Medical assistance in dying

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Medical Assistance in Dying (often shortened to MAiD) is a complex and very personal issue. The information presented here is intended to assist and support people living with dementia – together with their families and caregivers – make informed decisions about their care.

Senior man thinking and looking out the window.

If you have specific questions about your care and/or medical assistance in dying, please contact your healthcare provider.

What is medical assistance in dying (MAiD)?

Medical assistance in dying (often shortened to MAiD) is a medical procedure that involves the administration of medications to intentionally and safely end the life of a person who meets strict legal criteria, at the person’s request. 

MAiD became legal in Canada in 2016, when Parliament passed Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying). The legislation allows for two types of MAiD in Canada, both intended to relieve suffering and ensure quality of living and dying:

  • The direct administration of medications or substances by a healthcare provider to end the life of a person at their request.
  • The self-administration of medications or substances by a person to end their life, prescribed by a healthcare provider and at the person’s request. 

What are the requirements for a person to receive MAiD?

As of March 17, 2021, for a person to receive MAiD, they must:

  • be 18 years of age or older and be able to make informed decisions
  • be eligible for publicly funded health care services
  • make a voluntary request that is not the result of external pressure
  • give informed consent to receive MAID, meaning that the person has consented to receiving MAID after they have received all information needed to make this decision
  • have a serious and incurable illness, disease or disability (excluding a mental illness until March 17, 2023)
  • be in an advanced state of irreversible decline in capability
  • have enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable

What recently changed with MAiD?

On March 17, 2021, Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), received Royal Assent and became law. The amended legislation:

  • No longer limits eligibility for MAiD to persons whose natural death is reasonably foreseeable and provides additional safeguards for those persons whose natural death is not reasonably foreseeable. 
  • Eliminates the requirement that a person must be able to give final consent before the MAiD procedure is performed.
  • Allows people suffering solely from mental illness to gain access to MAiD – but within two years time.  
  • Requires a comprehensive review of the provisions of the Criminal Code relating to MAiD and its application – including advance requests, mature minors, the state of palliative care In Canada and protections for people with disabilities. This review will be conducted by a joint committee of both Houses of Parliament and must start within 30 days.
  • Requires the Committee to submit a report of its review – including a statement of any recommended changes to Parliament within one year.

Can a person in an early stage of dementia request access to MAiD for when they reach a later stage of the disease?

Yes, but only if certain requirements are met. If a person living with dementia is requesting MAiD, and they are at risk of losing capacity prior to the date that MAiD would be administered, they can now submit a waiver of final consent provided that:

  • The person’s natural death is reasonably foreseeable,
  • The person has been deemed eligible for MAiD after being assessed by a qualified healthcare provider, and
  • The person has set a date for when MAiD would be administered. 

What does a waiver of final consent do?

With a waiver of final consent in place, a person would no longer have to give express consent when the date arrives for MAiD to be administered. This means that a person living with dementia and requesting MAiD would not feel that they must set a date for MAiD earlier that they would want, due to fear of losing capacity before their preferred date.

Once a date to receive MAiD is set, the person requesting MAiD can still change it if they are deemed capable of providing consent. MAID can be provided before the set date but not after.

Can MAiD be refused by the person living with dementia after the date is set?

Yes. The agreement to waive final consent will be invalid if the person, after having lost decision-making capacity, demonstrates refusal or resistance to the administration of MAID by words, sounds or gestures. 

What about advance requests?

Advance requests are currently not permitted under Canadian law for people living with dementia. In an advance request, a person would stipulate the conditions under which they would want to receive MAiD at a future time along the disease progression. The waiver of final consent is different from an advance request, as a person must be assessed and approved for MAiD and set a date. 

How can I find out if I am eligible for MAiD?

If you’re a person living with dementia and would like to know if you are eligible for MAiD, we recommend speaking with your healthcare provider. Usually, this would be your family doctor.

If you do not have a family doctor, you may speak to the physician or nurse practitioner who is most responsible for your care. You may also ask other members of your care team to connect you with a care provider who can speak with you about your request.

You can also check with the resources available in your province or territory for more information on eligibility and referrals for MAiD:

Canada-wide
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon

How many medically assisted deaths occur in Canada?

  • In 2020, there were 7,595 cases of MAiD reported in Canada, accounting for 2.5% of all deaths in Canada.
  • Cancer (69.1%) was the most common underlying medical condition of persons who received MAID, followed by cardiovascular (13.8%), chronic respiratory (11.3%) and neurological (10.2%) conditions.

These statistics are taken from Health Canada’s Second Annual Report on MAID in Canada (2020). The report contains information collected from MAiD practitioners and pharmacists.

Health Canada: Second Annual Report on Medical Assistance in Dying in Canada, 2020 (PDF)

June 2021

This second annual report provides insight in how medical assistance in dying (MAiD) was delivered in Canada in 2020, including data on requests and the administration of MAiD across the country. Source: Health Canada.

Health Canada: Second Annual Report on Medical Assistance in Dying in Canada, 2020 - cover

Do MAiD recipients have access to supportive services such as palliative care?

Health Canada’s Second Annual Report on MAID in Canada (2020) reports that the majority of people who received MAiD in 2020 (82.8%) received palliative care services.

Is the Alzheimer Society supporting advance requests for MAiD?

The Alzheimer Society recognizes that people living with dementia are individuals – first and foremost. They have the same rights as everyone else, including the right to participate in decisions about their life and care. We respect the rights of all people with dementia to advocate for their individual best interests, including advocating for access to MAiD through advance requests. 

Read our full statement on medical assistance in dying (PDF).

What is the Alzheimer Society doing to support the end-of-life wishes of people living with dementia?

The Society’s role is to educate, inform and support people living with dementia and to honour their rights and their choices. Here’s how we support the end-of-life wishes of people living with dementia through advocacy, education and research:

Advocacy

As a member of the Quality End-of-Life Care Coalition of Canada (QELCCC), we work with other organizations to increase public awareness and improve access to quality end-of-life care for all Canadians. The Alzheimer Society will continue to ensure that people with dementia are represented when changes to government policy are being considered.

Learn more about our advocacy efforts.

Education

The Alzheimer Society provides people living with dementia and their families with the support and information needed to make informed decisions about their care, including at the end of life. We encourage people with dementia and their families to put an advance care plan in place as soon as possible after diagnosis.

Learn more about end-of-life care.

Research

The Alzheimer Society Research Program (ASRP) funds innovative research that brings us closer to a future without dementia, and that improves the quality of life and care for people with dementia. The ASRP has funded researchers who study end-of-life care options for people with dementia, including research that explores Canadians’ attitudes toward MAiD for people with dementia. 

Learn more about the ASRP and the research we fund.

How can I make my opinion on MAiD heard?

MAiD and advance requests for people living with dementia are complex issues with no easy answers. It’s important for the Alzheimer Society of Canada to be aware of what Canadians think about MAiD. Whether you are in favour or against, we are here to listen to you.

Please contact us at [email protected] or reach out to your local Society.

You can also make your voice heard by contacting your Member of Parliament: https://www.ourcommons.ca/Members/en.

More useful links and resources

Medical assistance in dying. Alzheimer Society of Canada, October 2019. Our full position statement on this topic.

Second annual report on medical assistance in dying in Canada, 2020Health Canada, June 2021. This second annual report provides insight in how medical assistance in dying (MAiD) was delivered in Canada in 2020, including data on requests and the administration of MAiD across the country.

First annual report on medical assistance in dying in Canada, 2019Health Canada, July 2020. This report lists the numbers behind medical assistance in dying (MAiD) in Canada, broken down by province and territory, for the 2019 calendar year. This provides the most comprehensive portrait of MAID in Canada to date.

Medical Assistance in Dying (MAiD) in Dementia. Canadian Association of MAiD Assessors and Providers, 2019. This paper provides a comprehensive overview of eligibility requirements for medical assistance in dying (MAiD) in Canada, helping healthcare providers assess whether a patient living with dementia can access MAiD should they request it.

Medical Assistance in Dying: Information for patients and loved ones. The Ottawa Hospital, 2019. This short, three-page summary provides concise answers to frequently asked questions about medical assistance in dying (MAiD) in Canada. Please note that this information does not reflect the latest changes to MAiD discussed in Parliament, and does not discuss dementia.

Medical assistance in dying. Government of Canada. On this governmental page, find information about medical assistance in dying (MAiD), including eligibility, how the request process works and the latest news on possibly changing legislation.

The state of knowledge on advance requests for medical assistance in dying. Council of Canadian Academies, December 2018. This report examines the complexity of advance requests for medical assistance in dying (MAID), considering scenarios that may prompt an advance request for MAiD, evidence from related practices in Canada and abroad and other topics related to the issue.

Canadian Hospice Palliative Care Association (CHPCA). Described as the “national voice” for hospice palliative care in Canada, this non-profit organization supports, promotes and advocates for increased research, education and training in hospice palliative care, including improved public awareness and more programs and services.

Vulnerable Persons Standard. The Vulnerable Persons Standard was developed by a group of advisors with expertise in medicine, ethics, law, public policy and needs of vulnerable persons. It is supported by an alliance of Canadian disability and health organizations. 

Dying with Dignity Canada. Through advocacy, public education and personal support, it is Dying With Dignity Canada's mission to ensure Canadians have access to quality end-of-life choice and care. Their website includes resources on advance care planning, palliative care and medical assistance in dying (MAiD).

Inclusion Canada. Consisting of a federation of associations across Canada that support people living with intellectual disabilities and their families, Inclusion Canada helps people living with intellectual disabilities realize and assert the rights they have in accordance with the UN Convention on the Rights of People with Disabilities.

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