Canada’s medical assistance in dying (MAID) laws could be changing again. On October 27, 2026, the federal government introduced Bill C-41, the Medical Assistance in Dying Safeguards Act, which would allow advance MAID requests in certain circumstances and stop the scheduled expansion of eligibility based on mental illness alone. The bill has not yet become law.
What is an advance request?
An advance request would allow someone to consent to MAID while capable, for it to be provided after they lose capacity.
For example, someone diagnosed with Alzheimer’s disease could describe the circumstances in which they would want MAID later in their illness. Making the request would not guarantee that MAID would be provided. Eligibility would still need to be assessed at that later time.
Could I make an advance request before being diagnosed?
A client asked me this recently. Dementia runs in their family, and they wondered whether they could get “pre-approved” for MAID in case they develop it in the future.
Under the proposed bill, the answer would be no. Before signing an advance request, the person would need to have been diagnosed with a serious and incurable illness or disease reasonably expected to cause an irreversible loss of capacity to consent to MAID. A family history of dementia, or concern about developing it, would not meet that requirement.
Even after a diagnosis, making an advance request would not amount to pre-approval. The person would still need to meet the eligibility requirements when MAID is to be provided.
Provinces would decide whether to make advance requests available
Each province or territory would decide whether to put the necessary legislation in place, which means the availability of lawful advance-request MAID could vary across Canada.
That legislation would have to identify a storage system for advance requests. It would also need rules addressing:
- How requests are made, signed and witnessed.
- How they are submitted, stored and accessed.
- How they can be withdrawn, amended or replaced.
- How the storage system is updated in a timely manner.
- How advance requests are protected against falsification and unauthorized changes.
The request would have to be stored in the designated system before MAID could be provided.
For Ontario families, this means federal passage of the bill alone would not make advance requests available. Ontario would also need a legislative framework meeting these requirements. Availability and administrative processes could therefore differ across Canada.
How would eligibility differ from the current law?
Under the current Criminal Code, a person generally needs capacity and informed consent, although limited exceptions already permit waiving final consent. They must have a serious and incurable illness, disease or disability, an advanced irreversible decline, and enduring suffering that is intolerable to them and cannot be relieved under conditions they consider acceptable.
The proposed advance-request pathway would differ in several ways:
- Diagnosis: Before signing, the person must have a serious and incurable illness or disease expected to cause irreversible loss of capacity. Disability alone would not qualify.
- Timing: Consent would be given while capable. Suffering and advanced decline would be assessed later.
- Circumstances: The person must repeatedly exhibit the medically recognized circumstances described in their request.
- Suffering: The proposed test is enduring and intolerable suffering that cannot be relieved through reasonable means. It omits the current wording about what is intolerable to the person and what conditions they consider acceptable.
Two independent practitioners would assess eligibility.
How would practitioners determine whether suffering is intolerable?
This is the part of the proposal I find most ambiguous.
The bill requires practitioners to consider the person’s current medical state and available information. They could not conclude that suffering is intolerable solely because the circumstances described in the advance request have occurred.
That provides some direction, but leaves a difficult practical question: how do practitioners determine what is intolerable for someone who can no longer make the MAID decision?
Losing decision-making capacity does not necessarily mean losing the ability to communicate pain, distress or enjoyment. Even so, interpreting those experiences may be difficult. How much weight should be given to the person’s earlier expectations, their present behaviour, and observations from caregivers?
These are questions about how the proposed test would work in practice. To me, they are among the most important details to clarify as the bill progresses.
What about mental illness?
Bill C-41 would stop the expansion scheduled for March 17, 2027, continuing the exclusion where mental illness is the sole underlying medical condition without setting a new expiry date. Mental illness would also be excluded as a basis for an advance request.
The bill would also update federal reporting, including collecting information about MAID provided through advance requests.
For more information, see the Department of Justice backgrounder.
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