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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About

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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Legislation in Canada

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:

provinces and territories
organizations that regulate the practice of medicine

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:

nausea
pain control
anaesthesia

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:

be eligible for health services funded by a province or territory, or the federal government
- You may also be eligible if you meet your province or territory's minimum period of residence or waiting period.
be at least 18 years old and mentally competent
- This means being capable of making health care decisions for yourself.
have a grievous and irremediable medical condition
make a voluntary request for medical assistance in dying
- The request cannot be the result of outside pressure or influence.
give informed consent to receive medical assistance in dying

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:

have a serious illness, disease or disability
be in an advanced state of decline that cannot be reversed
experience unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable

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:

your medical diagnosis
available forms of treatment
available options to relieve suffering, including palliative care

You must be able to give informed consent both:

at the time of your request
immediately before receiving medical assistance in dying, unless special circumstances apply

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:

medical institutions
provinces and territories
the organizations that regulate health professionals

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:

data and information collection
the use of specific forms to fill out
special medical training for providers of the service
rules or requirements for either type of medical assistance in dying

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 :

have 2 independent medical assessments
make a written request signed by an independent witness
know that you can withdraw your request at any time
provide final consent before receiving medical assistance in dying
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:

knowingly benefit from your death
hold a position of authority over the other
be connected to the other or to you in a way that could affect their objectivity

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:

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)
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:

the signing and dating of the request by the person requesting medical assistance in dying
that the person requesting medical assistance in dying understands what they're signing

An independent witness:

must be at least 18 years of age
can be a paid professional personal or health care worker
must understand what it means to request medical assistance in dying

To be considered independent means that the witness cannot:

benefit from your death
be an unpaid caregiver
be an owner or operator of a health care facility where you live or are receiving care

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:

be given the opportunity to withdraw consent
affirm your consent if you do not wish to withdraw it

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:

your natural death is reasonably foreseeable and
while you had decision-making capacity:
- you were assessed and approved to receive medical assistance in dying
- your practitioner advised that you are at risk of losing capacity to provide final consent
- you made a written arrangement with your practitioner to provide consent in advance on your chosen date, if you no longer have capacity to consent on that date

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:

no longer have capacity and
demonstrate refusal or resistance to the administration of MAID by words, sounds or gestures

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:

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.
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
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.
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.
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:

physicians
nurse practitioners (in provinces where this is allowed)

Those who can help provide medical assistance in dying include:

pharmacists, pharmacy technicians and assistants
family members or other people that you ask to help
health care providers who help physicians or nurse practitioners

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:

the rules set out in the Criminal Code
applicable provincial and territorial health-related laws, rules and policies

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:

your reporting obligations
specific practice guidelines