Medical assistance in dying
Medical assistance in dying (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 – in making informed decisions about their care.
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.
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 health services funded by the Canadian federal government, or a province or territory (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
- 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 illness, disease or disability (excluding mental illness until March 17, 2023)
- be in an advanced state of decline that cannot be reversed
- experience unbearable physical or mental suffering from illness, disease, disability or state of decline that cannot be relieved under conditions that the person considers acceptable
If you have questions about your own MAID eligibility, you should contact your health-care 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.
Recent changes and updates
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
Questions and answers
What, if anything, might be different about 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. It adds: "For example, Québec's law permits only physicians to administer MAID. Québec also does not allow MAID through self-administration."
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.
- British Columbia
- New Brunswick
- Newfoundland and Labrador
- Northwest Territories
- Nova Scotia
- Email the Nunavut Department of Health at [email protected]
- Prince Edward Island
Can a person in an early stage of dementia request access to MAID for when they reach a later stage of dementia?
Yes, but only if certain requirements are met.
If those requirements are met, someone living with dementia can request access to MAID through what is called a waiver of 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:
- the person’s natural death is reasonably foreseeable
- the person, when they had decision-making capacity, was deemed eligible for MAID after being assessed by a qualified health-care provider
- the person, when they had decision-making capacity, was advised by a health-care provider that they were at risk of losing capacity to provide final consent
- the person, when they had decision-making capacity, made a written agreement with a practitioner to consent to receive MAID on a chosen date if they no longer have capacity to consent on that date.
What happens after a waiver of final consent is submitted and/or is in place?
With a written waiver of final consent in place, and all the above conditions met, a person would no longer have to give express consent when the date arrives for MAID to be administered.
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 the proposed MAID date be changed once it is set on a waiver of final consent?
Yes. If the person and practitioner agree to change the scheduled date for the provision of MAID, they may do so by creating and filing a new waiver of final consent. Note that this is only a possibility if the person is capable of providing informed consent.
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?
Yes. The waiver of 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 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 stipulate the circumstances under which they would want to receive MAID at a future time in the progression of their condition.
The waiver of final consent is different from an advance request:
- For the waiver of final consent, a person must be assessed and approved for MAID and set a date; they must meet MAID criteria at the time of creating the waiver; and their natural death must be reasonably foreseeable.
- For the advance request, circumstances are stipulated, but not an exact date; and the person does not have to meet MAID criteria at the time of creating the advance request.
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.
How many medically assisted deaths occur in Canada each year?
- 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.
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."
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.
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:
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.
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.
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.
How can I make my 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 [email protected] or reach out to your local Alzheimer Society.
You can also make your voice heard by contacting your Member of Parliament.
More links and resources
Third annual report on medical assistance in dying in Canada, 2021. Health Canada, June 2021. The Third Federal Annual Report on Medical Assistance in Dying presents data for the 2021 calendar year. It builds upon the First and Second Annual Reports on Medical Assistance in Dying. With three full years of data collection now complete, three-year trends provide even greater insight into the picture of medical assistance in dying in Canada.
Second annual report on medical assistance in dying in Canada, 2020. Health Canada, June 2021. This second annual report provides insight in how medical assistance in dying 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, 2019. Health Canada, July 2020. This report lists the numbers behind medical assistance in dying 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 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 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, 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, 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 Virtual Hospice. This site provides various information about end-of-life care, palliative care and hospice care.
Canadian Hospice Palliative Care Association. 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.
Advance Care Planning Canada. This is a national collaborative project led by the Canadian Hospice Palliative Care Association. It offers online tools and resources for advance care planning.
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.
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.