Medical Assistance in Dying Timeline

The following timeline is a simplified resource to outline the history of end-of-life ethics in Canada. The timeline spans from the Rodriguez v British Columbia decision to the most recent amendments to Canada’s Medical Assistance in Dying (MAiD) legislation. The timeline represents Parliament and the judiciary’s stance on MAiD since its introduction to Canada’s legal system in 1993. Hyperlinks are available to the jurisprudence and legislation mentioned. 

Date of EventEvolution to MAiD Details of Changes
September 30, 1993Rodriguez v British Columbia, [1993] 3 SCR 519.
  • Sue Rodriguez challenged the constitutionality of s. 241(b) of the Criminal Code of Canada on the grounds of violations against s. 7, 12 & 15 of the Constitution Act of 1982 (Charter of Rights and Freedoms).

  • Upon reaching the Supreme Court of Canada, the court held that s. 241(b) of the Criminal Code of Canada violates the equality rights of all persons who desire to commit suicide but are physically unable to do so without assistance.  

  • The 5:4 court found no violation to s. 7 or 12 of the Charter.

  • Justice Sopinka (writing for the majority) noted that the issue should not resolved under s. 15 of the Charter but assuming it violated s. 15, it is saved under s. 1 of the Charter. The court found that the objective was rational, as well as pressing and substantive to the values of fundamental justice. 
    • February 6, 2015Carter v Canada, 2015 SCC 5. 
  • Lee Carter, Hollis Johnson, William Shoichet, the British Columbia Civil Liberties Association and Gloria Taylor challenged the constitutionality of s. 241 and s. 7 of the Criminal Code of Canada. The claimants challenged the provision claiming it violates s. 7 of the Charter.

  • The trial court revisited the SCC’s decision Rodriguez. The principles of stare decisis allow for trial courts to reconsider previous decisions on similar legal issues where there is a new legal issue raised, or where there is a change in the circumstances or evidence that fundamentally shifts the parameters of the debate. In this case, both conditions were met to revisit the SCC’s decision in Rodriguez. 

  • The trial judge held that there was a violation of s.7 of the Charter, and a total prohibition is overturned. The government appealed to the Court of Appeal for British Columbia, which overturned the trial judge’s decision in a 2:1 majority. The decision was appealed to the Supreme Court of Canada. 

  • The SCC held that the provision violated s. 7 of the Charter, where the prohibition on physician-assisted dying infringes the right to life, liberty and security of the person in a manner that is not in accordance with the principles of fundamental justice. The court held that the limitation on a person’s rights is not connected to the objective of preserving life, whatever the circumstances, especially those who are vulnerable persons who may be induced to commit suicide at a time of weakness. The prohibition catches people outside of the class of persons protected. Thus, the prohibition is overbroad and found unconstitutional. 

  • The court held that Canadians are eligible to receive physician-assisted death so long as they (1) clearly consent to the termination of life and (2) live with an irremediable or grievous condition causing enduring and intolerable suffering. This ruling does not permit minors or mature minors to choose physician-assisted death. These two conditions of eligibility are created as safeguards to be embedded into legislation. 

  • The court held that the prohibition on physician-assisted dying violates s. 7 and thus a consideration of a violation of s. 15 is unnecessary to consider the equal treatment of adults who are physically disabled.  

  • The violation was not saved by s. 1 of the Charter. The court considered whether the law has a pressing and substantial objective, the prohibition is not proportionate the objective. As the trial judge found, adequate safeguards can protect vulnerable people from abuse and error, and a total prohibition is not necessary. 

  • The court provided a suspended decision for 1 year in order for the federal government to produce legislation and to amend the affected provisions of the Criminal Code. A further 4-month extension was allotted to provide the newly elected government time to consult with the public
    • Assented on June 17, 2016Bill C-14 – an act to amend the Criminal Code and to make amendments to other acts (medical assistance in dying).
  • As a result of the Carter decision, Bill C-14 was created to satisfy the suspended decision ordered by the court. 

  • Bill C-14 looked to amend s. 241 and s. 7 of the Criminal Code of Canada.

  • Consultations with disability rights organizations, people with disabilities and other groups were conducted between July 17, 2015 and February 25, 2016. Parliament introduced 3 advisory bodies to conduct the consultations. 

  • The legislation incorporated the safeguards provided by the court in Carter, that an individual (1) clearly consents to the termination of life and (2) live with an irremediable or grievous condition causing enduring and intolerable suffering (enumerated as s. 241.2(1)(c))

    • Irremediable or grievous condition requires: 
    i) that the person has a serious or incurable illness, disease or disability, ii) that the person is in an advanced state of irreversible decline in capability, iii) that the illness, disease or disability or the state of decline causes enduring physical or psychological suffering that is intolerable and cannot be relieved under conditions that the person considers acceptable; and iv) that natural death has become reasonably foreseeable, taking into account all of the medical circumstances, although a prognosis as to the specific length of time remaining is not necessary.

    A. That a person be eligible for government-funded health services in Canada, or would be eligible for a minimum residency or waiting period (enumerated as s. 241.2(1)(a))
    B. A person be at least 18 years old and capable of making decision with respect to their health (enumerated as s. 214.2(1)(b)). *** This criteria include a definition from the Department of Justice online glossary which outlines competency and capacity to satisfy this eligibility condition.
    C. The person has made a voluntary request without external pressure (enumerated as s. 241.2(1)(d))
    D. The person gives informed consent (enumerated as s. 241.2(1)(e)).

    The legislation also included procedural safeguards:
    A. Be of the opinion that the conditions of eligibility in s. 241.2(1) are satisfied (enumerated as s. 241.2(3)(a))
    B. Ensure that the request was made in writing and signed by the patient (or another in the patient’s presence if they are unable to sign, provided the other person would not benefit financially or materially from the patient’s death) and that the written request was signed and dated after the physician had told the patient that the patient had a grievous and irremediable medical condition (enumerated as s. 241.2(3)(b)). 
    C. Be satisfied that the written request was signed and dated by the patient or another person authorized to do so before two witnesses who also signed and dated the request (witnesses must be 18 years of age) (enumerated as s. 241.2(3)(c) and 241.2(5))
    D. Ensure that the person is informed that the person may withdraw the request at any time and in any manner and, immediately before the provision of MAiD, ensure once more that the person gives express consent and is offered an opportunity to withdraw the request (enumerated as s. 241(3)(d) and 241.2(3)(h))
    E. Ensure that another physician or NP has provided a written opinion confirming that the person meets the criteria (enumerated as s. 241.2(3)(e))
    F. Be satisfied that both physician and NP’s are independent (not in a business relationship, mentorship or supervising one another, they do not know or believe to have financial or material benefit from their death and not connected in any other way) (enumerated as s. 241.2(3)(f) and 241.2(6))
    G. Ensure that 10 clear days elapse between the day the request is signed and the day when MAiD is provided. Where both physicians and/or NP’s are of the opinion that the person’s death or loss of capacity to provide informed consent is imminent, the waiting period will be based on what the first physician or NP considers appropriate in the circumstances (enumerated as s. 241.2(3)(g))
    H. Provide a reliable means of communication in situations where the patient has difficulty communicating (s. 241.2(3)(i)). 
    September 11, 2019Truchon v Quebec, 2019 QCCS 3792.
  • The Quebec Superior Court was tasked with determining whether the reasonable foreseeability of a natural death (s. 241.2(1)(c)) requirement was constitutional under s. 7 and s. 15 of the Charter.

  • The court held that as the law is currently written, the requirement that a death be reasonably foreseeable causes a level of inequality between people with disabilities, allowing some people with disabilities to access MAiD and prevents others from accessing end-of-life interventions. 

  • The court ruled for a suspended decision, providing the government 12 months to create amendments to MAiD legislation to remedy the inequality in the law. 

  • The government stated that they would not appeal this decision to the SCC 
    • Assented on March 17, 2021Bill C-7 – an act to amend the Criminal Code. 
  • Due to the Truchon ruling, the federal government created Bill C-7 

  • The federal government conducted consultations with the disability community over a 3-month period, where people with disabilities and disability organizations were able to comment on the proposed amendments.

    • The amendments include:
    A. Repealing provisions that only permit eligibility for those whose natural death is reasonably foreseeable
    B. Repealing provisions that prohibit mental illness as a sole underlying condition from accessing MAiD – repealing the blanket prohibition will only occur after the 24 month “Sunset Clause” period has elapsed, allowing for Parliament to conduct a review to create adequate safeguards that would protect “vulnerable individuals” from accessing MAiD and dying pre-maturely. 
    C. Creating 2 separate sets of safeguards that must be satisfied before MAiD can be approved and administered depending on whether a person’s condition has a prospect of a reasonably foreseeable natural death approaching.
    – i. (Only for those who do NOT have a natural death that is reasonably foreseeable) – 1. That an individual makes their request to utilize MAiD and wait 90-days from their first request to when MAiD is administered; 2. An individual may waive the need for a final consent before administering MAiD, where normally a practitioner would ask the individual one last time on the day of the procedure if they are sure they would like to proceed – waiving a final request can only be done when an individual is likely to lose capacity to consent
    D. MAiD can be administered to those who have applied and been approved but are likely to lose capacity before the procedure is administered. In these conditions, an individual may sign an advanced directive to waive the final consent requirement and move forward with MAiD without requiring informed consent on the day of the procedure. 
    E. Provides a practitioner the ability to administer end-of-life substances where the first dose that was self-administered by the patient does not end their life but renders them without capacity. This can only be done when there has been prior-written permission by the patient in the event that self-administration of substances under the supervision of a practitioner is unsuccessful. 

    Links to organizations and individuals who participated in consultations:

    Timeline created by Roxana Jahani Aval (JD Candidate – 2022), Research Assistant for the Law, Disability & Social Change Project at Windsor Law. 

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