Cameron Miranda
Canada's euthanasia laws have been a topic of debate and controversy, with human rights advocates criticising the lack of adequate safeguards and the potential devaluation of disabled people's lives. In 2016, Canada legalised medical assistance in dying (MAID) for adults with terminal illnesses, and in 2021, the law was expanded to include those with serious and chronic physical conditions, even if non-life-threatening. The inclusion of mental illness as a qualifying condition has sparked intense scrutiny, with critics arguing it may be too easy for vulnerable individuals to opt for euthanasia. While Canada's euthanasia law includes safeguards to prevent abuse and ensure informed consent, concerns have been raised about the potential impact on individuals with disabilities and the lack of monthly commissions to review cases.
| Characteristics | Values |
|---|---|
| Year of legislation | 2016 |
| Number of MAiD deaths since 2016 | 60,301 |
| MAiD provisions in 2022 | 15,343 |
| MAiD provisions in 2023 | 15,343 |
| MAiD provisions as % of all deaths in Canada in 2022 | 4.1% |
| MAiD provisions as % of all deaths in Canada in 2023 | 4.7% |
| Average age of individuals at the time of MAiD in 2023 | 77.6 years |
| Underlying medical conditions in 2022 | Cancer (63%), Cardiovascular (18.8%), Other (14.9%), Respiratory (13.2%), Neurological (12.6%) |
| Eligibility criteria | 18+ years, capable of making health decisions, grievous and irremediable medical condition, voluntary request, informed consent |
| Legal safeguards | Preventing abuse, ensuring informed consent, no legal or financial interest for physicians and witnesses, consent can be revoked at any time |
| Public opinion | 61% support current legislation, 31% support extending to mental disorders, 51% support expanding to mature minors |
| Provincial laws | Quebec permits doctors to prescribe and administer the substance that causes death, defining it as a medical service |
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What You'll Learn
The exclusion of mental illness as a qualifying condition
Canada's euthanasia law includes some legal safeguards aimed at preventing abuse and ensuring informed consent. To be eligible for euthanasia, a person must meet specific criteria, including having a grievous and irremediable medical condition and being capable of making decisions regarding their health.
While Canada's euthanasia law is one of the most liberal in the world, it currently excludes mental illness as a qualifying condition. In 2021, the government introduced legislation to delay the inclusion of mental illness as an eligible condition for euthanasia. This delay was initially set for two years, until March 17, 2023, to provide time to study how euthanasia for mental illness could be safely provided and to establish appropriate safeguards.
In February 2023, the government introduced further legislation (former Bill C-39) to extend the temporary exclusion of eligibility for euthanasia for those with mental illness as their sole underlying medical condition. This extension was set to expire on March 17, 2024. However, in February 2024, the government announced a further postponement of this provision until 2027, citing that "the country is not ready."
As of February 2024, the exclusion of mental illness as a qualifying condition for euthanasia in Canada remains in place, with the eligibility date for persons suffering solely from mental illness postponed until March 17, 2027.
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The legality of euthanasia
Euthanasia, or Medical Assistance in Dying (MAID), is a highly debated topic in Canada. The country's euthanasia law includes legal safeguards to prevent abuse and ensure informed consent. Patients must repeatedly express their consent, which can be revoked at any time and in any manner, and must be confirmed by an independent witness. Doctors are permitted to suggest euthanasia to patients, but neither they nor the legal witness can have any legal or financial interest in the patient's outcome.
In 2016, Quebec passed a right-to-die law, becoming the fourth jurisdiction in North America to allow what the bill describes as "medical aid in dying". This law permits doctors to prescribe and administer the substance that will cause the patient's death, though it avoids describing this as euthanasia to avoid friction with the Criminal Code of Canada, which previously defined all assistance in dying as culpable homicide. This law was passed under joint pressure from Quebec and the Supreme Court of Canada, which ruled that the Criminal Code provisions that made it a crime to help a person end their life violated the Canadian Charter of Rights and Freedoms.
The federal Criminal Code of Canada permits MAID to take place only under very specific circumstances and rules. To be eligible, individuals must be at least 18 years old, have a grievous and irremediable medical condition, and make a voluntary request for MAID free from external pressure. They must also give informed consent after being informed of all available means to relieve their suffering, including palliative care.
There have been several lawsuits and charter challenges regarding the legality of euthanasia in Canada. One such challenge was filed in 2024, arguing that the track 2 criteria caused the premature deaths of disabled people and that euthanasia should be limited to those with reasonably foreseeable deaths. Another lawsuit was filed in the same year regarding the legality of delaying the expansion of euthanasia to those with mental disorders, arguing that this was discriminatory and violated the Charter of Rights and Freedoms. As of 2024, the Canadian government has postponed the expansion of MAID to people with mental illness until 2027, citing the country's lack of readiness.
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MAID requests and safeguards
Medical assistance in dying (MAID) is a process that allows eligible individuals to receive assistance from a medical practitioner in ending their life. MAID is a complex and sensitive issue, and the Government of Canada has emphasised that its federal framework governing MAID is designed with stringent safeguards to protect the inherent and equal value and dignity of every person's life.
MAID Requests
Anyone requesting MAID must meet specific eligibility criteria. Requests can be made verbally or in writing, including through direct communication with a physician or nurse practitioner, email, text message, written note, or speech-generating device. A written request must be signed by the requester and witnessed and signed by one or two independent witnesses, depending on the specific circumstances. The request does not have to be in the format required by the Criminal Code as a safeguard when MAID is provided (i.e., duly signed, dated, and witnessed). However, a written request must be completed before MAID is provided.
Safeguards
Before a physician or nurse practitioner can provide MAID, certain safeguards must be met. These include procedural safeguards, such as requiring two independent doctors or nurse practitioners to provide an assessment and confirm that all eligibility requirements are met. Additionally, the person requesting MAID must be informed that they can withdraw their request at any time and in any manner. They must also be given an opportunity to withdraw their consent immediately before receiving MAID, although this "final consent" requirement can be waived in certain circumstances.
For individuals whose natural death is not reasonably foreseeable, there are extra safeguards in place. In these cases, if neither of the two practitioners assessing eligibility has expertise in the medical condition causing the person's suffering, they must consult with a practitioner who possesses such expertise. The person requesting MAID must also be informed of available and appropriate means to relieve their suffering, including counselling and support services.
The Government of Canada has also established an Expert Panel on MAID and Mental Illness to make recommendations on protocols, guidance, and safeguards for requests from individuals with mental illness. In March 2023, legislation was passed to extend the temporary exclusion of eligibility for persons suffering solely from a mental illness.
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The right to die for those without a terminal illness
Canada's euthanasia laws have been criticised for lacking safeguards and devaluing the lives of disabled people. However, Canada's euthanasia law does include some legal safeguards aimed at preventing abuse and ensuring informed consent. Neither the legal witness nor the physicians involved can have any legal or financial interest in the patient's outcome. Consent must be repeatedly expressed, not implied, and can be revoked at any time. To receive euthanasia, patients must sign a written request expressing their wish to end their life in front of an independent witness.
Canada's first MAID (Medical Assistance in Dying) law, Bill C-14, passed in 2016. It was reserved for those over 18, eligible for health care, and mentally competent to consent to death. They needed to have a "serious and incurable illness, disease or disability", be in an "advanced state of irreversible decline in capability", and have "enduring physical or psychological suffering" that was "intolerable". Their natural deaths also had to be "reasonably foreseeable".
In 2021, the Canadian government passed Bill C-7, which removed the criteria that a patient's death be "reasonably foreseeable". This change in the law meant that Canadians who are chronically sick or disabled can now receive MAID from a doctor or nurse practitioner. While this new kind of MAID, known as Track 2, is also technically open to people without any physical condition applying because of mental illness, this has been delayed until 2027.
There has been criticism of the expansion of MAID to those without a terminal illness. Some argue that it isn't really "assistance in dying" if the patient isn't dying. There is also concern that those with material conditions that make their medical problems worse will end up applying for MAID because of suffering imposed on them by the system. However, Canadians have largely been supportive of this expansion, with a 2022 poll showing that 86% supported MAID's legalization.
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The impact on disabled people
Canada's euthanasia laws have been criticised by human rights advocates for lacking safeguards, devaluing the lives of disabled people, and prompting health workers and doctors to suggest euthanasia to people who would not otherwise consider it. The laws have also been criticised for allowing euthanasia to be administered to people who were not receiving adequate government support to continue living.
In 2024, a lawsuit was filed challenging the legality of delaying the expansion of euthanasia to those with a mental disorder. The lawsuit argued that denying euthanasia on these grounds is discriminatory and violates the Charter of Rights and Freedoms. A separate charter challenge was also filed in 2024, arguing that the track 2 criteria cause premature deaths of disabled people and that euthanasia should be limited to those with reasonably foreseeable deaths.
Canada's euthanasia law includes some legal safeguards aimed at preventing abuse and ensuring informed consent. Consent must be repeatedly expressed, not implied, and can be revoked at any time. Doctors are permitted to suggest euthanasia to patients, regardless of whether the patient has already refused. To receive euthanasia, patients with a disease, disability, or terminal illness must sign a written request expressing their wish to end their life in front of an independent witness who can confirm it was done willingly and free of coercion.
The inclusion of people with mental illnesses in Canada's euthanasia laws has been controversial and has been repeatedly delayed. In 2024, the government postponed until 2027 the provision allowing mentally ill patients to apply for euthanasia. This postponement has been criticised as discriminatory and a violation of the Charter of Rights and Freedoms.
The impact of Canada's euthanasia laws on disabled people is complex and multifaceted. While some argue that the laws provide vulnerable individuals with autonomy and freedom of choice, others argue that the laws devalue the lives of disabled people and make it easier for them to be coerced into ending their lives. The laws have also been criticised for not providing adequate access to care for people with mental disorders before granting them the right to euthanasia. Overall, the impact of Canada's euthanasia laws on disabled people remains a highly debated and controversial issue.
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Frequently asked questions
Canada's right-to-die law is known as Medical Assistance in Dying (MAID). It allows eligible adults to seek medical assistance to end their lives.
MAID in Canada is available for adults with terminal illnesses or serious and chronic physical conditions, even if the condition is non-life-threatening. As of 2021, a person's natural death no longer needs to be reasonably foreseeable to access MAID. However, those with mental illness are currently not eligible for MAID, and this exclusion is set to remain in effect until at least March 17, 2027.
To request MAID in Canada, an individual must meet the eligibility criteria and provide informed consent. The request must be assessed and confirmed in writing by two independent practitioners, such as physicians or nurse practitioners.
There are concerns that MAID laws in Canada lack adequate safeguards and may devalue the lives of disabled people. Critics argue that the absence of monthly commissions to review cases, as seen in other countries, is a shortcoming. Additionally, there are worries that MAID may be too readily available for vulnerable individuals, potentially impacting those with capacity-eroding conditions like dementia.
