Medical assistance in dying

Medical assistance in dying (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).

In 2021, MAID legislation (former Bill C-7) was also revised and became law.

The current legislation allows for two types of MAID in Canada. Both are intended to relieve suffering and ensure quality of living and dying. These two types of MAID are:

The direct administration of medications or substances by a health-care 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 health-care provider and at the person’s request.

Eligibility

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

be 18 years of age or older
be eligible for publicly funded health care services (or during the applicable minimum period of residence or waiting period for eligibility). Generally, visitors to Canada are not eligible for MAID.
make a voluntary request that is not the result of external pressure
have a serious and incurable illness, disease or disability (excluding a mental illness until March 17, 2027)
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
have decision-making capacity:
- be able to 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)
- be able to give informed consent both at the time of their request for MAID and immediately before receiving MAID, unless they are at risk of losing capacity and have applied for a waiver of the requirement to provide final consent.

An experienced MAID provider (nurse practitioner or doctor) will be able to determine if you meet the above criteria. If you have questions about your own MAID eligibility, you should contact your health-care provider. 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.

Also, see information below on advance requests for MAID.

Is dementia classified under mental illness in terms of MAID access?

No. The “mental illness” classification under MAID law “includes conditions that are primarily within the domain of psychiatry, such as depression and personality disorders,” says the Government of Canada’s website. “It does not include neurocognitive and neurodevelopmental disorders, or other conditions that may affect cognitive abilities.”

In other words, in this context (and numerous other contexts) dementia is classed as a neurological or neurocognitive disorder.

Recent changes and updates

February 1, 2024

The federal government has extended the temporary exclusion of eligibility for MAID where a person’s sole medical condition is a mental illness until March 17, 2027.

February 15, 2023

Parliament’s Special Joint Committee on Medical Assistance in Dying (MAID) released its second report on MAID, providing additional insight and recommendations on requests in complex circumstances, including for advance requests.

After hearing from Canadians, the committee has recommended to the Government of Canada that advance requests be permitted following a diagnosis of a serious and incurable medical condition, disease or disorder leading to incapacity.
The committee also made a variety of other recommendations related to MAID. You can read the full report on Parliament’s website.

You can read the Alzheimer Society of Canada's statement about the February 2023 MAID report on our national statements page. Or download our statement PDF now.

February 2, 2023

The federal government introduced legislation to extend the temporary exclusion of eligibility for MAID where a person’s sole medical condition is a mental illness until March 17, 2024.

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 limited eligibility for MAID to persons whose natural death was reasonably foreseeable and it provided additional safeguards for those persons whose natural death was not reasonably foreseeable
eliminated the requirement that a person must be able to give final consent before the MAID procedure was performed
projected that people whose sole condition was mental illness would gain access to MAID within two years’ time

MAID-related processes across different provinces and territories

"Policies and procedures for medical assistance in dying may vary among provinces and territories," says the Government of Canada's MAID webpage.

So while all health-care providers must follow federal law (including federal laws related to MAID), the Government of Canada also explains that "provinces and territories may create additional health-related laws or rules... If these rules are within provincial power, they may address health and other aspects of MAID, such as: the use of specific forms to fill out; special medical training for providers of the service; how information and data on the service are provided; rules or requirements for either type of MAID."

If you have questions about law and policies in your specific location after speaking with your health-care provider, contact your province or territory.

Canada-wide

Government of Canada

Alberta

British Columbia

Manitoba

Shared health Manitoba

New Brunswick

Newfoundland and Labrador

Government of Newfoundland and Labrador (PDF)

Northwest Territories

Government of Northwest Territories

Nova Scotia

Nova Scotia Health Authority

Nunavut

Email the Nunavut Department of Health at Maid.Info@gov.nu.ca

Ontario

Government of Ontario

Prince Edward Island

Government of Prince Edward Island

Quebec

Government of Quebec

Saskatchewan

Government of Saskatchewan

Yukon

Government of Yukon

Waiver of the requirement to provide final consent

What are the requirements a person – including a person living with dementia – must meet to use a waiver of final consent?

MAID law allows people to waive the requirement for giving final consent just before MAID is provided, if all of the following conditions are met:

your natural death is reasonably foreseeable and while you had decision-making capacity:
- you were assessed and approved to receive medical assistance in dying
- you scheduled a date for the MAID procedure
- your practitioner advised that you are at risk of losing capacity to provide final consent
- you made a written arrangement with your practitioner to provide consent in advance of your chosen MAID date, if you no longer have capacity to consent on that date

What happens after a waiver of final consent is submitted and/or is in place?

When the waiver of final consent is approved, the health-care practitioner can administer MAID (with your prior consent) on or before your preferred date if you have lost the capacity to provide final consent at that time.

However, the agreement to waive final consent will be invalid if you, after having lost decision-making capacity, demonstrate refusal or resistance to the administration of MAID by words, sounds or gestures. Reflexes and other types of involuntary movements, such as a response to a touch or to the insertion of a needle, do not constitute refusal or resistance.

Can the proposed MAID date be changed once it is set on a waiver of final consent?

A person may create and file a new waiver of final consent and change the proposed MAID date if:

the person has decision-making capacity
the person can provide consent and
the practitioner agrees to complete another waiver of final consent form

Are there any other ways the actual date of receiving MAID might change following creation of a waiver of final consent?

Yes. As noted above, the person and the practitioner may also agree that if the person loses capacity to provide consent, the practitioner may provide MAID sooner than the scheduled date. This agreement must be made in writing as part of the waiver of final consent terms.

Can MAID be refused by the person living with dementia after the date is set by a waiver of final consent?

MAID can be refused at any time (regardless of decision-making capacity) by demonstrating refusal or resistance to the administration of MAID using words, sounds or gestures. Reflexes and other types of involuntary movements, such as a response to a touch or to the insertion of a needle, do not constitute refusal or resistance.

Advance requests

What is an advance request for MAID, and how would it different from a waiver of final consent?

Advance requests are currently not permitted under Canadian law for anyone seeking MAID. But on February 15, 2023, a parliamentary committee did recommend them for implementation in certain circumstances.

In an advance request:

a person would set conditions for when MAID should be given at a future time in the progression of their condition, but not an exact date and
the person does not have to meet MAID criteria at the time of creating the advance request.

The waiver of final consent is different from an advance request. For a waiver:

a person must be assessed and approved for MAID and set a date
a person must meet MAID criteria at the time of creating the waiver and
their natural death must be reasonably foreseeable.

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

Advance requests are currently not permitted under Canadian law for anyone seeking MAID. However, a person can request MAID when the following criteria are met:

be 18 years of age or older
be eligible for publicly funded health care services (or during the applicable minimum period of residence or waiting period for eligibility). Generally, visitors to Canada are not eligible for MAID.
make a voluntary request that is not the result of external pressure
have a serious and incurable illness, disease or disability (excluding a mental illness until March 17, 2027)
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
have decision-making capacity:
- be able to 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)
- be able to give informed consent both at the time of their request for MAID and immediately before receiving MAID, unless they are at risk of losing capacity and have applied for a waiver of the requirement to provide final consent.

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.

Is the Alzheimer Society supporting advance requests for MAID?

The Alzheimer Society of Canada supports the right of people living with dementia to make an advance request for a medically assisted death.

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.

You can access the Alzheimer Society of Canada's statement about the most recent Parliament recommendations on advance requests on our national statements page. Or download our statement PDF now.

Access to palliative care and end-of-life services

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

Health Canada’s Third Annual Report on MAID in Canada (2021) reports that the majority of people who received MAiD in 2021 (80.7%) received palliative care services.

Also, MAID law requires that people seeking MAID be informed of the following:

available forms of treatment
available options to relieve suffering, including palliative care

And if MAID is being sought in a situation where natural death is not reasonably foreseeable, the Government of Canada's website says that the following conditions must also be met:

"You must be informed of available and appropriate means to relieve your suffering, including counselling services, mental health and disability support services, community services, and palliative care, and you must be offered consultations with professionals who provide those services."
"You and your practitioners must have discussed reasonable and available means to relieve your suffering, and all agree that you have seriously considered those means."

MAID Statistics

In 2021, there were 10,064 cases of MAID reported in Canada, accounting for 3.3% of all deaths in Canada.
The number of cases of MAID in 2021 represents a growth rate of 32.4% over 2020. All provinces continue to experience a steady year over year growth.
When all data sources are considered, the total number of medically assisted deaths reported in Canada since the Parliament of Canada passed federal legislation that allows eligible Canadian adults to request medical assistance in dying in 2016 is 31,664.

These statistics are taken from Health Canada’s Third annual report on Medical Assistance in Dying in Canada (2021). The report contains information collected from MAID practitioners and pharmacists.

What is the Alzheimer Society is 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, 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.

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.

Research

The Alzheimer Society Research Program 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.

Make your opinion heard on MAID

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 info@alzheimer.ca or reach out to your local Alzheimer Society.

You can also make your voice heard by contacting your Member of Parliament.

References

Dalhousie University Health Justice Institute, End-of-Life Law and Policy in Canada. Interpreting Canada’s MAiD legislation.

Dying With Dignity Canada. Dementia and medical assistance in dying (MAID) fact sheet.

Government of Canada. Canada’s medical assistance in dying (MAID) law.

Government of Canada. Medical assistance in dying: Overview.

Government of Canada. Medical assistance in dying: Implementing the framework.

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