Kara Sears
Canada's Medical Assistance in Dying (MAID) law permits eligible adults to request assistance from a medical practitioner in ending their life. MAID is fully covered by insurance in all Canadian jurisdictions. The law has been criticised for lacking safeguards, devaluing the lives of disabled people, and killing people who were not receiving adequate government support to continue living. There have also been concerns that the law is based on ableist assumptions. However, advocates of MAID have argued that prohibiting it or restricting it to terminally ill patients is paternalistic. Since the introduction of legislation in 2016, there have been 60,301 MAID deaths reported in Canada.
| Characteristics | Values |
|---|---|
| What is MAID? | Medical assistance in dying |
| MAID eligibility | Adults with a "serious and incurable illness, disease, or disability...in an advanced state of irreversible decline in capability" and experiencing "enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable" |
| MAID eligibility extension | Persons whose sole medical condition is a mental illness |
| MAID eligibility extension date | March 17, 2027 |
| MAID safeguards | Requiring cognitive capacity to consent, voluntary informed consent, assessors and witnesses who are independent of each other and with no conflicts of interest, and waiting periods between different stages of the process |
| MAID funding | Fully covered by insurance in all Canadian jurisdictions |
| MAID in Quebec | Quebec became the first province in Canada to allow advance requests for MAID in 2024 |
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What You'll Learn
MAID eligibility criteria
As of March 17, 2021, when Bill C-7 received Royal Assent, the eligibility criteria for Medical Assistance in Dying (MAID) in Canada are as follows:
Firstly, the person must be 18 years of age or older and have decision-making capacity. They must also be eligible for publicly funded health care services in Canada.
Secondly, the person must make a voluntary request for MAID that is not the result of external pressure. This request must be in writing and signed by the individual.
Thirdly, the person must give informed consent to receive MAID. This means they have consented after receiving all the information needed to make this decision.
Fourthly, the person must have a serious and incurable illness, disease, or disability (excluding a mental illness until March 17, 2027). They must be in an advanced state of irreversible decline in capability, and their suffering must be enduring and intolerable and cannot be alleviated under conditions they consider acceptable.
It is important to note that MAID eligibility criteria do not require a person's natural death to be reasonably foreseeable anymore. However, there are extra safeguards that must be met if the medical practitioners assessing the request determine that death is not reasonably foreseeable. These safeguards include having one of the two assessing medical practitioners be an expert in the medical condition causing unbearable suffering, informing the individual of available means to relieve their suffering, and discussing these means with the individual to ensure they have seriously considered them.
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MAID safeguards
In Canada, Medical Assistance in Dying (MAID) is a complex and deeply personal issue. MAID laws and policies vary across different locations in Canada. The federal Criminal Code of Canada permits MAID to take place only under very specific circumstances and rules. Anyone requesting this service must meet specific eligibility criteria. Any medical practitioner who administers an assisted death must satisfy certain safeguards.
The 2021 revisions to Canada's MAID law created a two-track approach to procedural safeguards for medical practitioners to follow, based on whether a person's natural death is reasonably foreseeable. This approach ensures that sufficient time and expertise are spent assessing MAID requests from persons whose natural death is not reasonably foreseeable, while easing procedural safeguards in cases where natural death is reasonably foreseeable.
The following procedural safeguards apply to persons whose natural death is reasonably foreseeable: the request for MAID must be made in writing and signed by one independent witness (a paid professional personal or health care worker can be an independent witness); two independent doctors or nurse practitioners must provide an assessment and confirm that all eligibility requirements are met; the person must be informed that they can withdraw their request at any time, in any manner; the person must be given an opportunity to withdraw consent and must expressly confirm their consent immediately before receiving MAID.
The following procedural safeguards apply to persons whose natural death is not reasonably foreseeable: the request for MAID must be made in writing and signed by one independent witness; two independent doctors or nurse practitioners must provide an assessment and confirm that all eligibility requirements are met; if neither of the two practitioners who assess eligibility has expertise in the medical condition that is causing the person's suffering, they must consult with a practitioner who has such expertise; the person must be informed that they can withdraw their request at any time, in any manner; 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 these services.
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MAID and mental illness
Canada's medical assistance in dying (MAID) law allows eligible adults in Canada to request medical assistance in ending their lives. MAID is a complex and deeply personal issue. While it has been legalised in Canada since 2016, it has faced several criticisms and concerns, especially regarding mental illness.
Currently, MAID in Canada is only legal for people with physical health conditions. People whose sole medical condition is mental illness are not eligible for MAID. However, this is expected to change in March 2027, making Canada one of the few countries that allow MAID for mental illness. The extension of MAID to include mental illness has sparked controversy and raised several ethical, moral, and legal concerns. Critics argue that there are inadequate safeguards and limited healthcare coverage for psychiatric and psychological issues, which may lead individuals to view MAID as their only option. The difficulty in predicting the progression and potential improvement of mental illnesses further complicates the matter.
The Canadian government has introduced legislation to address these concerns and ensure appropriate protections are in place. The legislation includes additional safeguards and eligibility criteria for MAID requests where mental illness is the sole underlying condition. These safeguards aim to assess if an individual's mental illness is "grievous and irremediable," considering the severity, duration, impact on functioning, and the outcomes of treatment attempts. The patient must demonstrate a sustained desire for MAID and be informed of all reasonable treatment options. Additionally, two independent healthcare practitioners must certify that the individual's suffering is "grievous and irremediable" and cannot be relieved through other acceptable means.
While the inclusion of mental illness in MAID eligibility has sparked debates, it is important to note that MAID activists and some ethicists believe that providing this option to patients with mental illness is morally required. They argue that for individuals who have spent years suffering from mental illness, exhausted reasonable treatment options, and maintained a desire for MAID, it may be appropriate. However, the key issue remains in differentiating between acute suicidality, which may be a symptom of mental illness, and a thoughtful decision made after long consideration.
The extension of MAID eligibility to include mental illness in Canada has been delayed multiple times to ensure that the healthcare system and practitioners are prepared to handle these complex cases. This delay also provides time for further development of clinical guidelines and standards to assess eligibility and make informed decisions regarding MAID for mental illness.
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MAID and euthanasia
In Canada, Medical Assistance in Dying (MAID) is a legal process that allows eligible adults to receive assistance from a medical practitioner in ending their life. MAID laws in Canada have evolved since the Supreme Court's 2015 ruling in Carter v. Canada, which deemed that prohibiting medical assistance in dying violated the Canadian Charter of Rights and Freedoms. The government then passed legislation in 2016, allowing eligible adults to request medical assistance in dying.
The MAID process in Canada involves specific eligibility criteria and safeguards. Those requesting MAID must meet the eligibility criteria, which include having a "serious and incurable illness, disease, or disability" and experiencing "enduring and intolerable physical or psychological suffering." Two independent medical practitioners must assess the request, and one must have expertise in the underlying medical condition. The practitioners must also ensure that the individual has explored all available means to relieve their suffering and has provided informed consent.
There have been several criticisms and concerns regarding Canada's MAID laws. Some argue that the laws lack adequate safeguards and devalue the lives of disabled people. There are worries that vulnerable individuals may be coerced into MAID and that the laws perpetuate negative stereotypes about disabilities. Additionally, there have been lawsuits and charter challenges regarding the inclusion of those with mental disorders and the potential premature deaths of disabled people.
On the other hand, MAID advocates argue that restricting MAID only to terminally ill patients is paternalistic and prevents individuals capable of decision-making from escaping their suffering. The laws aim to reflect Canadians' needs, protect vulnerable individuals, and support autonomy and freedom of choice. Quebec, for instance, became the first province in Canada to allow advance requests for MAID, recognizing the concerns of those with capacity-eroding conditions like dementia.
As of March 2024, persons with a sole underlying mental illness were included in MAID eligibility. However, there have been delays in implementing this change, with the most recent extension pushing the eligibility date to March 17, 2027. These delays have been made to allow more time for provinces, territories, and healthcare professionals to prepare and ensure appropriate protections are in place.
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MAID and human rights
Canada's medical assistance in dying (MAID) law has been the subject of much debate and discussion since its introduction in 2016, with critics arguing that it lacks adequate safeguards and devalues the lives of disabled people. The law allows eligible adults in Canada to request medical assistance in ending their lives, but it has been criticised for positioning death as an easier alternative to addressing the root causes of patients' suffering.
Human rights advocates and observers have raised concerns about the potential violation of the right to life of people with disabilities, as well as the belief that the law does not adhere to international human rights standards. They argue that the law is based on ableist assumptions that devalue the lives of disabled people and imply that life with a disability is worse than death. In addition, there have been concerns about the lack of social support and the potential for coercion, particularly for those from marginalised communities.
In response to these criticisms, the federal government has worked with provinces, territories, and healthcare professionals to implement appropriate protections. The law includes safeguards such as requiring cognitive capacity to consent, voluntary informed consent, independent assessors and witnesses, and waiting periods between different stages of the process. However, it's important to note that Canada's MAID law does not require that all reasonable treatments be made available before a patient can access MAID, which is a requirement in all other jurisdictions that permit it.
The eligibility criteria for MAID have also been a point of contention. Initially, only those with a reasonably foreseeable death were eligible, but this was expanded in 2021 to include those whose natural death was not imminent. In 2024, a lawsuit was filed challenging the legality of delaying MAID expansion to those with mental disorders, arguing that it was discriminatory and violated the Charter of Rights and Freedoms. As of March 2024, persons whose sole medical condition is a mental illness are also eligible for MAID, but this has been postponed until March 17, 2027, to allow more time for preparation and training.
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Frequently asked questions
MAID stands for Medical Assistance in Dying. It is a process that allows eligible individuals to receive assistance from a medical practitioner in ending their life.
In February 2015, the Supreme Court of Canada ruled in Carter v. Canada that parts of the Criminal Code prohibiting medical assistance in dying were inconsistent with the Canadian Charter of Rights and Freedoms. The government was given until June 6, 2016, to create a new law. In June 2016, Parliament passed federal legislation allowing eligible adults to request medical assistance in dying. Since then, Canada's MAID law has continued to evolve.
To be eligible for MAID in Canada, individuals must meet specific criteria. As of March 2024, persons with a sole underlying mental illness are also eligible for MAID. Other criteria include suffering from a serious and incurable illness, disease, or disability, experiencing enduring and intolerable physical or psychological suffering, and having a natural death that is reasonably foreseeable.
There are several safeguards in place for MAID in Canada. These include requiring cognitive capacity to consent, voluntary informed consent, independent assessors and witnesses, and waiting periods between different stages of the process. Two independent medical practitioners must assess and confirm eligibility, and only medical practitioners are permitted to conduct assessments and provide MAID.
Human rights advocates and observers have criticized Canada's MAID laws for lacking adequate safeguards and devaluing the lives of people with disabilities. There are concerns that the laws are based on ableist assumptions and may contravene international human rights standards and the Canadian Charter of Rights and Freedoms. Lawsuits and charter challenges have been filed on these grounds.
