OTTAWA — Canadian Justice Minister Sean Fraser and Health Minister Marjorie Michel unveiled significant developments regarding medically assisted dying (MAID) on Wednesday. The government has opted against expanding MAID to include individuals whose sole underlying condition is mental illness. Additionally, legislation will be introduced to permit individuals suffering from an incurable illness to give advance consent for MAID, in anticipation of potential future incapacity to provide such consent.
The evolution of MAID legislation in Canada has undergone several pivotal moments over the years, shaping the current legal landscape. In 1892, Canada’s first Criminal Code included provisions that criminalized aiding or abetting suicide and imposed a life sentence for such offenses.
In 1972, under Prime Minister Pierre Elliott Trudeau's government, the Criminal Code provision that criminalized suicide was repealed while maintaining the prohibition against assisting someone in ending their life. Following this, between 1991 and 2010, six private member's bills aimed at decriminalizing assisted suicide were introduced in the House of Commons but none succeeded.
A landmark case in 1993 involved Sue Rodriguez, diagnosed with amyotrophic lateral sclerosis (ALS), who challenged the law prohibiting assisted suicide in the Supreme Court of Canada. The court ruled against her in a 5-4 decision, leading Rodriguez to end her life with the assistance of an anonymous physician in 1994.
Following this, a Senate committee released a special report in 1995, expressing varied opinions on euthanasia and assisted suicide while emphasizing concerns regarding the implications of such practices. Some members suggested safeguards, asserting that a person seeking assisted death must be competent and enduring intolerable suffering without any coercion.
In 2009, the Collège des médecins du Québec published a discussion paper suggesting that euthanasia could serve as a final option in end-of-life care under specific exceptional circumstances. By 2010, various countries and jurisdictions had already legalized some form of assisted dying, including the Netherlands, Belgium, and certain U.S. states.
In 2011, the British Columbia Civil Liberties Association launched a legal challenge against the Criminal Code's assisted death prohibitions, arguing they violated individual rights under the Charter of Rights and Freedoms. This case, known as Carter v. Canada, saw the Supreme Court of British Columbia rule in favor of the plaintiffs in 2012, but the federal government under Prime Minister Stephen Harper appealed the decision.
Subsequent developments included Quebec’s National Assembly's 2012 report on "dying with dignity," advocating for the legalization of MAID for consenting adults suffering from serious, incurable illnesses. In 2014, Quebec passed a law permitting medical aid in dying for such patients, which took effect in 2015.
The pivotal 2015 Supreme Court decision in Carter v. Canada struck down key provisions of the Criminal Code that restricted assisted dying. The court determined that it was "cruel" to deny individuals assistance in ending their lives under certain conditions, ruling that the laws violated Section 7 Charter rights. Parliament was given a year to implement a legal framework for assisted dying.
By June 2016, the House of Commons successfully passed Bill C-14, allowing doctors to assist those with terminal illnesses in ending their lives, although attempts to broaden this definition were opposed. In 2019, a ruling from the Superior Court of Quebec stated that limiting MAID to cases of foreseeable death was unconstitutional, a decision which the federal government chose not to appeal.
The law evolved further in 2021, with Parliament removing the requirement for foreseeable death and creating two tracks for MAID eligibility, distinguished by additional criteria for non-terminal conditions. The legislation also temporarily exempted individuals with mental illnesses from eligibility pending further review.
In 2022, an expert panel suggested several recommendations for managing MAID in cases of mental illness. However, in 2023, the federal government extended the exclusion for mental illness by an additional year to ensure adequate preparations for safe assessments. Furthermore, Quebec's National Assembly permitted advance requests for MAID, which would take effect if individuals lost their capacity to consent.
As of 2024, the government delayed eligibility for individuals solely suffering from mental illness until March 2027. By mid-2026, a parliamentary committee recommended an indefinite exclusion for these cases, arguing for a more cautious approach to medical aid in dying for those with mental health conditions. Justice Minister Sean Fraser then confirmed that the government would act on this recommendation, proposing legislation to codify this exclusion.
Fraser also indicated that the new legislation would facilitate access to MAID for individuals with incurable illnesses who have provided advance consent, reflecting the ongoing complexities in the landscape of medically assisted dying in Canada.
