Minister of Justice Mickey Amery unveiled new restriction to medical assistance in dying in Alberta.--CP FILE PHOTO
zmason@medicinehatnews.com
The government of Alberta is introducing legislation that will restrict access to medical assistance in dying to individuals considered likely to die in the next year.
Bill 18 imposes new limits on eligibility for MAiD and sticks doctors with new restrictions on how it is discussed and authorized.
If passed, the Safeguards for Last Resort Termination of Life Act will limit eligibility for MAiD to those whose natural death is reasonably foreseeable.
Federal guidelines also adopt this standard. However, Bill 18 departs from the federal framework by outlining a definition of “reasonably foreseeable,” which limits access to MAiD to individuals considered likely to die of natural causes within 12 months.
The legislation is effectively putting an end to current practice, which allows individuals not considered to have “reasonably foreseeable” deaths access MAiD under “Track 2.”
“Alberta believes that patient safety is and must always be our first concern, and our government has been highly skeptical of federal moves to widen eligibility to those whose only medical condition is mental illness,” said Premier Danielle Smith at a news conference Wednesday.
MAiD was legalized in Canada in 2016. Canada’s MAiD laws were expanded in 2021 to include Track 2.
The most recent numbers reported by the federal government show 16,499 Canadians received MAiD in 2024, up from 10,066 in 2021.
The vast majority of individuals receiving MAiD qualified as Track 1. More than 95 per cent of MAiD recipients fell into this category, leaving only 4.4 per cent of MAiD provisions in the Track 2 category.
Underlying medical conditions cited by recipients of Track 2 MAiD included neurological conditions, diabetes, chronic pain and autoimmune conditions.
In Alberta, the number of individuals receiving MAiD grew from 594 in 2021 to 1,242 in 2025. MAiD rates remain below the national average.
Dr. Ramona Coelho is a family physician and a member of Ontario’s MAiD Death Review Committee.
She says the most recent report of the Ontario MAiD Death Review Committee showed patients receiving MAiD on Track 2 were more likely to be poor, less likely to access disability and mental health supports and often unable to list next of kin, demonstrating severe social isolation.
“The stats there are very concerning for Track 2,” she said. “These are people that we are not taking care of well as a society … that’s structural forces influencing them to die. And that, to me, is neglect. So I’m very happy that Alberta is getting rid of Track 2.”
The proposed legislation also includes a suite of new restrictions on the provision of MAiD by health-care practitioners.
Health professionals will be prohibited from initiating conversations about MAiD, and public display of MAiD information will be restricted within health-care facilities.
The current federal framework allows physicians to discuss MAiD as a treatment option and does not feature provisions preventing physicians from initiating these discussions.
Health Canada guidance notes physicians have professional obligations to inform patients about relevant care options, including MAiD.
Bill 18 also prevents practitioners from making referrals for individuals to receive MAiD eligibility assessments outside the province.
Smith referenced a recent case in which a 26-year-old Ontario man was refused MAiD for his mental health condition in that province before ultimately having his request approved in British Columbia.
“These are things we want to stop,” she said. “We don’t want anyone to be counselled to end their life prematurely if they do not have a terminal illness, and if we have to make that clear in law, we’ll make it clear in law,” said Smith.
The legislation will also introduce mandatory sanctions for physicians and nurse practitioners found to be in violation of either provincial or federal regulations on MAiD.
The sanctions come in addition to the existing reporting requirements under the Criminal Code that presently monitor compliance with federal MAiD guidelines.
The proposed legislation would also prohibit MAiD for advance requests, those under 18, those without capacity to make their own health-care decisions and individuals whose sole underlying medical condition is a mental illness.
These restrictions largely mirror federal guidelines, which likewise deny access to MAiD for minors and those with limited mental capacity.
A temporary exclusion of MAiD for individuals with a mental illness as their sole underlying condition was extended until Mar. 17, 2027.
Smith says her government expects the exclusion to lift after that deadline. She says her government has “profound misgivings” about the extension of eligibility.
Under federal legislation, advance requests for MAiD are prohibited. Individuals are required to have the capacity to provide express consent to receive MAiD immediately before it is administered.
However, in 2024, Quebec began allowing advance requests for individuals with illnesses like Alzheimer’s that may lead to loss of capacity. The federal government has stated it will not challenge Quebec’s legislation.
“We are taking a proactive approach here in anticipation that they may come forward in the future, and if they do, we’ll be prepared,” said Justice Minister Mickey Amery at Wednesday’s press conference.
Amery said it’s too soon to comment on whether his government would use the notwithstanding clause to defend these changes if necessary.
Smith said the clause is not included in the bill because her government believes it to be reasonable and justified. If the courts do challenge it, she says her government is prepared to use whatever tools are at their disposal.
Dr. Coelho told reporters Wednesday about a United Nations report issued last year that called on Canada to repeal Track 2 MAiD.
The United Nations Committee on the Rights of Persons with Disabilities wrote that Canada lacked a strong framework for implementing and monitoring MAiD, and that many of the people accessing the option were otherwise marginalized.
The report pointed out several aspects of the policy it found “extremely concerning,” including the possible expansion of eligibility to mature minors and advance requests, and the absence of an independent oversight mechanism to monitor and handle complaints related to MAiD.
