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.

On this page

• About
• Eligibility
• The MAID process
• The role of medical practitioners

About

Medical assistance in dying (MAID) is a health service that allows eligible people to receive help from a medical practitioner in ending their life. To be found eligible, you must:

• meet all eligibility criteria set out in federal laws
• have an assessment by a qualified medical practitioner

MAID operates within a federal framework established through the Criminal Code of Canada that sets out its eligibility criteria and safeguards.

Provinces and territories organize, manage and deliver MAID as part of end-of-life and complex care services. There is no automatic right to receive medical assistance in dying in Canada. Individuals must meet all eligibility criteria established in federal law and be assessed by qualified medical practitioners in accordance with applicable legal and professional requirements.

The delivery of MAID services, including care pathways, clinical practices and referral processes, is determined by provinces and territories and regulated health professionals within the framework established by federal law. Policies and procedures may vary across jurisdictions.

Learn more:

• Legislation in Canada
• Supports and resources

Eligibility

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

• live in Canada (visitors to Canada are not eligible)
• be eligible for government-funded health services
  • 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 capable of making health care decisions for yourself
• have a "grievous and irremediable" medical condition, which is defined as:
  • having a serious illness, disease or disability
  • being in an advanced state of decline that cannot be reversed
  • experiencing unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable
• 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

If your sole underlying medical condition is a mental illness, you are not eligible for MAID.

Learn more:

• Eligibility of mental illness as a medical condition

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.

The MAID process

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, nurse practitioner or most responsible health care provider. You can discuss options related to your circumstances and your possible interest in medical assistance in dying.

How and where this service is offered is determined by:

• health care providers
• 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.

Provincial and territorial health websites explain how to access MAID. They may also have central care coordination services that can help you.

Learn more:

• Support and resources

Medical assessments

When you make your request for MAID, 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:

1. 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)
2. being signed and dated before 1 independent witness, who must also sign and date the request

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

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

Learn more:

• Support and resources

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

In most instances, 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 MAID
  • 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 MAID, 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.

Under Bill C-41, the Government of Canada is proposing to allow advance requests for MAID with certain safeguards. You will only be eligible to make these requests if you have been diagnosed with an incurable condition that will later limit you from making informed decisions.

Learn more:

• Backgrounder: Proposed legislation to allow advance requests for MAID and prevent the scheduled expansion of MAID on the basis of a mental illness

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 MAID 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 MAID, the practitioner must:
   • give you an opportunity to withdraw your request
   • ensure that you give express consent to receive MAID

The role of medical practitioners

Only qualified medical practitioners can conduct assessments and provide medical assistance in dying. They are:

• physicians
• nurse practitioners in some provinces, where allowed

Other providers may also play a role, such as:

• pharmacists, pharmacy technicians and assistants
• 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

Learn more:

• Criminal Code provisions on Medical Assistance in Dying legislation

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 MAID 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

Learn more:

• Support and resources
• For health professionals and regulators

Related links

• Canada's Medical Assistance in Dying Law
• Criminal Code provisions on Medical Assistance in Dying legislation