Canada expands assisted dying access with safeguards

Summary#

This bill changes Canada’s Criminal Code rules for medical assistance in dying (MAID). It removes the rule that a person’s death must be reasonably foreseeable, adds new safeguards, and allows advance consent in limited cases. It also excludes cases where mental illness is the only medical condition and expands national reporting.

• Removes the “reasonably foreseeable” death requirement for eligibility (Bill Clause 1; repeals s.241.2(2)(d)).
• States that a mental illness alone does not make someone eligible (s.241.2(2.1)).
• Creates two safeguard tracks: one for deaths that are foreseeable and one for those that are not (s.241.2(3), (3.1)).
• Allows a waiver of final consent for those with foreseeable death who lose capacity after being found eligible and making a written plan (s.241.2(3.2)–(3.4)).
• Lets a practitioner complete MAID if a person self-administers and then loses capacity without dying, if a written plan exists (s.241.2(3.5)).
• Reduces witnesses from two to one and allows certain paid caregivers to act as the witness, with limits (s.241.2(3)(c), (5.1)).

What it means for you#

• Households and patients

  • Eligibility no longer depends on whether death is foreseeable. People with a grievous and irremediable condition may apply even if they are not near death (repeal of s.241.2(2)(d); new s.241.2(3.1)).
  • If mental illness is your only medical condition, you are not eligible under this bill (s.241.2(2.1)).
  • If your death is foreseeable, the 10‑day waiting period is removed. You still must give consent immediately before MAID, unless you signed a waiver of final consent and later lost capacity (amendment to s.241.2(3)(g); s.241.2(3)(h), (3.2)).
  • If your death is not foreseeable, there is a minimum 90‑day assessment period from the start of the first assessment to provision, unless loss of capacity is imminent and assessments are complete (s.241.2(3.1)(i)).
  • If you plan to self-administer a prescribed substance and then lose capacity, a practitioner may administer a second substance if a written plan was made in advance and conditions are met (s.241.2(3.5)).
  • If you show refusal or resistance at the time of provision, MAID cannot proceed on the basis of advance consent (s.241.2(3.2)(c), (3.4)).

• Workers and caregivers

  • One independent witness is now enough for a written request. A paid caregiver can be the witness, except the MAID providers and the practitioner who gave the required opinion in the case (s.241.2(3)(c); s.241.2(5.1)).
  • “Involuntary” words or gestures in response to touch do not count as refusal or resistance (s.241.2(3.3)).

• Health professionals (physicians and nurse practitioners)

  • Two safeguard tracks apply:
    • Foreseeable death: follow s.241.2(3). No 10‑day reflection period. Final consent needed immediately before MAID unless a valid waiver applies (s.241.2(3)(h), (3.2)).
    • Not foreseeable: follow s.241.2(3.1), including 90‑day assessment minimum, independence requirements, one assessor with expertise in the person’s condition, discussion and offers of services (counselling, mental health, disability supports, community services, palliative care), and express final consent immediately before provision (s.241.2(3.1)(e)–(k)).
  • Independence tests apply to assessors and providers (s.241.2(6)).
  • Failing to meet safeguards can trigger criminal liability (s.241.3).

• Pharmacists and pharmacy technicians

  • Reporting duties expand to include pharmacy technicians who dispense MAID-related substances (s.241.31(2)).
  • Offence provisions apply to pharmacists and pharmacy technicians for reporting failures (s.241.31(4)).

• Data reporting and monitoring

  • Anyone responsible for preliminary eligibility assessments must report data under federal regulations, not just MAID providers (s.241.31(1.1), (3)(a)(i)).
  • The federal monitoring regime is expanded to capture more stages and actors (s.241.31(1)–(4)).

• Timing

  • Most changes take effect on Royal Assent.
  • If someone signed a MAID request before Royal Assent, the old rules apply to their case, except the 10‑day waiting period is not required and the new advance‑consent provisions apply (Transitional Provision; s.241.2(3.2)–(3.5)).

Expenses#

Estimated net cost: Data unavailable.

• The bill changes criminal law and reporting duties. It does not include new federal spending authority or fees in the text (Bill Clauses 1–3).
• Added federal monitoring and reporting duties may require regulatory updates and administration. Quantitative cost estimates: Data unavailable.
• Provincial or territorial health system costs or savings are not specified in the bill. Data unavailable.

Proponents' View#

• Expands access beyond those near death while keeping protections. Two safeguard tracks tailor requirements to risk, including a 90‑day assessment and expert input when death is not foreseeable (s.241.2(3.1)(e), (i)).
• Reduces unnecessary suffering for dying people by removing the 10‑day waiting period and allowing a waiver of final consent if they lose capacity after being found eligible (amendment to s.241.2(3)(g); s.241.2(3.2)).
• Ensures people are offered supports and alternatives before proceeding, such as counselling, mental health and disability services, and palliative care (s.241.2(3.1)(g)–(h)).
• Improves accountability and transparency by expanding who must report MAID data, including preliminary assessors, pharmacists, and pharmacy technicians (s.241.31(1.1), (2), (3)(a)(i)).
• Limits risk in complex cases by excluding eligibility where mental illness is the sole condition, pending further review (s.241.2(2.1); Preamble).

Opponents' View#

• Safeguards for non‑foreseeable death may still be insufficient. The 90‑day period can be shortened if loss of capacity is imminent, which could weaken the intended caution (s.241.2(3.1)(i)).
• Reducing witnesses from two to one, and allowing some paid caregivers to be the witness, could lower safeguards against coercion or undue influence, despite exclusions for the MAID providers (s.241.2(3)(c), (5.1)).
• Allowing a waiver of final consent risks proceeding when a person cannot reconfirm their wishes. Although refusal or resistance stops MAID, interpreting gestures can be difficult in practice (s.241.2(3.2)–(3.4)).
• Excluding people whose sole condition is a mental illness may be seen as discriminatory and could create unequal access to MAID based on diagnosis rather than individual circumstances (s.241.2(2.1)).
• Expanded reporting and offence provisions add administrative and legal burdens for providers and pharmacies. Implementation quality and consistent compliance depend on forthcoming regulations (s.241.31(1)–(4)).