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 or an advance request (Quebec only).

See information below on advance requests for MAID.

An experienced MAID provider (nurse practitioner or doctor) will be able to determine if you meet the above criteria. When you make your request for medical assistance in dying, two independent medical practitioners (physicians or nurse practitioners) must assess it. 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.

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

December 12, 2024

Health Canada launched a national consultation on advance requests for medical assistance in dying (MAID). The consultation deadline is February 14, 2025. The conversation will conclude on January 2025, and a report on the findings of the conversation will be published in the spring of 2025.

October 30, 2024

Quebéc will allow advance requests for MAID as of October 30, 2024. See information below on advance requests.

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.

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

• Alberta Health Services
• Medical Assistance in Dying: Getting More Information (PDF)

British Columbia

• Government of British Columbia
• Fraser Health
• Interior of Heath
• Island Health (Vancouver Island Health Authority)
• Northern Health
• Vancouver Coastal Health

Manitoba

• Shared health Manitoba

New Brunswick

• Government of New Brunswick
• Horizon Health Network
• Vitalité Health Network

Newfoundland and Labrador

• Government of Newfoundland and Labrador (PDF)

Northwest Territories

• Government of Northwest Territories

Nova Scotia

• Nova Scotia Health Authority

Nunavut

• Nunavut Department of Health

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 differ from a waiver of final consent?

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.

On February 15, 2023, a parliamentary committee did recommend advance requests for implementation in certain circumstances. 

Advance requests are currently not permitted under Canadian law for anyone seeking MAID, except in the province of Quebec. In Quebec, a person who has been diagnosed with a serious and incurable illness, including Alzheimer's disease and other dementias, may make an advance request for MAID. Read more about advance requests in Quebec.

Read the Alzheimer Society of Canada's statement on Quebec’s implementation of advance requests for medical assistance in dying (MAID).

On December 12, 2024, Health Canada launched a national consultation on advance requests for medical assistance in dying (MAID). The Alzheimer Society of Canada encourages adults living in Canada—especially those living with dementia, their caregivers, and health-care professionals—to participate. Your feedback will help shape future policies on autonomy, equitable access to care, and safeguards for vulnerable populations. The conversation will conclude on January 2025, and a report on the findings of the conversation will be published in the spring of 2025.

Key details: 

• Who can participate: Adults living in Canada are encouraged to participate. 
• Deadline: The consultation deadline is February 14, 2025. 
• How to participate: To learn more and complete the survey, visit Health Canada’s consultation page. 
• For questions or comments: Contact Health Canada directly at eolc-sfv@hc-sc.gc.ca.
   

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, except in the province of Quebec. Read more about advance requests in Quebec.

Elsewhere in Canada, 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.

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.

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 statements about advance requests on our national statements page. Or download our statements below:

Alzheimer Society of Canada’s statement on Quebec’s implementation of advance requests for medical assistance in dying - November 12, 2024

Alzheimer Society of Canada’s statement on the latest federal MAID report (advance requests) - February 17, 2023

Access to palliative care and end-of-life services

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

Health Canada’s Fifth Annual Report on MAID in Canada (2023) reports that the majority of people who received MAiD in 2023 (75%) 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 2023, there were 15,343 cases of MAID reported in Canada.
• The number of cases of MAID in 2023 represents a growth rate of 15.8% over 2022. It is not yet possible to make reliable conclusions about whether or not these findings represent a stabilization of growth rates over the longer term.
• 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 60,301.

These statistics are taken from Health Canada’s Fifth annual report on Medical Assistance in Dying in Canada (2023). The report contains information collected from MAID practitioners and pharmacists.

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, 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.

• Share your views on advance requests for MAID.
• You can also make your voice heard by contacting your Member of Parliament.
• Please contact us at info@alzheimer.ca or reach out to your local Alzheimer Society.

More links and resources

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.

Advance request for medical aid in dying. Government of Quebec.

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.

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.

Canadian Virtual Hospice. This site provides various information about end-of-life care, palliative care and hospice care.

Medical Assistance in Dying (Canadian Virtual Hospice). Provides answers to common questions, plus information about how MAiD works, and about its emotional impacts.

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. 

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.

Health care system and services: Reports and publications - Medical assistance in dying. Government of Canada, Annual reports on MAID.

Medical Assistance in Dying (MAID) in Dementia. Canadian Association of MAID Assessors and Providers. 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.

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.

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. Medical assistance in dying: Overview.

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

Last updated: November 2024