In 2014, Quebec enacted its Act respecting end-of-life care, which includes rules relating to “medical aid in dying.” In 2015, the Supreme Court of Canada declared in Carter v. Canada (Attorney General)^[1] that the sections of the Criminal Code (Code) that prohibited assisted death infringed the Canadian Charter of Rights and Freedoms. In June 2016, Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying) received Royal Assent. The amendments to the Code allow a person aged 18 or older who has a grievous and irremediable medical condition and whose natural death is reasonably foreseeable to access medical assistance in dying (MAID), provided that they meet certain additional requirements.

In 2021, the MAID law was revised by Bill C-7, An Act to amend the Criminal Code (medical assistance in dying). Following this change, people who do not have a reasonably foreseeable natural death can apply for MAID. However, the law specifies that you cannot apply for MAID if your sole medical condition is a mental disorder until March 2023. These changes were in response to the decision of the Superior Court of Quebec in Truchon c. Procureur général du Canada (Truchon).^[2] Truchon held that the reasonably foreseeable death requirement under the Code and the end-of-life requirement under Quebec’s legislation were contrary to the Charter. With the new amendments, there are two “tracks” for MAID applications: “track one” for people whose natural death is reasonably foreseeable, and “track two” for people whose natural death is not reasonably foreseeable. There is no waiting period for people who apply under track one. People who apply under track two have a 90-day waiting period, which can be waived if someone is going to imminently lose capacity to consent to MAID.

Bill C-7 required that an expert panel look at issues relating to MAID where a mental disorder is the sole underlying medical condition (MAID MD-SUMC). The Expert Panel on MAID and Mental Illness was established in August 2021, and released its Final Report of the Expert Panel on MAiD and Mental Illness in May 2022.

Bill C-7 required that a parliamentary committee review the law. Bill C-14 had also required a parliamentary committee review but that review had not taken place before Bill C‑7 was introduced. According to Bill C-7, the review had to include the following five issues:

• the state of palliative care in Canada;
• protections for Canadians with disabilities;
• MAID MD‑SUMC;
• MAID for mature minors; and
• advance requests for MAID.

A special committee of the House of Commons and the Senate was established for this purpose (Special Joint Committee on Medical Assistance in Dying), and it started its study of the MAID law in May 2021. However, the study was interrupted by the federal election. The committee started meeting again in April 2022. It released an interim report on MAID MD‑SUMC in June 2022, and then continued to hear from witnesses in the fall of 2022.

In total, the committee held 36 meetings and heard from close to 150 witnesses. It also received more than 350 briefs and other correspondence, demonstrating the level of engagement on this issue.

One theme that cuts across many of the topics the committee examined is the importance of MAID training materials for healthcare professionals. These training materials, which are being developed by the Canadian Association of MAID Assessors and Providers, will help standardize approaches to MAID assessments across Canada. The committee also heard that there needs to be better engagement with Indigenous Peoples and communities on MAID, including MAID for mature minors and MAID MD-SUMC, as well as with persons with disabilities.

On the topic of palliative care, the committee heard that not everyone has access to palliative care, and that access can depend on where you live. Witnesses talked about the need for palliative care to be provided earlier and not only at end-of-life.

For persons with disabilities, the committee heard that more financial supports are needed so that persons with disabilities do not live in poverty. Better access to social supports, disability supports and healthcare are also important. Without these, the committee heard that persons with disabilities might see MAID as a way to relieve suffering due to poverty and lack of services. Unless their natural death is reasonably foreseeable, a person who is applying for MAID on the basis that their disability is a grievous and irremediable medical condition would apply under track two. Much discussion focused on how to balance protecting people who might be vulnerable with allowing MAID for individuals who want to have access to that choice. A bill that will establish a federal disability benefit was introduced in June 2022,^[3] and in October 2022, the federal government released Canada’s Disability Inclusion Action Plan, 2022. In addition to recommending continued support for persons with disabilities, the committee recommends examining the language in the Criminal Code MAID provisions to make sure that they do not contribute to stigma.

Access for MAID MD-SUMC was to be permitted as of March 2023. Applying for MAID MD-SUMC would also be under track two. As mentioned above, the committee released an interim report on mental disorder in June 2022 that discusses issues related to MAID MD‑SUMC. The committee heard concerns that more time was needed to make sure that standards are in place before someone is able to apply for MAID MD-SUMC. On 15 December 2022, an announcement was made that the federal government would “work with our parliamentary colleagues in the House of Commons and the Senate to negotiate an extension of the March 17, 2023 eligibility date” for MAID MD-SUMC. The committee supports this extension. Bill C-39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying) was introduced in the House of Commons on 2 February 2023 and proposes a one year delay to the date for eligibility for MAID MD‑SUMC.

For MAID and mature minors, the committee heard a mix of views about whether MAID should be available to those under the age of 18. Many witnesses believed that age alone does not determine whether someone is capable of consenting to MAID. At the same time, a cautious approach was recommended, especially since there is little evidence from youth themselves on this topic. Most witnesses agreed that if MAID for mature minors were allowed, it should only be under track one (reasonably foreseeable natural death). The committee recommends that mature minors should have access to MAID under track one. The committee also recommends that youth be consulted on the topic of MAID and mature minors.

Finally, the committee heard that there is significant support among Canadians to be able to make an advance request for MAID. A key requirement for MAID is that a person have the capacity to consent to its provision. When someone has a diagnosis that involves the future loss of capacity, such as dementia, an advance request would allow the person to indicate under what conditions they would like MAID to be provided in future. The advance request would have to be made while the person still has capacity. The committee heard details about what the advance request should contain, and that the request should be periodically reviewed. While most of the details relating to advance requests fall to the provinces and territories since they are primarily responsible for healthcare, the Criminal Code would still need to be amended to allow advance requests, and the committee supports amending the Criminal Code in that manner.