What We Heard Report
A Public Consultation on Medical Assistance in Dying (MAID)

March 2020

This report is also available in a simplified, accessible version.

1.0. Introduction

MAID became legal in Canada in June 2016. Canada's Criminal Code now exempts doctors and nurse practitioners who provide, or help to provide, MAID.

"Medical assistance in dying" includes:

The law currently sets out eligibility criteria for those who wish to apply for MAID. It also sets out safeguards that doctors and nurse practitioners must follow before providing MAID, in particular to make sure that the patient requesting MAID is fully informed and has given their consent freely.

Visit the Government of Canada's medical assistance in dying webpage for more information on:

Evolution of MAID in Canada

The MAID legislation (former Bill C-14), enacted in 2016, created an end-of-life MAID regime. Its core policy was to give Canadians who were suffering intolerably during the dying process, the choice to have a medically assisted death.

Following the enactment of the MAID legislation, the Government of Canada asked the Council of Canadian Academies (CCA) to study three complex issues: requests for MAID by mature minors, advance requests, and requests where mental illness is the sole underlying medical condition. The reports and a summary are available on the CCA's website.

The 2016 MAID legislation required the creation of a monitoring regime. Regulations setting out what information practitioners are required to provide in relation to a MAID written request came into effect in November 2018. A first report of the federal monitoring regime data is expected in spring 2020. In the meantime, Health Canada has published four interim reports based on data provided voluntarily by the provinces and territories. All are available on Health Canada's website.

As legalizing MAID was a significant step for Canada, the 2016 MAID legislation also required a parliamentary review of the law five years after it was passed. This review will provide the opportunity to hear from Canadians about how MAID is working, and to see if any changes should be made. It is expected that this review will start in 2020.

Finally, since the enactment of the MAID legislation, litigation challenging the MAID regime was initiated in British Columbia, Ontario, Quebec and Saskatchewan. The British Columbia (Lamb) and Quebec (Truchon) cases challenged the MAID law on the basis that its eligibility criteria violated the Canadian Charter of Rights and Freedoms because they were too restrictive. The Ontario (Foley) and Saskatchewan (Katzenback) cases also allege that the MAID law violates the Charter, but on the basis that its safeguards are insufficient to protect Canadians who are offered MAID instead of adequate support services and other means to relieve suffering.

Context and objectives of the consultations

On September 11, 2019, the Superior Court of Qu├ębec found that it was unconstitutional to limit access to MAID to people nearing the end of life (Truchon v. Attorney General of Canada). The case was brought by two persons living with disabilities, Mr. Truchon, who has lived with cerebral palsy since birth, and Ms. Gladu, who lives with paralysis and severe scoliosis as a result of poliomyelitis.

Practitioners who assessed them were of the view that they met all eligibility criteria for MAID, with the exception of nearing the end of life. The court declared the "reasonable foreseeability of natural death" criterion in the federal Criminal Code, as well as the "end-of-life" criterion in Quebec's provincial law on medical assistance in dying, to be unconstitutional.

While this ruling only applies in the province of Quebec, the Government of Canada has accepted the ruling and has committed to changing the MAID law for the whole country. This means that the MAID law will change from a regime that aims to enable people to have a peaceful death rather than a painful or prolonged dying process, to a regime that offers the choice of MAID to relieve intolerable suffering, regardless of proximity to natural death.

In light of the Government's decision to change Canada's MAID regime and to inform the way forward, these consultations sought Canadians' views on the need for additional safeguards in a regime that will no longer be limited to dying persons, and on advance requests for MAID.