Medical assistance in dying: Overview

What medical assistance in dying is, who is eligible, how to make a request, the process, and who can provide medical assistance in dying.

Eligibility for MAID for persons suffering solely from a mental illness has been delayed until March 17, 2027.

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Medical assistance in dying (MAID) is a process that allows someone who is found eligible to be able to receive assistance from a medical practitioner in ending their life. The federal Criminal Code of Canada permits this to take place only under very specific circumstances and rules. Anyone requesting this service must meet specific eligibility criteria to receive medical assistance in dying. Any medical practitioner who administers an assisted death to someone must satisfy certain safeguards first.

Only medical practitioners are permitted to conduct assessments and to provide medical assistance in dying. This can be a physician or a nurse practitioner, where provinces and territories allow.

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There are 2 methods of medical assistance in dying available in Canada.

Method 1: a physician or nurse practitioner directly administers a substance that causes death, such as an injection of a drug. This is sometimes called clinician-administered medical assistance in dying.

Method 2: a physician or nurse practitioner provides or prescribes a drug that the eligible person takes themselves, in order to bring about their own death. This is sometimes called self-administered medical assistance in dying.

Clinical guidelines and practices outline which drugs to use, and are established by:

Many of the drugs commonly used for this procedure are already available in Canada. Health care providers usually prescribe them at lower dosages for common purposes, such as:

As the regulator of drug products, Health Canada is working with partners to help support access to drugs for medical assistance in dying.

Eligibility

To be eligible for medical assistance in dying, you must meet all the following criteria. You must:

Generally, visitors to Canada are not eligible for medical assistance in dying.

Grievous and irremediable medical condition

To be considered as having a grievous and irremediable medical condition, you must meet all of the following criteria. You must:

You do not need to have a fatal or terminal condition to be eligible for medical assistance in dying.

If your only medical condition is a mental illness, you are not eligible for medical assistance in dying until March 17, 2027.

If you have a mental illness along with other medical conditions, you may be eligible for medical assistance in dying.

Eligibility is always assessed on an individual basis and takes all relevant circumstances into account. However, you must meet all the criteria to be eligible.

Updates to legislation

Informed consent

Informed consent is when you give permission to receive medical assistance in dying after you receive all of the information you need to make your decision. This includes:

You must be able to give informed consent both:

You can withdraw your consent at any time and in any way.

Making a request

Regardless of location, you can request medical assistance in dying if you're eligible.

If you're experiencing a lot of pain and suffering due to your medical situation, talk to your physician or nurse practitioner. You can discuss options related to your circumstances and your possible interest in medical assistance in dying.

How and where this service will be offered is determined by:

You may have to meet other requirements. Your health care provider can tell you more.

If you don't have a regular practitioner, your province or territory may have a central coordination service that can help you.

Support and resources

The role of provinces and territories

Policies and procedures may vary depending on where you live. Provinces and territories can create health-related laws or rules that may affect medical assistance in dying services. However, they cannot permit actions that are prohibited under the Criminal Code.

Rules that can affect medical assistance in dying can include:

If you have questions about the law and policies in your specific location, contact your province or territory.

Procedural safeguards

Before a medical practitioner administers medical assistance in dying, they must satisfy certain safeguards. These include making sure that you :

  1. have 2 independent medical assessments
  2. make a written request signed by an independent witness
  3. know that you can withdraw your request at any time
  4. provide final consent before receiving medical assistance in dying
  5. give advance consent, if applicable

They must also meet extra safeguards in the event that your death is not naturally foreseeable.

Medical assessments

When you make your request for medical assistance in dying, 2 independent medical practitioners (physicians or nurse practitioners) must assess it.

Your medical practitioner must make sure that you meet all of the listed eligibility criteria. The second practitioner must also provide a written opinion confirming that you're eligible.

The medical practitioner providing the original assessment and the one giving the second opinion must be independent. This means they cannot:

Making a written request

You must sign a written request that says you want to have a medically assisted death. The request must include your:

  1. signature confirming your request for medical assistance in dying. If you can't write, another adult can sign the request on your behalf under your clear direction. This adult must:
    • be at least 18 years of age
    • understand what it means to request medical assistance in dying
    • not benefit from your death (for example, they must not be an heir to your estate)
  2. written request must be signed and dated before 1 independent witness, who must also sign and date the request

Some provinces and territories may have a specific request form for you to complete. You can get this form from your health care provider or your provincial or territorial government website.

Support and resources

Independent witness

The role of the independent witness is to confirm:

An independent witness:

To be considered independent means that the witness cannot:

Withdrawing your request

You must be informed of your right to withdraw your request for medical assistance in dying at any time and in any manner.

You do not have to proceed even if you're found eligible for the service.

Final consent

Immediately before receiving medical assistance in dying, you must:

An exception to this requirement is possible if you have a waiver of final consent. You can waive the requirement to provide consent just before you receive medical assistance in dying, only if:

Any arrangement for the waiver of final consent will be considered invalid if, at the time that you are to receive medical assistance in dying, you:

Reflexes and other types of involuntary movements do not constitute refusal or resistance. Examples of involuntary movements include responses to touch or the insertion of a needle.

Advance consent in cases of self-administered medical assistance in dying

You can make a written arrangement with your practitioner so that they can administer medical assistance in dying in the event of failed self-administration.

This arrangement allows for clinician-administered medical assistance in dying if there are complications during self-administration that cause your loss of decision-making capacity but not your death. This means that your medical practitioner must be present at the time that you self-administer the medications.

Requests where your natural death is not reasonably foreseeable

If the medical practitioners assessing your request for MAID determine that your death is not reasonably foreseeable, there are extra safeguards that must be met before medical assistance in dying can be provided:

  1. One of the 2 medical practitioners who provides an assessment must have expertise in the medical condition that is causing your unbearable suffering.
    • If neither of them have this expertise, they must consult another practitioner with expertise in the medical condition during the assessment process.
  2. You must be informed of available means to relieve your suffering, and offered consultations with professionals who provide services including, where appropriate:
    • palliative care
    • community services
    • counselling services
    • mental health and disability support services
  3. You and your practitioners must have discussed reasonable and available means to relieve your suffering, and all agree that you have seriously considered those means.
  4. Your eligibility assessment must take a minimum of 90 days, unless the assessments have been completed sooner and you are at immediate risk of losing your capacity to consent.
  5. Immediately before you receive medical assistance in dying, the practitioner must:
    • give you an opportunity to withdraw your request
    • ensure that you give express consent to receive medical assistance in dying

Medical practitioners

Those who can conduct assessments and provide medical assistance in dying are:

Those who can help provide medical assistance in dying include:

These people can assist in the process without being charged under criminal law. However, physicians, nurse practitioners and other people who are directly involved must follow:

Criminal Code provisions on Medical Assistance in Dying legislation (effective March 17, 2021)

Provider's rights

Not all health care providers are comfortable with medical assistance in dying. Federal legislation does not force anyone to provide or help to provide medical assistance in dying.

Provincial and territorial governments are responsible for determining how and where to provide health care services. They may also make policies around where medical assistance in dying can take place. However, they cannot permit actions that are prohibited under the Criminal Code.

Supporting access

We understand that these provider rights could create challenges if you want to access medical assistance in dying. Contact your health care provider for questions about access. You can also contact your province or territory for information on the procedure and other care options.

If you're a health care provider, contact your provincial or territorial professional regulatory body for information about:

Learn more:

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