New changes to MAiD legislation – what doctors need to know about Bill C7

In March of 2021, the federal government passed Bill C7 amending Medical Assistance in Dying (MAiD) legislation, which was established nearly five years ago. The most significant change removes the requirement that a person's natural death be reasonably foreseeable – and introduces a two-track approach with different procedural safeguards depending on whether the person's natural death is reasonably foreseeable or not. Other changes include witness requirements, eligibility criteria, and waiver of final consent.

More than 300,000 Canadians, experts, stakeholders, and Indigenous groups across the country provided feedback during a consultation period in early 2020. The revisions are also informed by the testimony of more than 120 expert witnesses heard throughout Bill C7’s study by the House of Commons and Senate.

What are the key changes to the MAiD legislation?

For individuals whose natural death is reasonably foreseeable, the process remains largely the same: a written request for MAiD is required, a doctor or nurse practitioner determines eligibility, and a second doctor or nurse practitioner must confirm. What’s new here is the elimination of the ten day waiting period between the request and when the procedure can occur, and just one independent witness is required to sign the request (instead of two).

For those whose natural death is not reasonably foreseeable, modified safeguards are in place, and include:

• The patient has a grievous and irremediable medical condition and has made the request for MAiD after being informed of their condition.
• One assessor must have expertise, or consult with someone who has the relevant expertise, in the condition that is causing suffering to the patient.
• There is a required assessment period of 90 days, after which patients who are found to be eligible can receive MAiD.
• The assessors or consultant must ensure the patient is fully aware of and seriously considers other alternatives to MAiD (counselling, disability supports, palliative care, etc.)

Those who suffer solely from a diagnosis of mental illness are not eligible at this time, however this part of the legislation will be reviewed in 24 months. 

A final important change in the legislation is that for those patients whose natural death is reasonably foreseeable, but who lose the capacity to consent between the time the request was made and the time the procedure was to take place, can still have the procedure. This provided that all other criteria were met and in the written arrangement with the doctor or nurse practitioner the patient consented to the procedure even in the event that they lost capacity in the meantime. Patients whose natural death is not reasonably foreseeable must still be capable of providing consent at both points in time.

What if I need more information?

To learn more about reporting requirements, prescriptions, and policy, visit the BC government’s information page for doctors and other health care providers. This page also includes MAiD contact details in each health authority.

You can read more about the legal changes on the website of Canada’s Department of Justice.

You can discover more information on the evolution of federal MAiD legislation by reading the federal government’s 2019 annual report on MaiD in Canada.