If the physician determines that medical aid in dying cannot be administered, the physician must inform the patient of the reasons for that decision.

If the physician determines that medical aid in dying cannot be administered, the physician must inform the patient of the reasons for that decision.

If a physician determines, subsequent to the application of section 29, that medical aid in dying may be administered to a patient requesting it, the physician must administer such aid personally and take care of and stay with the patient until death ensues.

The physician consulted must be independent of both the patient requesting medical aid in dying and the physician seeking the second medical opinion. The physician consulted must consult the patient’s record, examine the patient and provide the opinion in writing.

The physician consulted must be independent of both the patient requesting medical aid in dying and the physician seeking the second medical opinion. The physician consulted must consult the patient’s record, examine the patient and provide the opinion in writing.

obtain the opinion of a second physician confirming that the criteria set out in section 26 have been met.

( 3 ) obtain the opinion of a second physician confirming that the criteria set out in section 26 have been met.

make sure that the patient has had the opportunity to discuss the request with the persons they wished to contact; and

( 2 ) make sure that the patient has had the opportunity to discuss the request with the persons they wished to contact; and

discussing the patient’s request with the patient’s close relations, if the patient so wishes;

( e ) discussing the patient’s request with the patient’s close relations, if the patient so wishes;

discussing the patient’s request with any members of the care team who are in regular contact with the patient; and

( d ) discussing the patient’s request with any members of the care team who are in regular contact with the patient; and

verifying the persistence of suffering and that the wish to obtain medical aid in dying remains unchanged, by talking with the patient at reasonably spaced intervals given the progress of the patient’s condition;

( c ) verifying the persistence of suffering and that the wish to obtain medical aid in dying remains unchanged, by talking with the patient at reasonably spaced intervals given the progress of the patient’s condition;

making sure that the request is an informed one, in particular by informing the patient of the prognosis for the illness and of other therapeutic possibilities and their consequences;

( b ) making sure that the request is an informed one, in particular by informing the patient of the prognosis for the illness and of other therapeutic possibilities and their consequences;

making sure that the request is being made freely, in particular by ascertaining that it is not being made as a result of external pressure;

( a ) making sure that the request is being made freely, in particular by ascertaining that it is not being made as a result of external pressure;

(1) be of the opinion that the patient meets all the criteria of section 26, after, among other things,

A patient may also, at any time and by any means, request that the administration of medical aid in dying be put off.

A patient may also, at any time and by any means, request that the administration of medical aid in dying be put off.

A patient may, at any time and by any means, withdraw their request for medical aid in dying.

If the patient requesting medical aid in dying cannot date and sign the form referred to in section 26 because the patient cannot write or is physically incapable of doing so, a third person may do so in the patient’s presence. The third person may not be a member of the team responsible for caring for the patient, a minor or a person of full age incapable of giving consent.

The form must be signed in the presence of and countersigned by a health or social services professional; if the professional is not the attending physician, the signed form is to be given by the professional to the attending physician.

The form must be signed in the presence of and countersigned by a health or social services professional; if the professional is not the attending physician, the signed form is to be given by the professional to the attending physician.

26. […] The patient must request medical aid in dying themselves, in a free and informed manner, by means of the form prescribed by the Minister. The form must be dated and signed by the patient.

26. […] The patient must request medical aid in dying themselves, in a free and informed manner, by means of the form prescribed by the Minister. The form must be dated and signed by the patient.

As well, health professional regulatory bodies have developed guidelines and standards to further regulate practice in relation to MAiD.

Provincial and territorial governments have developed policies and practices with respect to the implementation and regulation of MAiD under the federal regime:

It remains to be seen how the inconsistencies between the federal Criminal Code and the Quebec legislation will be resolved. Quebec’s legislation is more restrictive and that may be resolved by the Quebec National Assembly amending its legislation to make is consistent with the federal Criminal Code or by a court ruling that the Quebec National Assembly does not have the authority to restrict access to MAiD as it has. See Recent Developments for more information.

How did we get here?

Old Legislation

Historically, all forms of assisted suicide were an offence under s. 241 of Canada’s

Criminal Code:

Suicide Counselling or aiding suicide 241. Every one who (a) counsels a person to commit suicide, or (b) aids or abets a person to commit suicide, whether suicide ensues or not, is guilty of an indictable offence and liable to imprisonment for a term not exceeding fourteen years.

Charter Challenge — Carter v Canada (Attorney General)

On June 15, 2012, Justice Lynn Smith struck down the Criminal Code prohibition of assisted suicide (Carter v Canada (Attorney General), 2012 BCSC 886). She found that it violated sections 7 and 15 of the Canadian Charter of Rights and Freedoms. Her declaration of invalidity of s.241(b) of the Criminal Code was suspended for twelve months to give the government time to fix the law. The government appealed and Justice Smith’s decision was overturned by the British Columbia Court of Appeal in 2013 (Carter v Canada (Attorney General)). The majority (2:1) allowed the appeal on the grounds of stare decisis (that the issue had been decided by the Supreme Court of Canada in Rodriguez v British Columbia (Attorney General) in 1993). The Supreme Court of Canada heard the appeal on this case in October 2014 and released its decision on February 6, 2015 (Carter v Canada (Attorney General)). The Supreme Court (unanimously and with a decision authored by “The Court”) found that the prohibition on assisted suicide violates section 7 of the Canadian Charter of Rights and Freedoms when it prohibits access for “a competent adult person who (1) clearly consents to the termination of life and (2) has 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” (irremediable, the Court said, means that the condition cannot be alleviated by means acceptable to the person).

The Court’s declaration of invalidity of s.241(b) of the Criminal Code was suspended for twelve months to give the federal/provincial/territorial governments time to revise existing or craft new laws if they chose to do so. However, in October 2015, the Conservative Government was defeated and, in December 2015, the new Liberal Government made a motion for a six-month extension to the suspension of the declaration of invalidity. On January 15, 2016, (Carter v Canada (Attorney General)) the Supreme Court granted a four-month extension, giving the governments an additional four months within which to make any changes to the law. The Supreme Court also established a constitutional exemption under which individuals throughout Canada could access physician-assisted dying without fear of criminal liability for those who assist them by applying to a court for a judicial authorization based on a demonstration that they meet the criteria set out in the 2015 Carter v Canada (Attorney General). The following cases were decided by the courts under the Supreme Court of Canada’s constitutional exemption:

One case was decided after the Supreme Court of Canada’s decision in Carter v. Canada (Attorney General) came into effect in June 2016 – i.e., when the prohibitions under the Criminal Code were no longer in effect. In this case, Justice Perrell of the Ontario Superior Court concluded that individuals would still need to seek court orders until federal legislation came into force. Given the introduction of the legislation shortly thereafter, this decision is not being appealed.

Materials from the various levels of court in the Carter v. Canada (Attorney General) litigation are available here:

The development of the new federal legislation

In August 2015, a Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying was created by provincial-territorial governments across Canada. Its mandate was “to provide non-binding advice to participating Provincial-Territorial Ministers of Health and Justice on issues related to physician-assisted dying. The advice is meant to assist provinces and territories in deciding what policies and procedures should be implemented within their jurisdictions in response to the Supreme Court’s decision in Carter.” The Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying delivered its final report on November 30, 2015. It made 43 recommendations for how federal, provincial, territorial governments (and other relevant actors) should implement a regulatory framework for physician-assisted dying in Canada.

In December 2015, a Special Joint Committee on Physician-Assisted Dying was appointed by Parliament. Its mandate was “to review the report of the External Panel on Options for a Legislative Response to Carter v. Canada and other recent relevant consultation activities and studies, to consult with Canadians, experts and stakeholders, and make recommendations on the framework of a federal response on physician-assisted dying that respects the Constitution, the Charter of Rights and Freedoms, and the priorities of Canadians.” The Special Joint Committee delivered its final report on February 25, 2016. It made 21 recommendations for a regulatory framework for medical assistance in dying and related initiatives.

On April 14, 2016, the federal Minister of Justice introduced Bill C-14: An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying).

On May 12, the Bill was reported back to the House with amendments.

On May 17, the Senate tabled a pre-study report on Bill C-14 and made a set of recommendations for amendment to the Bill.

On May 31, the House passed the Bill.

On June 15, the Senate sent the Bill with amendments to the House.

On June 16, the House considered the Senate’s amendments, made more amendments itself, and sent it back to the Senate.

On June 17, the Senate considered the House’s amendments and passed the Bill. The Bill then received Royal Assent.

Bill C-14 was subjected to extraordinary debate in both the House and the Senate. Links to the speeches made in the House and the Senate are here.

Quebec’s legislation

Quebec passed An act respecting end-of-life care in June 2014. It came into force in December 2015. Its key procedural safeguards are: