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 Event||Evolution to MAiD||Details of Changes|
|September 30, 1993||Rodriguez v British Columbia,  3 SCR 519.|
|February 6, 2015||Carter v Canada, 2015 SCC 5.|
|Assented on June 17, 2016||Bill C-14 – an act to amend the Criminal Code and to make amendments to other acts (medical assistance in dying).|
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, 2019||Truchon v Quebec, 2019 QCCS 3792.|
|Assented on March 17, 2021||Bill C-7 – an act to amend the Criminal Code.|
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:
- The Vulnerable Persons Standards comments on MAiD legislation and amendments
- Heidi Janz – Chair of the Council of Canadians with Disabilities End-of-Life Ethics Committee commenting on the proposed amendments
- Dr. Leonie Herx – Past-President of the Canadian Society of Palliative Care Physicians and Chair of the Division of Palliative Medicine at Queen’s University comments on the proposed amendments
- Dr. Ramona Coelho – Family Physician commenting on the proposed amendments
- The United Nations Special Rapporteur for the Rights of Persons with Disabilities writes an open letter to comment on the proposed amendments
- Additional comments by community at Parliament
Timeline created by Roxana Jahani Aval (JD Candidate – 2022), Research Assistant for the Law, Disability & Social Change Project at Windsor Law.