Medical Assistance in Dying (MAID) is a deeply personal matter for many people. It is a complex issue that has implications for patients and families, health care providers, and health policy and programs.
MAID occurs when a physician or registered nurse (nurse practitioner) [RN(NP)]* administers or provides a prescription for self-administration of a lethal dose of drugs to intentionally cause the death of a competent adult, at the adult's request. In 2015, the Supreme Court of Canada struck down the current law that makes it a criminal offence for a physician or RN(NP) to assist a patient in dying in certain circumstances.
Status of Legislation
On June 17, 2016, federal legislation on MAID (Bill C-14) was passed and received Royal Assent. On March 17, 2021, the amended federal legislation on MAID (Bill C-7) received Royal Assent and immediately came into force. The legislation permits MAID for patients who meet all the criteria as outlined below.
Eligibility
The amended federal legislation no longer requires a person’s natural death to be reasonably foreseeable as an eligibility criterion for MAID.
Under the amended federal legislation, an individual needs to meet the following criteria to be considered eligible for MAID.
A patient must:
- be 18 years of age or older and have decision-making capacity;
- be eligible for health services funded by the federal government, or a province or territory (generally, visitors to Canada are not eligible for MAID);
- make a request for MAID which is not the result of outside pressure or influence;
- give informed consent to receive MAID. This means the person has consented to MAID after receiving all the information needed to make a decision. This includes information about:
- their medical diagnosis,
- available forms of treatment, and
- available options to relieve suffering, including palliative care; and
- have a grievous and irremediable medical condition which means a person must meet all of the following conditions:
- have serious and incurable illness, disease or disability (excluding a mental illness until March 17, 2023),
- be in an advanced state of irreversible decline in capabilities, and
- have enduring and intolerable physical or psychological suffering, caused by either the illness, disease or disability, or by the advanced state of decline in capabilities, that is intolerable to the person and cannot be relieved under conditions that they consider acceptable.
Eligibility for persons suffering from mental illness
Canadians whose only medical condition is a mental illness, and who otherwise meet all eligibility criteria, will not be eligible for MAID until March 17, 2023. This includes conditions that are primarily within the domain of psychiatry, such as depression and personality disorders. It does not include neurocognitive and neurodevelopmental disorders, or other conditions that may affect cognitive abilities.
This temporary exclusion will provide the Government of Canada with more time to study how MAID on the basis of a mental illness can safely be provided and to ensure appropriate safeguards are in place to protect those persons. To support this work, the law requires the Ministers of Justice and Health to initiate an expert review, which will be tasked with considering protocols, guidance and safeguards for MAID for persons suffering from mental illness, and to make recommendations within the next year (by March 17, 2022).
Requesting MAID
An individual seeking MAID must clearly provide informed, expressed, written, and voluntary consent to the termination of life. Informed consent means that a patient understands the nature, benefit, risks, alternatives and consequences of a health care decision. It also means the patient has had all their questions sufficiently answered.
Getting more information or requesting MAID
Patients interested in MAID can contact the Saskatchewan Health Authority at 1-833-473-6243 to inquire about eligibility and the MAID process in Saskatchewan.
If a patient's physician or RN(NP) doesn't provide the service
Not all physicians or RN(NP)s will be able to offer this service or will choose to do so. However, they will continue to provide other medically required care, and ensure the patient has access to information on end-of-life care options and access to information on MAID if that is their wish. Physicians and RN(NP)s are guided by their respective regulatory bodies: the College of Physicians and Surgeons of Saskatchewan and the Saskatchewan Registered Nurses Association.
Additional support and information
The College of Physicians and Surgeons of Saskatchewan and the Saskatchewan Registered Nurses' Association can provide details about processes and guidelines for physicians and RN(NP)s. Health providers can contact their respective professional regulatory bodies for information specific to their areas of practice.