Quebec has a regime, Alberta bars requests, and critics warn of a patchwork
Ottawa has tabled a bill that would allow advance requests for medical assistance in dying (MAID) and end a planned expansion for mental illness.
Justice minister Sean Fraser introduced Bill C-41, the MAID Safeguards Act, on Tuesday. Health minister Marjorie Michel joined him. Provinces and territories, which deliver health care, would decide whether to offer advance requests.
What the bill would do
- Advance requests: Adults diagnosed with an incurable illness that is expected to remove their capacity to consent could state in advance when they would want MAID. Justice Canada’s example is Alzheimer’s disease.
- Safeguards: All eligibility rules would still apply. The person must be suffering intolerably when MAID is provided, even if the request’s conditions are met. Two independent practitioners must confirm the criteria, The Canadian Press reported.
- Mental illness: People whose sole condition is mental illness would stay ineligible. Under current law, that exclusion expires March 17, 2027. The bill must pass both chambers before then.
The government said a joint parliamentary committee recommended against the expansion in a June 17 report. Fraser said the change would ensure “their wishes could be respected” for people who lose capacity to decide.
Michel said: “Our approach must respect personal autonomy and individual choice while maintaining robust safeguards for those who may be vulnerable.”
A patchwork across provinces
Quebec is the only province with an advance request regime, CP reported. It said Alberta has passed legislation barring them.
Dying With Dignity Canada, which supports advance requests, called the bill “flawed.” It said the approach gives each province and territory “a veto on advance requests.” The group also said the bill requires provinces to pass laws creating a repository for requests. Justice Canada’s release does not mention that requirement.
The group opposes the mental illness exclusion, calling it unconstitutional. It has been in a court challenge since August 2024.
Fraser said he was concerned about a patchwork. He said he would be “more concerned about extending access without the safeguards in place.” He also warned that missing the March deadline carries consequences that are “extraordinarily serious.”
Other groups oppose advance requests. Inclusion Canada said they leave “consequential judgments about their suffering and expressions of refusal to others.” Cardus, a Christian think-tank, also voiced concern.
Context for advisers
Health Canada’s latest report counted 16,499 MAID provisions in 2024, or 5.1% of deaths. Growth slowed to 6.9%. Ottawa says 67% to 69% of Canadians support advance requests.
Ottawa also announced $1.2 billion for 2027-28 to support mental health, substance use, and home and community care.
For benefits and pension advisers, uneven provincial rules could matter for clients with workers in several provinces. They could also matter for dementia and end-of-life planning.
