Canada’s federal government has tabled legislation to prevent people whose sole underlying condition is a mental illness from becoming eligible for euthanasia, while simultaneously proposing to allow people to request an assisted death in advance of losing mental capacity.
Bill C-41, the MAID Safeguards Act, was introduced on 27 October. It would halt the planned expansion of Canada’s Medical Assistance in Dying (MAID) regime, which was due to come into effect on 17 March 2027 and would have extended eligibility to people suffering from mental illness alone.
The decision follows sustained concerns about whether mental illness could be assessed reliably enough to determine eligibility for euthanasia. A special joint parliamentary committee had recommended against proceeding with the expansion following months of scrutiny.
However, the same legislation proposes a major change to the law on advance requests. It would protect medical practitioners from criminal prosecution for carrying out euthanasia on a patient who had previously consented to the procedure, provided they had since lost the capacity to make decisions.
The provision is intended to apply to people diagnosed with conditions expected to cause a loss of decision-making capacity, such as dementia. An individual would be able to draw up an advance request with the assistance of a doctor or nurse practitioner, specifying the circumstances in which they would want their life ended.
Under the proposed safeguards, the person would have to be experiencing unbearable suffering and be in a state of irreversible decline before euthanasia could be carried out. Practitioners would also be prohibited from administering the lethal substance if the patient demonstrated refusal or resistance through words, sounds or gestures. Where there was uncertainty, a further 30-day waiting period would apply.
The provinces and territories would decide whether to implement the system. Quebec already permits advance requests in certain circumstances, while Alberta has banned the practice.
The proposal has prompted serious concerns from disability rights advocates, who argue that a decision made before the onset of dementia cannot take account of how a person may feel or experience life once the condition develops.
“Advance consent is not informed consent,” said Daniel Zekveld, a policy analyst with ARPA Canada. He warned that the legislation would leave a future life-and-death decision to third parties, who would determine when someone should die.
Krista Carr, chief executive of Inclusion Canada, also challenged the principle behind advance requests. “Consent at the time is the most basic protection a person has. Parliament should not take it away,” she said.
Campaign Life Coalition president Jeff Gunnarson criticised the government for combining the two measures, saying that it was offering protection to people with mental illness at the expense of those living with dementia.
The bill therefore marks a significant development in Canada’s euthanasia regime. While it would prevent one planned extension of eligibility, it would also create a route for assisted death without the patient’s consent at the time it is carried out. Bill C-41 must pass through Parliament before its proposals become law.
