Ten years after medical assistance in dying (MAiD) was legalized, Quebec now has the highest rate of deaths by medically assisted death in the world. Initially permitted only for people at the end of life, the eligibility criteria for MAiD have since been expanded several times. Here are some aspects of MAiD that are rarely discussed.
The Emergence of the Term “Medical Assistance in Dying”
When MAiD was legalized in Quebec in 2015, the Canadian Criminal Code still prohibited ending a person’s life, even with their consent. By defining the practice—referred to as euthanasia elsewhere—as a form of health care, Quebec bypassed the Criminal Code, since health care falls under provincial jurisdiction. A few months after Quebec passed its legislation, and following the Carter decision, the rest of Canada authorized MAiD (which includes assisted suicide).
Quebec therefore invented the term “medical assistance in dying,” a term later adopted across Canada and now in France as well.
Public Confusion
Studies have shown that the Quebec population often confuses MAiD with other end-of-life practices, such as refusing or withdrawing treatment, palliative care, and continuous palliative sedation. This confusion may be exacerbated by socio-economic factors. Some researchers question whether the broad social consensus around MAiD in Quebec is partly due to people associating MAiD with any medical assistance aimed at reducing suffering at the end of life—such as palliative care or the cessation of treatment.
A Brief Overview of the Removal of Eligibility Criteria
Shortly after MAiD was legalized, two people with disabilities who were not at the end of life filed legal challenges against the Attorneys General of Canada and Quebec. They argued that MAiD’s eligibility criteria were unconstitutional and violated the Canadian Charter of Rights and Freedoms. In her ruling, Justice Baudouin struck down the requirement that a person must be at the end of life to receive MAiD. Since 2020, being at the end of life is no longer necessary to qualify.
Previously, a person had to be capable of giving final consent immediately before the procedure. However, with the adoption of Bill C-7 in 2021, eligible individuals who risk losing their decision-making capacity can waive the requirement for final consent. Since March 2024, a person with a severe physical disability causing significant and persistent impairments is eligible for MAiD. Finally, on October 30, 2024, advance requests for medical assistance in dying (ARMAID) were legalized in Quebec. To make an advance request, a person must have a serious and incurable illness expected to lead to incapacity, and must be capable of consenting to care at the time of the request. Individuals whose sole condition is a mental disorder are expected to become eligible for MAiD in 2027.
As we have seen, both the legislation and the social acceptability surrounding MAiD have evolved since its creation. Without questioning the core principle, it remains important to reflect on the scope of these changes. In a context where access to palliative care remains uneven and where many people live in precarious conditions, could MAiD at times become a response to unaddressed social suffering?
Ariane Plaisance holds a PhD in Community Health and is a writer, speaker, end-of-life doula, and consultant on equitable access to palliative and end-of-life care. To learn more about her services, visit www.qulysis.com
