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Photo by Graham Hughes/The Canadian Press/File

The Quebec decision is not binding in other provinces, but any amendments to the federal Criminal Code will be.

Both governments said they would not appeal. Quebec said it would simply let the “end of life” requirement be stripped from its law, and ask medical regulators to provide further guidance. The federal government has committed to bringing new legislation. It had already sought expert reports on how the MAiD law might apply to mature minors, people who wish to give directions in advance of losing their capacity to make decisions, and the people whose only illness is mental.

The Quebec decision marked a conceptual shift in Canada’s assisted-dying regime that has led to this urgent moment. After the ban on assisted suicide was struck down by the Supreme Court in 2015, medical aid in dying was presented politically as hastening a death from sickness that was already imminent and inevitable. But the court had allowed it in order to relieve suffering, not just in those about to die, but in anyone with a “grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”

This difference in fundamental purpose has now come into conflict, and as the report notes, there is a need for more parliamentary guidance. Without it, there would be a patchwork of access in Canada, and another charter challenge would be simply a matter of time. But the questions are just as hard as they were when the legislation was first passed, such as whether it is ethical for a person with mental illness to seek assisted death, and if it is unethical in some cases, whether medicine is able to reliably tell them apart.