Proposed Changes to Medical Assistance in Dying Legislation : Canadian Government
Author: Department of Justice Canada(i) : Contact: www.justice.gc.ca
Synopsis and Key Points:
Medical Assistance In Dying (MAID) is a complex and deeply personal issue. Article outlines reintroduced proposed changes to Canada's Criminal Code provisions on MAID.
MAID became legal in Canada in June 2016. The current legislation sets out eligibility criteria for those who wish to apply for MAID, as well as safeguards physicians and nurse practitioners must follow.
Cancer is the most frequently cited underlying medical condition, followed by respiratory, neurological and cardiovascular conditions.
The Honourable David Lametti, Minister of Justice and Attorney General of Canada, the Honourable Patty Hajdu, Minister of Health, and the Minister of Employment, Workforce Development and Disability Inclusion, Carla Qualtrough, have reintroduced proposed changes to Canada's Criminal Code provisions on MAID. These changes are the same as those proposed by Bill C-7 in the previous parliamentary session.
The Reintroduced Bill Proposes To:
1. Remove the requirement for a person's natural death to be reasonably foreseeable in order to be eligible for MAID
2. Introduce a two-track approach to procedural safeguards based on whether or not a person's natural death is reasonably foreseeable
- a. existing safeguards will be maintained and certain ones will be eased for eligible persons whose death is reasonably foreseeable
- b. new and modified safeguards will be introduced for eligible persons whose death is not reasonably foreseeable
3. exclude eligibility for individuals suffering solely from mental illness
4. allow the waiver of final consent for eligible persons whose natural death is reasonably foreseeable and who may lose capacity to consent before MAID can be provided
5. expand data collection through the federal monitoring regime to provide a more complete picture of MAID in Canada
The proposed amendments would respond to the Superior Court of Québec's September 2019 Truchon decision by expanding eligibility for MAID to individuals whose death is not reasonably foreseeable. In cases where a person's death is not reasonably foreseeable, the amended procedural safeguards would require practitioners to take appropriate steps to ensure that the request for MAID is fully informed and considered, and that individuals making the request have given serious consideration to reasonable and available treatment options.
The Bill reflects emerging societal consensus and was informed by views and concerns raised by Canadians, experts, practitioners, stakeholders, Indigenous groups, as well as provinces and territories during the public consultations undertaken in January and February 2020 . It is also informed by the past four years of experience with MAID in Canada.
If passed by Parliament, the Government of Canada would continue to work closely with provinces and territories, health system partners, and health practice regulatory bodies to support the implementation of the proposed changes to the legislation. This includes the development of monitoring, reporting, best practices, and guidance for the MAID regime. In addition, the federal government will work with provincial and territorial partners to enhance disability support.
Other important questions relating to MAID in Canada - such as advance requests for persons newly diagnosed with a condition that could affect their decision-making capacity in the future, eligibility for persons suffering solely from mental illness and eligibility for mature minors - could be considered during a broader parliamentary review of MAID legislation, as required by the original legislation passed in 2016.
"The COVID-19 pandemic has posed unprecedented challenges for all Canadians. This includes the disruption of the legislative process to review the proposed changes to Canada's MAID legislation. We understand MAID is a deeply personal issue that touches individuals and families. The Government of Canada remains committed to making the necessary changes to the federal MAID legislation. This is why we have reintroduced these important proposed amendments, which aim to reduce suffering, while also supporting individual autonomy and freedom of choice."
The Honourable David Lametti, P.C., Q.C., M.P. - Minister of Justice and Attorney General of Canada.
"While COVID-19 has disrupted our lives, it was important for the government to reintroduce this legislation. The feedback we received from individuals, experts, advocacy groups, health professionals and other key stakeholders helped us shape legislation that respects the autonomy of Canadians and protects vulnerable people."
The Honourable Patty Hajdu, P.C., M.P. - Minister of Health.
"Medical assistance in dying is a human rights issue. The proposed legislation recognizes the equality rights of personal autonomy and the inherent and equal value of every life. This legislation also recognizes the significant role that social, mental health, disability and community support services play in the full realization of these rights. In doing so, it remains true to the principles of the Accessible Canada Act that everyone must be treated with dignity; everyone must have meaningful options and be free to make their own choices; and everyone must have the same opportunity to make for themselves the lives that they are able and wish to have, regardless of their disabilities. As we move forward to meet the Court-imposed deadline, we will continue to work with the disability community, and not shy away from the long-overdue conversations that we need to have in our country with respect to disability inclusion and systemic disability discrimination. We will also take action by bringing forward the first-ever national Disability Inclusion Plan."
The Honourable Carla Qualtrough, P.C., M.P. - Minister of Employment, Workforce Development and Disability Inclusion.
- MAID became legal in Canada in June 2016. The current legislation sets out eligibility criteria for those who wish to apply for MAID, as well as safeguards physicians and nurse practitioners must follow.
- On July 24, 2020, Health Canada released the First Annual Report on Medical Assistance in Dying in Canada (2019) which is the first report using data collected under the Regulations for the Monitoring of MAID.
- Since June 2016, there have been more than 13,000 reported medically assisted deaths in Canada. This figure is based on voluntarily reported data from the provinces and territories prior to November 1, 2018, and data collected under the new monitoring regime(1) after that date.
- MAID deaths as a percentage of all deaths in Canada remains consistent with other international assisted-dying regimes.
- Cancer is the most frequently cited underlying medical condition, followed by respiratory, neurological and cardiovascular conditions.
- The majority of individuals receiving MAID (82.1%) were reported to have received palliative care services.
- In January and February 2020, the Government of Canada engaged with provinces, territories, Canadians, Indigenous groups, key stakeholders, experts, and practitioners to receive their feedback on expanding Canada's MAID framework.
- Over 300,000 Canadians participated in the online public consultations between January 13 and 27, 2020.
- Ministers Lametti, Hajdu and Qualtrough, and their Parliamentary Secretaries, also met with stakeholders, experts, practitioners, and Indigenous groups to consult them directly on revising Canada's federal MAID legislation.
- The federal government will continue to engage with the provinces and territories, both through federal, provincial, and territorial ministers, and through an officials' level intergovernmental working group on medical assistance in dying.
- The proposed amendments would become law once they have gone through the legislative process in Parliament and received Royal Assent.
- The Council of Canadian Academies completed reviews(2) in three areas where MAID was not allowed under the 2016 legislation: requests by mature minors, advance requests, and requests where a mental disorder is the sole underlying medical condition.
- Canada's current MAID legislation requires a parliamentary review of the law's provisions, as well as the state of palliative care in Canada, by one or more committees, starting at the beginning of the fifth year after becoming law. This review would allow for further public engagement and parliamentary study on all aspects of MAID in Canada.
1 - https://www.gazette.gc.ca/rp-pr/p2/2018/2018-08-08/html/sor-dors166-eng.html
2 - https://cca-reports.ca/reports/medical-assistance-in-dying/
(i)Source/Reference: Department of Justice Canada. Disabled World makes no warranties or representations in connection therewith. Content may have been edited for style, clarity or length.
- 1 - Proposed Changes to Medical Assistance in Dying Legislation : Canadian Government : Department of Justice Canada (2020/10/07)
- 2 - Focuses on Aging and End-of-Life Challenges in the LGBT Community : Hospice Foundation of America (2011/02/09)
- 3 - Palliative Care Findings on Caregiver Depression, LGBT Partners, Moral Distress : Loyola University Health System (2018/02/20)
- 4 - End-of-life Discussions Do Not Affect Survival Rate : Wiley-Blackwell (2011/09/29)
- 5 - Defining the Changing Nature of Wisdom at the End of Life : University of California - San Diego (2018/01/25)
- 6 - Vermont Gov. Signs First Death-with-Dignity Law : Compassion & Choices (2013/05/20)
- 7 - How Do Doctors Make Decisions When Managing Care for Critically & Terminally Ill Patients? : The Dartmouth Institute for Health Policy & Clinical Practice (2017/12/05)
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