MAID – medical assistance in dying – has been a highly charged issue in Canada for decades. It raises important and emotional legal, medical, ethical and religious questions that do not have easy answers.
For many of us, the Sue Rodriguez story marked the beginning of the public discourse about MAID in this country. In 1993, the Supreme Court of Canada ruled 5-4 against Rodriguez, a B.C. woman with ALS, who had challenged the validity of the Criminal Code provisions prohibiting assisted suicide. The following year, she ended her life with the assistance of an anonymous medical professional.
Over the next several years, challenges to legislation that stopped people from being assisted to die continued to make their way through the courts. In 2012, in response to a case undertaken by the British Columbia Civil Liberties Association, the B.C. Supreme Court ruled that the right to die with dignity was protected by the Charter of Rights and Freedoms. The federal government appealed that decision, but 2015, in the case of Carter v Canada, the Supreme Court of Canada upheld the B.C. decision.
In 2016, Bill C-14 legalized and regulated medical assistance in dying. Over the decade that MAID has been legal in Canada, challenges to the law – some saying it goes too far, some saying it doesn’t go far enough – have continued. The federal law has changed to make MAID somewhat more accessible. Initially, it was only available to people where their death was reasonably foreseeable, but that requirement – just one of many – has been removed.
Requests on a steady increase
In 2019, 5,660 people accessed MAID. In 2024, that number was 16,499. Five percent of deaths in Canada in 2024 were medically assisted. The vast majority of those who have a medically assisted death – 95.6% — have reasonably foreseeable deaths.
Issues that continue to challenge lawmakers – and the rest of us — include whether MAID should be available to:
- mature minors (people under 18 years of age)
- people whose sole medical condition is mental disorder
- people who are not competent at the time they wish to have MAID but were approved and consented when they were competent
The question of whether publicly funded, religious institutions must provide MAID is also an area of legal (and ethical) disagreement.
Quebec has consistently moved more quickly than the federal government or other provinces and territories to expand the availability of MAID. In 2019, medical assistance in dying became available to Quebecers, even if their deaths were not reasonably foreseeable, with the federal law changing two years later. Beginning last year, MAID has been available in Quebec to people who have made an advance request for it, but the federal government has not taken steps to make this change to the law, despite the fact that more than 65% of Canadians believe advance requests for MAID should be permitted. (For a timeline of Canada’s laws relating to MAID, see Dying with Dignity’s website.)
Taking it to court
Two MAID-related cases are making their way through the legal system at the moment. The first, filed in 2024, calls for medical assistance in dying to be extended to people whose sole medical condition is mental disorder. This constitutional challenge is being brought by two people who want to access MAID because of their severe mental illnesses – Claire Brosseau and John Scully – and Dying with Dignity, and is being opposed by some disability rights organizations.
The federal government had committed to changing the legislation to permit MAID for people whose sole medical condition was mental disorder in 2023. That date was pushed back to 2024, but in 2024 the government passed Bill C-62, which set a new date of 2027.
The plaintiffs argue that denying access to MAID to those whose sole condition is mental illness violates their Charter rights; specifically, that by forcing them to choose between suicide and endless suffering, they are denied their right to life, liberty and security of the person, as set out in Section 7 of the Charter, and that providing MAID to one group (the physically ill) and not to another (the mentally ill) violates the section 15 equality rights of those with a mental disorder.
It’s a complicated question, which has been written about sensitively and intelligently in recent articles in both the New York Times and Macleans magazine. It is hard not to be compelled by arguments on both sides of the issue, but I fall on the side of personal autonomy in situations like those of Brosseau and Scully. How can I argue with someone who, as Brosseau said to Macleans magazine, wants nothing other than to die; hopefully in comfort, and with certainty and dignity?
“All I’ve ever wanted, even on my best of days, is to die.”
Whatever the trial court says, this case is inevitably going to be appealed to Canada’s highest court, which means Brosseau, Scully and others will be waiting a long time for a decision. And, it’s not impossible that revisions to the Criminal Code will push this issue farther one way or the other.
The other case began its no-doubt-long legal journey in British Columbia in January of this year.
The plaintiffs in the case are families of two people who, because they were receiving medical care in a publicly funded but religiously run health care facility, were not able to access MAID when they wanted and needed to, as well as one doctor who has stopped practising in facilities that, for religious reasons, do not allow patients to receive MAID. Patients in this situation must endure what is called a “forced transfer,” often when they are extremely compromised physically and emotionally, to a facility where they can receive MAID.
(Where I live, in Kingston, Ontario, the only hospice is run by Providence Care, a Roman Catholic institution. It provides excellent care to patients at the end stages of their lives as well as much-needed support to family and friends. But, if that patient decides they want MAID, they will have to be transferred to a non-religious facility.)
These two cases are important, as are other MAID-related issues like advance requests and MAID for mature minors. We should all engage with the political processes that will shape what choices will and will not be available to us, should we need them.
There’s no better place to start than by joining Dying with Dignity Canada and using the excellent advocacy tools they have developed.