure, which is what the law required at the time.
The revised law now allows the waiver of the requirement to provide final consent immediately before receiving MAID for patients whose natural death is reasonably foreseeable.
If your death is reasonably foreseeable, and you would like to complete a waiver of final consent with your MAID provider, please contact us at firstname.lastname@example.org. We will send you the forms and help you navigate the process.
If you are eligible for MAID and choose to self-administer the prescribed medications orally, you have the option to provide advance consent – a written arrangement with your medical practitioner in the event of complications with self-administration.
For example, if you lose decision-making capacity while self-administering, but it does not cause your death, your practitioner can administer the medications for you via an IV (if you have consented in writing in advance). In this situation, your medical practitioner must be present at the time you take the prescription. In fact, some colleges recommend that providers always be present for self-administered MAID. This is also recommended by the Canadian Association of MAID Assessors and Providers (CAMAP).
There are additional safeguards in place for those whose death is not reasonably foreseeable, in addition to the safeguards listed above for all medical assistance in dying requests.
One of the two practitioners who assess your eligibility for medical assistance in dying must have expertise in the medical condition causing unbearable suffering.
The person must be informed of available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services, and palliative care, and must be offered consultations with professionals who provide those services.
The eligibility assessments must take at least 90 days (about 3 months), but this period can be shortened if the person is about to lose the capacity to make health care decisions, if both assessments have been completed.
Immediately before MAID is provided, the practitioner must give the person an opportunity to withdraw their request and ensure that they give express consent.
The waiver of final consent is not available to individuals whose death is not reasonably foreseeable.
At this time, advance requests for MAID are not legal.
An advance request for MAID would allow an individual to describe, in writing, a future circumstance in which they would like to access an assisted death.
In February 2023, after month of consultation, the final report from the Special Joint Committee on MAID made three recommendations in support of advance requests for MAID including Recommendation 21: that the Government of Canada amend the Criminal Code to allow for advance requests following a diagnosis of a serious and incurable medical condition disease, or disorder leading to incapacity.
In Quebec, Bill 11 – an Act to amend the Act respecting end-of-life care – was adopted in June 2023. The new law will allow for advance requests for MAID with a maximum of 24 months to prepare but it means that MAID laws would not align across the country.
In the Senate, public Bill S-248 in support of advance requests for MAID has been referred to the Senate Committee on Legal and Constitutional Affairs.
An advance request for MAID is not the same thing as advance consent or waiver of final consent. See sections above for information about advance consent and waiver of final consent for individuals whose death is reasonably foreseeable.
The eligibility criteria may limit the circumstances in which a person with dementia could be eligible for access. A person with a capacity-eroding condition such as dementia might lose capacity before they satisfy one or more of the other eligibility criteria in the law. For example, the person might already be suffering intolerably, but they may not be in an advanced state of irreversible decline. By the time they have reached an “advanced state of irreversible decline,” they may no longer be capable of providing consent for MAID. In some cases, the waiver of final consent can be used for those with dementia.
Watch our webinar on Dementia, MAID, and other end-of-life options for more information.
There is a sunset clause for MAID and mental disorders, this exclusion will remain in effect until March 17, 2024.
When the Senate introduced the sunset clause, allowing MAID for those whose sole underlying medical condition is a mental disorder in March 2021, they recognized that excluding those individuals would be a breach of the Canadian Charter of Rights and Freedoms; it would discriminate on the basis that a person has a mental disorder.
Preparations for this change in the law are complete and include the development of the Model Practice Standard, its accompanying Advice to the Profession document, and the release of the first nationally accredited Canadian MAID Curriculum
This exclusion includes conditions that are primarily within the domain of psychiatry, such as depression and personality disorders. It does not include neurocognitive and neurodevelopmental disorders, or other conditions that may affect cognitive abilities. To be clear, neurocognitive disorders such as dementia, Huntington’s and Parkinson’s are not considered mental illnesses and are not included in the two-year restriction.
Only adults 18 years of age or older are eligible for MAID.
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