On March 17, 2021, the Government of Canada announced that changes to Canada’s medical assistance in dying (MAID) law are officially in force. The new law includes changes to eligibility, procedural safeguards, and the framework for the federal government’s data collection and reporting regime. Show
The information provided in the sections below reflect Canada’s revised MAID regime. On this page, you can also read reports published about MAID in Canada. Information on this web page will continue to be updated as needed. On this page
About medical assistance in dyingChanges to the Criminal CodeIn 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. In June 2016, the Parliament of Canada passed federal legislation that allows eligible Canadian adults to request medical assistance in dying. On October 5, 2020, the Minister of Justice and Attorney General of Canada introduced Bill C-7: An Act to amend the Criminal Code (medical assistance in dying) in Parliament, which proposes changes to Canada’s law on medical assistance in dying. On March 17, 2021, Parliament passed revised legislation that makes important changes to who may be eligible to obtain medical assistance in dying and the process of assessment. These changes take effect immediately. The government is working with provinces and territories and with health care professionals to ensure eligible Canadians will be able to request MAID according to the new law, and that the appropriate protections are in place.
Who can provide medical assistance in dying and who can helpThose who can provide MAID are:
Those who can help provide MAID include:
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:
Protecting the right of providers to act according to their beliefs and valuesNot all health care providers are comfortable with medical assistance in dying. Participating in MAID may not be consistent with a provider's beliefs and values. The federal legislation does not force any person to provide or help to provide medical assistance in dying. Provincial and territorial governments have the responsibility for determining how and where health care services are provided. 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 for patients seeking medical assistance in dyingWe understand that these provider rights could create challenges for patients who want to access medical assistance in dying. Patients are encouraged to contact their physician or nurse practitioner (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 MAID and other care options. (See: Supporting access to a range of care and support options) Physicians and nurse practitioners are encouraged to contact their provincial or territorial professional regulatory body for information about specific practice guidelines and about their reporting obligations. Available MAID optionsThere are 2 types of medical assistance in dying available to Canadians. They each include a physician or nurse practitioner who:
or
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:
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. EligibilityWho is eligible for medical assistance in dyingNew changes to the legislation have allowed a broader group of people to be eligible to request and receive MAID. These changes came into effect on March 17, 2021. In order to be eligible for medical assistance in dying, you must meet all of the following criteria. You must:
Grievous and irremediable medical conditionTo 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. Canadians whose only medical condition is a mental illness, and who otherwise meet all eligibility criteria, will not be eligible for MAID until March 17, 2023 (see About mental illness and MAID). Informed consentTo be eligible, you must provide informed consent to your practitioner. This means you have consented (given permission) to MAID after you have received all of the information you need to make your decision, including:
You must be able to give informed consent both:
You can withdraw your consent at any time and in any manner. About mental illness and MAIDIf a mental illness is the only medical condition leading you to consider MAID, you are not eligible to seek MAID at this time. Under the new changes made to the law, the exclusion will remain in effect until March 17, 2023. This temporary exclusion provides the Government of Canada and health professional bodies more time to consider how MAID can be provided safely to those whose only medical condition is a mental illness. To support this work, the government initiated an expert review to provide recommendations on protocols, guidance and safeguards for those with a mental illness seeking MAID. After March 17, 2023, people with a mental illness as their sole underlying medical condition will have access to MAID if they meet all of the eligibility requirements and the practitioners fulfill the safeguards that are put in place for this group of people. If you have a mental illness along with other medical conditions, you may be eligible to seek MAID. Eligibility is always assessed on an individual basis, taking into account all of the relevant circumstances. However, you must meet all the criteria to be eligible for medical assistance in dying. Obtaining medical assistance in dyingWhere and how services are providedRegardless of location, eligible Canadians can request medical assistance in dying. If you are experiencing a lot of pain and suffering due to your medical situation, talk to your physician or nurse practitioner about options in relation to your medical condition or circumstances and your possible interest in MAID. If you do not have a regular practitioner, your province or territory may have a central MAID coordination service that can help you with the process. How and where this service will be offered is determined by:
There may be additional requirements that you have to complete. Your health care provider can provide you with more information. Requesting the serviceOn March 17, 2021, changes to the legislation on MAID took effect that change existing safeguards for eligible people whose natural death is considered reasonably foreseeable. The revised law also contains new safeguards for eligible people who are requesting MAID and whose death is not considered reasonably foreseeable. All safeguards aim to make sure that those who ask for MAID:
Safeguards guide health care providers to carry out this service appropriately and in a way that protects people from abuse or misuse. Procedural Safeguards - All Requests for MAIDUndergo medical assessments.Your request for MAID must be assessed by two independent practitioners. 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. 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:
Submit a signed written request for MAID.For any person, whether your natural death is considered reasonably foreseeable, or not, you must sign a written request that says you want to have a medically assisted death. Some provinces and territories may require that you complete a specific request form. These forms may be provided by your health care provider or available on a provincial or territorial website. A written request for MAID must include:
Independent WitnessThe role of the independent witness is to confirm to the signing and dating of the request by the person requesting MAID and that they understand what they are signing. An independent witness must be at least 18 years of age and understand what it means to request MAID. An independent witness can be a paid professional personal or health care worker. To be considered independent means that the witness cannot:
Withdrawal of your requestYou must also be informed of your right to withdraw your request for MAID at any time and in any manner. You are not obligated to proceed with MAID even if you are found eligible for the service. Just before receiving MAID, you will also be given a final opportunity to withdraw your request. Final ConsentImmediately before MAID is provided to you, you must be given the opportunity to withdraw consent, and you must affirm that you consent to receive MAID. An exception to this requirement is possible in the case of people whose deaths are reasonably foreseeable (see Waiver of Final Consent). Waiver of Final ConsentOn March 17, 2021, changes to the legislation on medical assistance in dying allow you to waive the requirement for giving final consent just before MAID is provided, only if:
AND
Any arrangement for the waiver of final consent will be considered invalid if, at the time that MAID is to be provided, you no longer have capacity and you demonstrate refusal or resistance to the administration of MAID by words, sounds or gestures. For further clarity, reflexes and other types of involuntary movements, such as response to touch or the insertion of a needle, would not constitute refusal or resistance. Waiver of final consent if you choose MAID by self-administrationIf you are eligible for MAID and you choose to self-administer prescribed medications for MAID, you may make an arrangement in writing with your practitioner so that they can administer MAID to you in a specific situation. This specific arrangement allows for practitioner-administered MAID in the event of complications with self-administration that cause your loss of decision-making capacity but not your death. This means that your practitioner must be present at the time that you self-administer the medications. Procedural Safeguards – Requests where your natural death is not reasonably foreseeable:If the practitioners assessing your request for MAID determine that your death is not reasonably foreseeable, there are added safeguards that must be met to be eligible to receive MAID:
Implementing the framework - for healthcare providersHealth Canada is providing additional information for healthcare providers that:
This information is updated periodically.
Roles of the provinces and territoriesThe federal legislation on medical assistance in dying is part of the Criminal Code. It states that a person is not guilty of a criminal offence if they provide or assist in providing MAID according to the conditions and safeguards in the law. All health care providers must follow the criminal law. Provinces and territories may create additional health-related laws or rules; however, they cannot permit actions that are prohibited under the Criminal Code. If these rules are within provincial power, they may address health and other aspects of MAID, such as:
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, Québec's law permits only physicians to administer MAID. Québec also does not allow MAID through self-administration. Monitoring and reporting on medical assistance in dyingMonitoring and reporting are critical components in building transparency and public trust in the law. 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. According to the law, the Minister of Health must:
Public reports can give a clear picture of how the legislation is working and help us to understand the impact of the legislation. Regulations for the monitoring of medical assistance in dyingOn August 8, 2018, the Government of Canada published regulations to create a federal, pan-Canadian monitoring system on medical assistance in dying. The Regulations for the Monitoring of Medical Assistance in Dying came into force November 1, 2018. Learn more about the:
On March 17, 2021, the Government announced changes to the law which came into effect immediately. This includes changes to the framework for collection of data on MAID in Canada. Health Canada is in the process of amending the current Regulations to align with these recent legislative changes. The amended Regulations will improve data collection and reporting through the federal MAID monitoring regime and enhance the federal government's ability to provide Canadians with a more comprehensive and inclusive picture about persons that request and receive MAID. The revised Regulations are expected to come into effect on January 1, 2023. Until that time, health care providers should consult with their professional regulatory bodies to learn about any changes to their reporting obligations for MAID. Annual reports on medical assistance in dying in CanadaRegulations require that the Minister of Health publish a report at least once a year using the information collected under the federal MAID monitoring system. The reports provide information on:
When the amended Regulations come into force, the expanded data collection requirements will begin for the 2023 calendar year. Data collected as a result of these new requirements will be reflected in the federal annual report on MAID in Canada for 2023, to be released in the summer of 2024. Annual reports
Interim reports on MAID in Canada:Federal, provincial and territorial governments recognized the importance of the timely release of accurate information and collaborated to produce a series of interim reports about medical assistance in dying until the regulations were established in 2018. The first interim report was released on April 26, 2017 and covered the first 6 months that MAID was available in Canada (June 17, 2016 to December 31, 2016). Three additional interim reports were produced, with the fourth being the final report under this interim reporting protocol.
Independent reviewsParliamentary Review of Canada’s MAID lawAs mandated in the revised MAID legislation, passed in March 2021, a Special Joint Committee on Medical Assistance in Dying has been appointed to undertake a review the provisions of the Criminal Code relating to MAID and their application, including but not limited to issues relating to mature minors, advance requests, mental illness, the state of palliative care in Canada and the protection of Canadians with disabilities. The Committee is expected to conclude its review within a year and present its report to Parliament. Expert Panel on MAID and Mental IllnessAs required by the recently amended framework for MAID in Canada, the Government of Canada established an Expert Panel on MAID and Mental Illness tasked with making recommendations on protocols, guidance and safeguards to apply to requests for MAID by persons who have a mental illness. This work will help ensure that practitioners are equipped to assess these requests in a safe and compassionate way based on rigorous clinical standards and legally mandated safeguards that are applied consistently across Canada. On May 13, 2022, the Ministers of Health, and Justice, with the support of the Minister of Mental Health and Addictions and Associate Minister of Health, tabled the final report of the Expert Panel on MAID and Mental Illness in Parliament. The findings will assist the Government in developing its approach for safely providing access to MAID for persons with a mental illness. Health professional regulatory bodies and associations who are already considering new guidance and resources for their members in anticipation of MAID eligibility for persons with a mental illness by March 17, 2023 will also benefit from the Expert Panel's advice and recommendations.
Council of Canadian AcademiesOn December 13, 2016, the Government engaged the Council of Canadian Academies (CCA) to conduct independent reviews related to specific types of requests for medical assistance in dying - requests by mature minors, advance requests, and requests where a mental disorder is the sole underlying medical condition. These issues were the subject of debate when Bill C-14, the Government's legislation on medical assistance in dying, was being considered by Parliament. The Act required the Ministers of Health and Justice to initiate independent reviews on the three issues and table reports in Parliament within 2 years of initiation. The final reports on these reviews have been tabled in Parliament and are available to the public on the CCA website. The purpose of the reviews was to gather and analyze relevant information and evidence on the diverse perspectives and issues surrounding requests for medical assistance in dying in the three areas, in order to facilitate an informed, evidence-based, dialogue among Canadians and decision-makers. The CCA reviews were led by a multidisciplinary panel of 43 experts who reviewed an extensive body of evidence including Canadian and international academic and policy research, written submissions from organizations affected by, or involved in, assisted dying, and conversations with Indigenous Elders. The reviews do not include recommendations, as is the practice with every CCA report, but synthesize the body of evidence. Supporting access to a range of care and support optionsWe strongly support better access and availability of care options for all Canadians. To better meet the palliative and end-of-life care needs of Canadians, we are committed to:
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To better meet the needs of disability communities in Canada, we are committed to:
Learn more about benefits and supports for persons with disabilities in Canada:
To better meet the mental health needs of Canadians, we are committed to:
We also are making additional efforts and investments aimed to:
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