In February 2015, the Supreme Court of Canada released Carter v. Canada (Attorney General), an important decision about the law on assisted dying. The decision found 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. As a result, several groups were formed to study the issue of assisted dying and to consider options for changing the law and related policies. This included a joint Senate and House of Commons committee that used the term “medical assistance in dying,” or MAID.
In April 2016, the federal Minister of Justice tabled Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying). The bill set out rules about who could have access to MAID and about the procedures that health care providers had to follow. The eligibility criteria for MAID included having a “serious and incurable illness, disease or disability,” experiencing intolerable suffering, and having a “reasonably foreseeable” natural death. Bill C-14 also required an independent review of issues relating to MAID for mature minors, advance requests for MAID and MAID where mental illness is the sole underlying medical condition. These reviews were conducted by the Council of Canadian Academies between December 2016 and December 2018.
Bill C-14 became law in June 2016. The law was challenged almost immediately as being too restrictive. In September 2019, the Superior Court of Quebec declared unconstitutional the part of the law that said that a person’s natural death had to be reasonably foreseeable to access MAID. In March 2021, Parliament responded by passing Bill C-7, An Act to amend the Criminal Code (medical assistance in dying). The bill removed the “reasonably foreseeable” natural death eligibility criterion and established a different set of rules for cases where a person’s natural death is not reasonably foreseeable. It also prohibited MAID on the basis of mental illness for a period of two years. That period has since been extended twice.
Bill C-7 required an independent expert panel to study the issue of MAID and mental illness, as well as a parliamentary review of the law on MAID. The former study was completed in May 2022; it found that changes to the law were not necessary to provide MAID on the basis of mental disorder. The report of the joint committee that conducted the parliamentary review, released in February 2023, made a number of recommendations regarding MAID as it relates to palliative care, persons with disabilities, mature minors, persons with mental disorders and advance requests. Both the expert panel and the parliamentary committee recommended the development of harmonized standards of practice for MAID across the country.
In March 2023, Parliament passed Bill C‑39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying) which delayed eligibility for MAID where mental illness is the sole underlying medical condition by one year. The joint parliamentary committee was re‑established in October 2023 to assess Canada’s readiness to provide MAID on this basis. In January 2024, the committee released another report which recommended further delaying eligibility for this form of MAID, leading to the enactment of Bill C‑62, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2. Eligibility for MAID on the basis of mental illness is now set to come into force on 17 March 2027.
Quebec has been a leader in the development of MAID law and policy. Prior to Bill C-14, Quebec passed its own legislation on end-of-life care which included provisions on “medical aid in dying.” Differences between Quebec’s legislation and the federal legislation have led to uncertainties about the applicable law in Quebec. On 7 June 2023, the National Assembly of Quebec passed amendments to Quebec’s law that will allow advanced requests for MAID, among other important changes.
Not everyone agrees with the practice of MAID, and health professionals who feel that MAID goes against their conscience or religious beliefs have sought to ensure that they are protected from having to participate in MAID. The removal of the reasonably foreseeable natural death requirement has heightened concerns about the practice of MAID. Some argue that the new law discriminates against persons with disabilities, and some worry that people may turn to MAID because they are not receiving adequate health care or social supports.
While some people want to restrict access to MAID, others would like to see access expanded to include mature minors and to allow for advance requests under certain conditions. In the meantime, the federal government and health care providers are preparing for MAID on the basis of mental illness to be legalized in March 2027.
Read the full text of the HillStudy: Medical Assistance in Dying in Canada After Carter v. Canada
By Marlisa Tiedemann, Library of Parliament
Revised by Dana Phillips, Library of Parliament
Categories: Executive summary, Health and safety, Law, justice and rights