Medical assistance in dying

Learn about medical assistance in dying, including the requirements of the law, eligibility and how the request process works. Find information about the independent reviews currently underway of requests that are not eligible under the law.

Also, read the public interim reports, which provide an overview of medical assistance in dying across the country.

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About medical assistance in dying

Changes to the Criminal Code

In February 2015, the Supreme Court of Canada ruled in Carter v. Canada that parts of the Criminal Code would need to change to satisfy the Canadian Charter of Rights and Freedoms. The parts that prohibited medical assistance in dying would no longer be valid. The Supreme Court gave the government until June 6, 2016, to create a new law.

Now, the federal government has passed legislation that allows eligible Canadian adults to request medical assistance in dying.

Who can provide medical assistance in dying and who can help

Those who can provide medical assistance in dying services are:

  • physicians
  • nurse practitioners (in provinces where this is allowed)

Those who can help provide medical assistance in dying include:

  • pharmacists
  • 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:

Protecting the right of providers to act according to their beliefs and values

Not all health care providers will be comfortable with medical assistance in dying. The practice may not be consistent with a provider's beliefs and values.

The legislation does not force any person to provide or help to provide medical assistance in dying.

Supporting access for patients seeking medical assistance in dying

We understand that these provider rights could create problems for patients who want to access medical assistance in dying. Most provinces and territories have developed care coordination systems to help patients learn more about this service.

That's why the federal government is working with provinces and territories to support access and referrals to medical assistance in dying and end of life care in Canada.

Available options

There are 2 types of medical assistance in dying available to Canadians. They each must include a physician or nurse practitioner who:

  • directly administers a substance that causes death, such as an injection of a drug
    • this is becoming known as clinician-assisted medical assistance in dying
    • it was previously known as voluntary euthanasia

or

  • provides or prescribes a drug that the eligible person takes themselves, in order to bring about their own death
    • this is becoming known as self-administered medical assistance in dying
    • it was previously known as medically assisted suicide or assisted suicide

Who to contact for questions about access to medical assistance in dying

Patients are encouraged to contact their physicians or nurse practitioners (if applicable) for questions about access. Patients may also wish to contact the resources set up within their province or territory to get information on medical assistance in dying and other end-of-life care options.

Physicians and nurse practitioners are encouraged to contact their provincial or territorial regulatory body for information about specific guidelines.

Eligibility criteria

Who is eligible for medical assistance in dying

In order to be eligible for medical assistance in dying, you must meet all of the following criteria. You must:

  • be eligible for health services funded by the federal government, or a province or territory
    • generally, visitors to Canada are not eligible for medical assistance in dying
  • 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 that is not the result of outside pressure or influence
  • give informed consent to receive 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
  • be at a point where your natural death has become reasonably foreseeable
    • this takes into account all of your medical circumstances and does not require a specific prognosis as to how long you have left to live

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

Informed Consent

This means you have consented (given permission) to medical assistance in dying after you have received all of the information you need to make your decision, including:

  • 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 medical assistance in dying is provided

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

About mental illness and physical disability

If you have a mental illness or a physical disability and wish to seek medical assistance in dying, you may be eligible. Eligibility is assessed on an individual basis, looking at all of the relevant circumstances. However, you must meet all the criteria to be eligible for medical assistance in dying, which means:

  • your natural death must be foreseeable in a period of time that is not too distant
  • you must be mentally competent and capable of making decisions at the time of your request
  • you must also be mentally competent and capable of making decisions immediately before medical assistance in dying is provided
    • the physician or nurse practitioner must ask you to confirm your choice before administering the service

You can withdraw your consent at any time and in any manner

Obtaining medical assistance in dying

Where and how services are provided

Regardless of location, eligible Canadians can request medical assistance in dying.

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

  • provinces and territories
  • the organizations that regulate health professionals
  • medical institutions

Which drugs to use are outlined in clinical guidelines and practices established by provinces and territories, or organizations that regulate the practice of medicine.

Many of the drugs commonly used for this procedure are already marketed in Canada and are prescribed at lower dosages for common purposes, such as:

  • nausea
  • pain control
  • anaesthesia 

As the regulator of drug products, Health Canada will work with partners, as needed, to help support access to drugs for medical assistance in dying.

Process for requesting the service

The legislation contains safeguards to make sure those who ask for medical assistance in dying:

  • request the service of their own free will
  • are able to make health care decisions for themselves
  • are eligible (this means they meet all of the listed criteria)
  • can and do give informed consent, which includes being informed of all care options available to them to help relieve suffering

These safeguards will guide health care providers to carry out this service appropriately and in a way that protects people from abuse or misuse.

You can ask a health care provider for information about medical assistance in dying at any time. The process for requesting medical assistance in dying requires you to complete the following steps:

Talk to your physician or nurse practitioner about end-of-life care options in relation to your medical condition or circumstances.

Submit a written request.

You must make a written request that says you want to have a medically assisted death. Some provinces and territories may require that you complete a specific form. This form may be provided by your health care provider or available on a provincial or territorial website.

If you are unable to 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)

You must sign and date your written request before two independent witnesses, who must also sign and date the request.

An independent witness must be 18 years of age and understand what it means to request medical assistance in dying.

To be considered independent means that the witnesses cannot:

  • benefit from your death
  • be an owner or operator of a health care facility where you live or are receiving care
  • be directly involved in providing you with health or personal care

Undergo medical assessments.

Your physician or nurse practitioner must make sure that you are eligible to receive medical assistance in dying according to all of the listed criteria.

A second physician or nurse practitioner must also provide a written opinion confirming that you are eligible.

You must also be informed that you have the right to withdraw your request at any time.

The physician or nurse practitioner providing the original assessment and the one giving the second opinion must be independent.

To be considered independent means that neither of them:

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

Wait a 10-day reflection period to receive the service.

You must wait a period of at least 10 clear days after signing your written request before the service can be provided so that you have time to consider your request. If you do decide to proceed after the 10 days, your practitioner can have confidence in your true desire to receive the service.

An exception may be made to the 10 clear day reflection period if both your first and second medical or nurse practitioner agree that:

  • your death is fast approaching
  • you might soon lose your capacity to provide informed consent

Choosing to withdraw your request

You may choose to withdraw your request at any time in the process and in any manner.

You are not obligated to proceed with medical assistance in dying even if you are found eligible for the service.

If you choose to continue, you must be asked to confirm your consent. You will also be given a final opportunity to withdraw your request just before receiving medical assistance in dying.

Roles of the provinces and territories

The legislation on medical assistance in dying is now part of the Criminal Code, which is set out by the federal government. It states that a person is not guilty of a criminal offence if they provide or assist in providing medical assistance in dying according to the conditions and safeguards in the law.

Practitioners must follow this new criminal law.

Provinces and territories may create additional health-related laws or rules as long as they do not conflict with what is in the criminal law. If these rules are within provincial power, they may address health and other aspects of medical assistance in dying, such as:

  • the use of specific forms to fill out
  • special medical training for providers of the service
  • how information and data on the service are provided
  • 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. Policies and procedures for medical assistance in dying may vary among provinces and territories. For example, in Quebec, physician-administered assisted dying is the only form available.

Federal guidelines: reporting of deaths in cases of medical assistance in dying

The Minister of Health must publish guidelines on what information to include on death certificates in cases of medical assistance in dying.

The federal guidelines reflect a clear way to identify all cases of medical assistance in dying. They also provide a consistent way to report medically assisted deaths across Canada.

In Canada, death reporting and investigation is the responsibility of individual provinces and territories.  Also, some provinces and territories have already adopted their own approaches to death certification for medically assisted deaths. That is why the federal guidelines are non-binding and respect provincial and territorial oversight for reporting deaths.

Independent reviews

There are sensitive and complex issues that are not addressed in the law and require careful consideration and review. These issues are:

  • requests by mature minors
  • advance requests
  • requests where mental illness is the sole underlying medical condition

The federal government was required to start the independent reviews of these 3 issues 180 days after the day the law was passed.

On December 13, 2016, the federal government announced that the Council of Canadian Academies was selected to conduct the reviews. The Council of Canadian Academies is a federally funded, independent, not-for-profit organization that does evidence-based, expert assessments to support and inform public policy development in Canada.

The final reports on these reviews will be tabled in Parliament and available to the public by December 2018.

The reports will not provide recommendations. Instead, they will:

  • summarize the relevant evidence on the diverse perspectives and issues surrounding medical assistance in dying in these 3 circumstances
  • facilitate an informed, evidence-based dialogue among Canadians and decision makers

Learn more about the background information on the independent reviews

Monitoring and reporting on medical assistance in dying

The Minister of Health must make regulations to collect information and publicly report on medical assistance in dying in Canada.

Monitoring and reporting are critical components in building transparency and public trust. They also help to reflect the seriousness of medical assistance in dying as an exception to the criminal laws that prohibit ending a human life.

Public reports can also give you a clear picture of how the legislation is working and help you understand the impact of the legislation.

These reports will include information about:

  • the types of medical conditions associated with requests
  • whether the safeguards in the law are working as intended
  • demographic information about people who request the service
  • whether there are regional differences in where and how the service is carried out across Canada
  • the number of requests made for medical assistance in dying and whether they were approved or not approved

The complexity of the regulations and the consequences for health care professionals mean that we must take the time needed to get the regulations right. The process will include consultations with stakeholders and the public in 2017. The monitoring system, including data collection and reporting activities, will begin in 2018.

Given the sensitive nature of the information, the regulations and all public reports will respect and protect the privacy and confidentiality of the patients and providers involved in medical assistance in dying. 

Interim reports on medical assistance in dying in Canada:

Federal, provincial and territorial governments recognize the importance of the timely release of accurate information on this issue. Until regulations are made, we are collaborating to produce a series of interim reports.

The first report covers the first 6 months that medical assistance in dying has been available in Canada (June 17, 2016 to December 31, 2016).

Report #1, issued on: April 26, 2017

Supporting palliative care and other end-of-life care options

We strongly support better palliative and end-of-life care services.

To better meet the needs of Canadians, we are committed to:

  • providing investments for better home care, including palliative care
  • supporting the provinces and territories to improve access to home and palliative care services as part of a new Health Accord

Learn about palliative and end-of-life care in Canada:

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