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

Backgrounder

Additional resources

On October 27, 2026, the Government of Canada introduced the Medical Assistance in Dying Safeguards Act (MAID) to update Canada’s MAID law. The Act would amend Canada’s Criminal Code MAID framework to:

  • allow advance requests where eligibility criteria and rigorous safeguards are satisfied and provincial or territorial legislation is in place
  • not move ahead with expanding MAID on the basis of a mental illness
  • streamline and update federal data collection and reporting

For more information on how MAID is currently delivered in Canada, including eligibility and rigorous safeguards, consult the Government of Canada webpage: MAID Overview.

On this page

Proposed amendments to the Criminal Code

The proposed amendments to the Criminal Code would update Canada’s federal MAID framework. Learn more about the proposed changes below.

Advance requests for MAID

What is an advance request?

An advance request permits an adult with a capacity-limiting disease to outline the circumstances under which they would want to receive MAID in the future while they still have the capacity to consent. Currently, the provision of MAID based on an advance request is not allowed under Canada’s Criminal Code.

What would the Medical Assistance in Dying Safeguards Act change?

The Act would set minimum requirements for the lawful provision of MAID based on an advance request. Provinces and territories that wish to permit advance requests in their jurisdictions would need to enact legislation to ensure safe implementation.

Adults who have been diagnosed with a capacity-limiting disease, like Alzheimer’s, would be eligible to make such a request in provinces or territories that have chosen to permit advance requests in their jurisdictions. Provinces and territories are responsible for regulating and delivering health care. The federal government will continue working with them in implementation.

Proposed eligibility criteria and rigorous safeguards for advance requests

Provincial and territorial legislation requirements

The province or territory where an advance request for MAID will be provided must have a law in place that identifies a repository, or storage system, for advance requests. The provincial or territorial law must also outline rules for how an advance request can be:

  • made, including signed and witnessed
  • submitted for storage in the repository, and accessed
  • changed or withdrawn
  • updated in the repository in a timely manner
  • protected from falsification
Criteria for making an advance request in a province or territory

An advance request would only be valid if the following criteria are met.

The requestor

  • makes the advance request voluntarily
  • is eligible for government-funded health services in Canada
  • is at least 18 years of age
  • is able to make their own decisions about MAID
  • is diagnosed with a serious and incurable illness or disease prior to making the advance request that is expected to lead to a permanent loss of capacity to consent to MAID

In drafting the advance request, the requestor

  • prepared the advance request with help from a medical or nurse practitioner
  • consulted with a medical or nurse practitioner with expertise in the illness or disease before signing the advance request
  • was informed by a medical or nurse practitioner before making the advance request, about:
    • their diagnosis
    • how their illness or disease is expected to progress
    • their prognosis
    • available options to relieve their expected suffering, including counselling, mental health and disability supports, community services and palliative care
  • was informed that the services and care available to them may be different at the time they would be eligible to receive MAID
  • was told how they can change or cancel the advance request, based on the rules in the province or territory in which they live
  • completed the advance request in a way that meets all legal requirements in the province or territory where it was made

The advance request includes

  • the observable, medically recognized circumstances related to their illness or disease that they believe will cause them intolerable suffering and for which they would want to receive MAID
  • their informed consent to receive MAID if they lose capacity to consent and exhibit the circumstances described in their request
National eligibility criteria for MAID to be provided based on an advance request

The medical or nurse practitioner would be required to make sure that a person meets all the following eligibility requirements at the time MAID is provided.  

  • The person must be eligible for health services funded by a government in Canada
  • The person must have permanently lost the capacity to consent to MAID because of their capacity-limiting illness or disease
  • The person must consistently show the circumstances set out in their advance request
  • The person must be in an advanced, irreversible decline in their abilities
  • The person must be in a medical state that allows the practitioner to determine—based on available information and direct observations—that they are experiencing enduring and intolerable suffering that cannot be relieved by reasonable means
National safeguards at time MAID is provided based on an advance request

The medical or nurse practitioner who administers MAID based on an advance request would be required to confirm that the following safeguards are satisfied before MAID is provided: 

  • The person meets all the eligibility criteria to receive MAID based on an advance request
  • A second medical or nurse practitioner has provided written confirmation that the person meets all the eligibility criteria to receive MAID based on an advance request
  • The two practitioners are independent
  • The advance request is stored in a provincial or territorial repository

Important: If a person shows a clear refusal or resistance to MAID — through words, sounds or gestures — the advance request would be invalid, and MAID would no longer be provided. If the medical practitioner or nurse practitioner is in doubt as to whether the person’s words, sounds or gestures constitute a demonstration of refusal or resistance, MAID cannot be provided at that time. A minimum 30-day waiting period is then required before MAID could be provided on the basis of that request.

Mental illness exclusion

In Canada, people seeking medical assistance in dying (MAID) on the basis of a mental illness are not eligible for MAID. In February 2024, the federal government delayed expansion of MAID for mental illness until March 17, 2027.

Many medical experts have expressed concerns about the difficulty of safely assessing eligibility for MAID in such cases. The Medical Assistance in Dying Safeguards Act would not move ahead with the scheduled expansion of MAID on the basis of a mental illness as an evidence-based approach that responds to these concerns. This approach is supported by expert and parliamentary recommendations.

Data collection and reporting regime

The Act would also update the MAID monitoring regime to:

  • collect data on MAID provided through advance requests
  • streamline reporting
  • reduce administrative burden on practitioners
Issue Current law Proposed change
Data collection for advance requests No data on advance requests for MAID Expand data collection on advance requests to provide the public with more comprehensive, evidence-based information about the provision of MAID in Canada
Data reporting and administration

There are reporting requirements for preliminary assessors in provinces and territories who authorize their involvement in triaging MAID requests

Only medical and nurse practitioners can complete reporting on MAID.

Remove reporting requirements for preliminary assessors, as this reporting requirement is not having the intended effect of providing a more complete picture of who is requesting MAID across the country.

Allow other professionals to assist medical and nurse practitioners with reporting, while maintaining accountability to reduce administrative burden on practitioners and improve access to care.

Plain language glossary

Advance directive

Documents an individual’s wishes regarding what personal care decisions are made for them, and/or who makes them, in the event that they are incapacitated and are unable to make these decisions themselves.

Note: terminology and definitions may vary across provinces and territories

Advance request

An advance request permits a person who has been diagnosed with a capacity-limiting disease, like Alzheimer’s disease for example, who still has decision-making capacity to outline the circumstances under which they would want to receive MAID, in the future, after they lose capacity to consent.

Capacity

The legal status of being able to provide informed consent for or refusal of healthcare interventions (i.e., having decision-making capacity).

Grievous and irremediable medical condition

A grievous and irremediable medical condition has all of the following characteristics:

  • a serious and incurable illness, disease or disability
  • the person is in an advanced state of irreversible decline in capability
  • the illness, disease, or disability or state of decline causes the person enduring physical or psychological suffering that is intolerable to them and that cannot be relieved in a manner that the person considers acceptable to them

Independent medical and nurse practitioners

Independent medical or nurse practitioners cannot be connected to each other in any way that could impair their objectivity, such as by being in a business or mentoring relationship with each other. They must also be independent of the patient, in the sense that they cannot be a beneficiary under their will, or be otherwise connected to the patient in a manner that could affect their objectivity.

Informed consent

Consent provided by a person who has the capacity to make the decision and has been given an adequate explanation about the nature of the proposed intervention and its anticipated outcome(s) as well as the potential benefits and material risks involved and alternatives available.

Medical assistance in dying (MAID)

An umbrella term which includes:

  • the administration by a medical practitioner or nurse practitioner of medication that will cause a person’s death at their request (clinician-administered)
  • the prescription or provision by a medical practitioner or nurse practitioner of medication that a person can self-administer to cause their own death (self-administered)

Nurse practitioner

Nurse practitioners have the authority to deliver many of the same medical services as family physicians; they can assess, diagnose, prescribe and treat patients. They can act independently in every jurisdiction.

Preliminary assessor

Any person who has the responsibility to triage MAID requests by carrying out preliminary assessments of whether or not a person who has made a request for MAID meets the eligibility criteria. A preliminary assessor may include any regulated professional in a care team, a care coordination service, or other relevant organizations that plays an active role in the preliminary assessment process. Preliminary assessors cannot establish or confirm a person’s eligibility for the purposes of MAID provision, but can determine that a person is ineligible for MAID. Health care delivery is a provincial and territorial responsibility and, as such, provinces and territories may have different policies regarding whether an individual, other than a medical or nurse practitioner, can conduct preliminary assessments for MAID.

Rigorous safeguards

Refers to protective legislative measures enacted through the Criminal Code.

Waiver of final consent

The waiver of final consent is the document that an individual must complete with their practitioner which identifies a chosen date to receive MAID and provides consent in advance of that date, should the individual no longer have capacity to consent at that time. It becomes invalid if the person, after having lost decision-making capacity, demonstrates refusal or resistance to the administration of MAID.