Letter: Where care happens matters – How facility policies shape access to MAiD

By Letter to the Editor on April 9, 2026.

Dear editor,

In discussions about medical assistance in dying, access is often framed in legal terms: whether it is permitted, and who qualifies. But in practice, access depends just as much on where care is delivered.

This includes hospitals, as well as continuing care, hospice, and long-term care settings – where policies and practical constraints may differ.

This distinction matters.

MAiD is a legal medical service in Canada, and in Alberta it is supported through a coordinated system involving centralized referrals, independent assessments, and multidisciplinary care. In principle, patients who meet the criteria should be able to access it.

In practice, however, access is shaped by the policies of the institutions where patients are receiving care.

Some facilities – often faith-based – do not permit MAiD to be provided on site. This can include certain hospitals as well as continuing care and hospice settings. In larger centres, this may be less visible, as patients can sometimes be transferred between institutions. In smaller communities, or for patients who are frail or medically unstable, that assumption does not always hold.

Providers within these facilities are not required to participate in MAiD. However, enabling access to assessment and provision by external teams is a reasonable expectation where patients are otherwise eligible.

For many patients, particularly those in continuing care or hospice, these settings are not temporary – they are where they live and receive ongoing treatment.

When MAiD cannot be provided in that setting, access may depend on whether a transfer is possible.

Transfers, while often described as a solution, are not straightforward. They require coordination between teams, availability of a receiving location, and the physical ability of the patient to move. For individuals nearing end of life, even short transfers can be destabilizing. For others, particularly those with significant frailty or cognitive impairment, transfer may not be feasible at all.

In these situations, access is not determined solely by eligibility. It is shaped by logistics.

This creates a gap between how access is understood in principle and how it functions in practice. A service that is legally available may not be practically accessible in the place where a patient is receiving care.

There are also practical and legal questions around how care can be delivered. A proposed 150-metre buffer zone around certain health-care facilities raises uncertainty about how such a restriction would be interpreted and enforced in practice. Patients do not choose where they are admitted, and for those who are seriously ill, transferring care may be possible but is often complex, destabilizing, and not always realistic.

Extending restrictions beyond facility walls may therefore have unintended consequences for access, particularly in settings where alternative care locations are limited.

The issue is not simply whether institutions can adopt different policies. Variation in health care delivery exists across many areas of medicine. The question is what happens when that variation determines whether a patient can access a federally recognized medical service.

In the case of MAiD, this variation is often concentrated in the settings where patients are most vulnerable – hospitals, long-term care, hospice, and continuing care. These are environments where patients may have limited mobility, complex medical needs, and strong reliance on their care team and surroundings.

For those patients, access is not an abstract concept. It is tied to whether care can be provided where they are.

The situation is further complicated by referral pathways. Where clinicians face uncertainty or restrictions around facilitating access – particularly across jurisdictions – patients may encounter additional barriers in navigating the system. Even where options exist elsewhere, they may not be easily reachable in practice.

Individually, each of these factors may appear manageable. Taken together, they can significantly shape access.

A patient in a large centre with multiple facilities may experience a relatively straightforward process. A patient in a smaller community, or in a facility with restrictive policies, may face delays, transfers, or limitations that are much harder to navigate.

This creates uneven access – not in law, but in reality.

None of this resolves the broader ethical questions surrounding MAiD. But it highlights an important practical issue: access depends not only on eligibility, but on where care is delivered and how systems are organized around the patient.

As policy discussions continue, this distinction matters.

Ensuring access to a legal medical service requires more than defining criteria. It requires attention to how care is actually delivered in the settings where patients live, receive treatment, and make decisions.

Without that focus, there is a risk of maintaining a system where MAiD is legally available – but unevenly accessible in practice, particularly for those who are least able to navigate its complexities.

Kathryn Andrusky, MD, CCFP, MBA

Physician, Edmonton

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