Alberta bill would limit medically assisted dying to patients facing ‘reasonably predictable’ death
The new law will prevent anyone in Alberta from receiving medical assistance in dying (MAID) if they are unlikely to die within the next 12 months.
Bill 18, the End-of-Life Safeguards Act, if passed, would bar doctors or nurse practitioners from giving MAID to patients whose only underlying condition is mental illness.
The Act will also require a direct family member of the patient to be present for the administration of MAID in almost all cases.
Alberta Premier Danielle Smith said at a news conference Wednesday that she thinks the federal guardrails around MAID are weakening as the government considers broadening eligibility.
“These increasing factors place the safety and well-being of vulnerable individuals at very serious risk,” Smith said.
Justice Minister Mickey Ameri introduced the bill in the legislature on Wednesday.
If the legislation is passed as written, it would make Alberta the first Canadian jurisdiction to impose these types of limits on federally permitted assisted deaths.
The legislation would already limit access to MAID in cases where the federal government has indicated it might make changes.
The province is set to impose some restrictions on medical assistance in dying, also known as MAID. It says these changes are to protect minors and Albertans with disabilities. As Travis McEwan reports, this will have implications for eligibility and how doctors approach MAID with their patients.
Although federal law requires a person requesting MAID to have the mental capacity to do so, Quebec began allowing people with incurable illnesses to request access to MAID in 2024 while they are in the clear. Alberta law will not allow such advanced requests.
The federal government has also passed legislation to allow only people with mental illnesses to request MAID starting in March 2027.
Smith told reporters the Alberta government is “highly skeptical” of the federal government legalizing MAID solely for mental illnesses.
Dr. Ramona Coelho, an Ontario family doctor who was at the press conference to support the legislation, said she has seen examples of some health-care workers offering MAiD to patients who are marginalized because of poverty or social isolation, rather than broader support that would help ease their suffering.
“The patient’s suffering can be addressed and their lives can be greatly improved if we take the time,” he said.
Bill will impose new limits on physicians
Bill 18, if passed, would also place new requirements and limitations on health care providers who administer MAID.
Doctors and nurse practitioners will be prohibited from referring a patient out of province for assessment of MAID eligibility. They would be prohibited from suggesting MAID as an option to any patient – the patient must first request information on MAID.
According to a government briefing, the law would prevent health facilities, such as clinics or continuing care homes, from publicly displaying any information about MAID, in order to “reduce the risk of undue influence or coercion”.
Although health-care workers already have the right to refuse to provide MAID, Bill 18 would enshrine that right in provincial law, and create a 150-metre “exclusion zone” around any health-care facility that refuses to allow MAID consultations on its premises.
Catholic health facilities that refuse to facilitate MAID evaluations have faced criticism and legal challenges because patients had to either transfer to another facility to receive them, or meet evaluators on sidewalks or bus shelters outside Catholic hospitals.
Provincial data for 2023 show that approximately nine per cent of patients receiving MAID required transfer to a different facility.
Bill 18 would require health providers to contact each practitioner who has been the primary care provider for a patient requesting MAID in the past year, and review all of the patient’s personal and health information.
The law requires MAID or anyone providing MAID assessment to previously complete professional training requirements.
Professional regulatory bodies in Alberta would be mandated to sanction any health-care worker who violates provincial law.
Government officials say these sanctions will begin with remedial training for the first offense, and extend to suspension and revocation of the ability to provide MAID for subsequent offenses.
In 2021, the federal government amended MAID eligibility to include people who are unlikely to die in the next 12 months in response to a Quebec court ruling that the restriction violates the Charter of Rights and Freedoms.
Alberta government officials said they did not believe the provincial law would violate the criminal code.
Support for proposed changes
Some organizations advocating for people with disabilities are happy with this law, particularly the ban on “Track 2” MAID for people whose death is not immediately probable.
Trish Bowman, CEO of Inclusion Alberta, said MAID is leading to medical systems that sometimes offer death as an option rather than the support people with disabilities need to have a high quality of life. He said Alberta’s borders could save lives.
Bowman said, “We know that this reinforces incredibly negative and dangerous stereotypes about the value and worth of the lives of people with disabilities. And so we’re very happy to see this legislation today that protects them.”
Inclusion Canada CEO Christa Carr says she hopes other provinces will follow Alberta’s example. However, he said the limitations should force governments to invest more in programs and supports that improve the quality of life of people with disabilities.
Robert Olson, research librarian at the Canadian Mental Health Association, called the legislation “pleasant”. He said the organization opposes the expansion of MAID to people with mental illness because many people can recover from mental illnesses or find successful treatment for them.
Disappointment for right to die supporters
Tania Stillson’s father chose a euthanized death in 2023 at the age of 83, after living for 12 years with chronic and debilitating pain that grew steadily worse and unresponsive to treatment.
She says her father, John Warren, had to undergo extensive evaluation and a 90-day waiting period when his suffering became unbearable. Stillson said it is “illogical” for the provincial government to attempt to remove the option for people who are in pain but not facing death in the near future.
“Canadians should not suffer,” he said. “And they make their own personal choices. No one should have to do that for me or for you.”
Kerry Hale, co-chair of the Calgary chapter of Dying with Dignity, said Alberta’s proposed restrictions would make it harder for people who may be near death to access legal, publicly funded services.
If governments want to protect vulnerable people, they must provide better health and social support, he said.
Hale is troubled that health providers won’t be able to point to MAID as an option, because some people don’t know it’s legal, he said. He said the law lacks compassion for people in dire circumstances.
“They are suffering unbearably and they want to end their lives,” he said. “I think we need to be compassionate toward those people and not make this choice any more difficult than it already is.”
Challenges to the federal MAIDS law
Before the bill was introduced, Lola Dandybayeva, a spokesperson for federal Justice Minister Sean Fraser, said in a statement that provinces and territories are responsible for providing health care and have the authority to develop frameworks around MAID delivery.
Dandybaeva said a special committee is studying the possible expansion of MAID eligibility, and its findings will guide any potential changes. Despite legislation set to expand the eligibility criteria in March 2027, he did not give any timeline for any potential changes.
Justice Minister Amery says the Quebec court’s decision does not apply in Alberta.
Smith said he had no immediate plans to use the section to defend the bill in court should it become law and face a legal challenge, though he did not rule out that option.
“I’m very hopeful that this will become law in Alberta,” he said.
Patrick Fafard, a health policy professor at the University of Ottawa, said the legislation errs on the side of caution in legislating in areas the province controls, such as the provision of health services and regulation of professionals. He believes that no matter what happens, a challenge in court is possible.
“People will allege that this somehow contradicts what the federal government does under its Criminal Code authority,” he said. “But it will be prosecuted. Partly to make a point, and partly because there could be a real conflict of laws.”
