Canada’s current medically assisted dying framework was shaped by court rulings and federal and provincial laws spanning from 1993 to 2027 delays for mental illness eligibility.
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Canada’s medically assisted dying (MAID) rules are being revisited as Justice Minister Sean Fraser and Health Minister Marjorie Michel prepare to outline a “path forward” on Wednesday, including whether people whose sole underlying condition is a mental illness should be allowed to access MAID.
The legal and policy timeline traces back to 1892, when Canada’s first Criminal Code barred people from aiding or abetting suicide and criminalized suicide.
In 1972, the federal government under Prime Minister Pierre Elliott Trudeau repealed the Criminal Code section that criminalized suicide, while keeping provisions that made it a criminal offence to aid or abet a person ending their life and stating that no person could consent to their life being ended.
After years of debate over assisted suicide in the House of Commons from 1991 to 2010—without any bill passing—Sue Rodriguez challenged the Criminal Code ban in 1993 after being diagnosed with ALS.
In a 5–4 decision in 1993, the Supreme Court of Canada ruled against Rodriguez, who died with the help of an anonymous physician in 1994.
In 2011, a challenge known as Carter v. Canada was launched by the British Columbia Civil Liberties Association, arguing that Criminal Code sections outlawing assisted death violated the Charter right to “life, liberty and security of the person.”
In 2012, the Supreme Court of British Columbia ruled in favour of the association, but the federal government appealed; the case later returned to the Court of Appeal for British Columbia in 2013, which overturned the lower court and required the judge to uphold the Supreme Court of Canada’s Rodriguez decision.
Quebec’s legislative approach also advanced during the same period, with the Quebec National Assembly in 2012 issuing a report concluding MAID should be an additional option for end-of-life care for a consenting adult suffering from a serious, incurable disease in an advanced state of decline.
In 2014, Quebec passed a law allowing MAID for adults in the province who are at the end of their lives, suffering from a serious and incurable illness and in an advanced state of irreversible decline, with the law set to take effect the following year.
In 2015, the Supreme Court of Canada struck down Criminal Code provisions that prohibited aiding and abetting suicide and the rule that no one could consent to have death inflicted on them, saying the prohibition was “cruel” and violated Section 7 Charter rights for competent adults with a grievous and irremediable medical condition causing enduring and intolerable suffering.
The Court gave Parliament one year to create a legal framework, and that grace period ended in February 2016, while training development for physicians began with the Canadian Medical Association in 2015.
In June 2016, Parliament passed Bill C-14, making it legal for doctors to help a person end their life if they had a terminal illness; the Senate sought to expand the right beyond those whose deaths were “reasonably foreseeable,” but members of Parliament voted against those amendments.
The next major shift came in 2019, when the Superior Court of Quebec ruled that limiting MAID to people whose natural deaths were reasonably foreseeable was unconstitutional in the case of Jean Truchon and Nicole Gladu, and both the federal and Quebec governments chose not to appeal.
In 2021, Parliament passed a law removing the requirement that death be reasonably foreseeable, creating “track 1” and “track 2” MAID; track 2 required additional eligibility criteria, including a 90-day assessment period and involvement of a practitioner with expertise in the condition causing the applicant’s suffering.
That 2021 law also excluded people whose sole underlying condition was mental illness, and the exclusion was scheduled to last two years until March 2023, with an independent expert review ordered to be completed within a year.
In 2023, the Liberal government extended the mental illness exclusion by one year to “provide additional time to prepare for the safe and consistent assessment and provision of MAID,” and it pointed to the prospect of considering a report from a special committee of MPs and senators studying MAID.
Also in 2023, Quebec passed amendments to its own assisted dying laws to allow advance requests that would take effect if a person loses capacity to request MAID.
Most recently in 2024, the government delayed eligibility for people whose sole underlying condition is mental illness until March 2027.
Earlier background also includes that Parliament began dealing with assisted suicide safeguards decades before the 2015 ruling, including Senate committee concerns in 1995 about implications of permitting assisted suicide, alongside suggested minimum safeguards such as competence, an irreversible condition at an intolerable stage, and a free and informed request without coercion.
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