In Road to Mercy, Canadian doctors and patients navigate the right to medical assistance in dying (MAiD) under a broad Supreme Court decision – the first of its kind outside Europe.

On February 6, 2015, the Supreme Court of Canada voted in favour of an amendment to Bill C-14, ultimately decriminalizing medical assistance in dying. The controversial bill received royal assent over a year later on June 17, 2016. While many Canadians celebrate the ruling, there are some who see it as an unethical overreach. So, what is physician assisted dying (PAD)? 

The following has been adapted from: (1) Get the Facts: Bill C-14 And Assisted Dying Law in Canada Dying with Dignity Canada (2) CanadiEM and (3) End-of-Life Law & Policy in Canada, Health Law Institute, Dalhousie University

Q: Is it legal in Canada for someone to commit suicide?
Yes, in 1972 suicide was removed from the criminal code and it has been legal ever since. 

Q: If Canadians already have the right to end their life, why do we need medically assisted dying?
While we have the right to end our own lives, few of us have the resources to do so peacefully. Taking an over-the-counter medication or most prescription medications, even in large doses, is unlikely to lead to death and more likely to lead to irreversible damage. Accessible and effective ways of ending our lives tend to be violent. These methods are traumatic for survivors, and the individual inevitably dies alone. And, most individuals with terminal or incurable illnesses will not, in the final days or weeks, be physically able to take their own lives.

Q: Before Bill C-14, what happened if an individual assisted someone else to die in Canada?
Before Bill C-14, Section 241 of the Canadian criminal code prohibited anyone from aiding, abetting or counselling someone to suicide. Breaking the law carried a maximum sentence of 14 years in prison. Bill C-14 has amended the criminal code to allow health care professionals to assist in a patient's death.

Q: What is assisted dying? 
Assisted dying is the act of intentionally killing oneself with the assistance of an authorized health care practitioner who provides the knowledge, means, or both.

Q: What is euthanasia?
Euthanasia is when an authorized health care practitioner directly administers a substance that causes death, such as an injection of a drug, at the request of the patient.

Q: What is medical assistance in dying (MAiD) or physician-assisted dying (PAD)?
MAiD is an umbrella term. It refers to assisted dying, euthanasia, or both.

Q: Is MAiD legal in Canada?
On June 17, 2016, new federal legislation came into force creating a regulatory framework for medical assistance in dying in Canada. Under this legislation, medical assistance in dying is legal if the eligibility criteria are met and the procedural safeguards are followed. 

Q: What types of MAiD are permitted in Canada?
There are two types of medical assistance in dying available to Canadians. They include:

  • An authorized health care provider directly administers a substance that causes death, such as an injection of a drug (this is also known as voluntary euthanasia).
  • An authorized health care provider gives or prescribes a drug that is self-administered to cause death (this is also known as assisted dying).

Q: Who is eligible for MAiD in Canada under the new law?
Under Canada's new law, two independent health care professionals need to evaluate an individual in order to determine whether he/she qualifies for MAiD. Patients must be 18 years or older and capable of providing informed consent at the time that MAiD is provided. To qualify, an individual must also meet the following four eligibility criteria:

  1. Have a serious and incurable illness, disease, or disability;
  2. Be in an advanced state of irreversible decline in capability; 
  3. Endure physical and psychological suffering that is intolerable to them; and
  4. Their natural death has become reasonably foreseeable.

Q: How does the new law differ from the Supreme Court’s Carter V Canada decision?
Canada's medical assistance in dying law is much more restrictive than the Supreme Court’s Carter V Canada decision. The Supreme Court’s decision made assisted dying available to any consenting, competent adult suffering intolerably from a grievous and irremediable medical condition. However, the new law includes two provisions that are much narrower in scope. To qualify for assisted dying under Bill C-14, an individual must be in an advanced state of irreversible decline and their natural death must be “reasonably foreseeable” – in other words, terminally ill.

This means some individuals who were granted the right to a peaceful death by the Supreme Court will now find themselves barred from access because their deaths may not be imminent. Other individuals, like those who have endured a serious stroke, will also be barred if no natural end is in sight or if they are incapable of providing informed consent at the time of MAiD. For many of these individuals, intolerable suffering can persist for years, which is the kind of fate the Supreme Court ruled against.