ANALYSIS: What Alberta’s Bill Reveals About the Lack of Safeguards for MAiD

New legislation introduced in Alberta sets restrictions and safeguards on medical assistance in dying (MAiD).

Bill 18, the Safeguards for Last Resort Termination of Life Act, restricts MAiD to Track One, where death is reasonably foreseeable within the next year. It also blocks the proposed 2027 planned expansion to provide medical euthanasia to individuals where mental health is the sole condition, as well as future expansions for advanced requests and mature minors.

“It’s a positive step in the right direction. It’s the first piece of legislation in a decade that is serious about putting meaningful guardrails into practice,” Jeff Hall, a disabled PhD student at the University of Toronto who writes about MAiD and education told the Canadian Health Sentinel. Though he understands the skepticism and distrust of Alberta’s UCP, “no other policy put forward in Canada has been in line with disabled writers, activists, and researchers, but also the UN Convention on the Rights of Persons with Disabilities.”

Bill 18 Aligns with Human Rights Concerns 

In the press conference for the Bill, Premier Danielle Smith recalled how those who spoke out about the initial MAiD provisions for terminal illness, because they were concerned of its expansion, were told that’s a slippery slope argument.

When Canada proposed expanding MAiD to those whose death was not reasonably foreseeable with Bill C-7 in 2021, Gabrielle Peters and Catherine Frazee co-founded the Disability Filibuster, a national grassroots initiative started on the eve of the passing of the bill, running a 60-hour Zoom protest. Peters, a disabled writer and policy analyst, said the implementation and expansion of MAiD was a result of the federal and provincial government choosing to ignore the warning, advice, and analysis from disabled individuals.

Reporting and data on MAiD shows that the fear of a slippery slope wasn’t unfounded. Eight years after its federal introduction, deaths by medical euthanasia have dramatically increased, now accounting for about one in 20 deaths in Canada.

It took the Netherlands more than twice as long to match the same rate while Belgium which approved medical euthanasia in 2002 still lags behind. The speed of growth combined with the lack of guardrails is raising alarms in Canada, and is seen as a cautionary example in the U.K., which is currently debating medical euthanasia, and Scotland which recently voted to reject it.

The legislation would not prevent the majority of MAiD recipients, who have a terminal illness from accessing it under Track 1. While some of the safeguards may affect Track 1, the biggest impact of Bill 18 is on Track Two, where death is not reasonably foreseeable. Track 2 currently accounts for roughly 4.4% of MAiD deaths.

Many critics have dismissed the bill as religious and ideological, ignoring the voices of disabled Canadians and international bodies. While the Canadian government “made the decision not to listen to our warnings,” Peters said, “other bodies did, including the United Nations Committee on the Rights of Persons with Disabilities.” The contents of Bill 18 also align with recommendations set out by this Committee which monitors how well countries adhere to the Convention on the Rights of Persons with Disabilities, which Canada has ratified. 

The committee has also called to eliminate Track 2, added in 2021, which allows for people to access MAiD when death is not foreseeable. The committee raised concerns that Track 2 leaves Canadians who are vulnerable due to poverty, lack of healthcare access, and other sociodemographic factors open to coercion.

These concerns are not recent either. “Disabled writers and activists like Catherine Frazee have been warning this country for at least 30 years about euthanasia and assisted suicide,” said Hall. “Since the murder of Tracy Latimer in 1993, disabled communities and organizations have been writing and rallying about the dangers that MAiD presents to disabled people.” Latimer, a twelve-year old girl with a severe form of cerebral palsy, was killed by her father to prevent what he perceived as a lifetime of suffering.

“Disability advocates maintained prior to legalization that it is impossible to have such a thing as safe MAiD in a society where disabled people are devalued and oppressed,” said Peters.

Rather than accessing medical euthanasia as a last resort, the committee is worried that people are accessing it due to a lack of adequate healthcare, income, and community supports. The pace of MAiD expansion has outpaced investment into palliative care and other supports.

Palliative care remains inaccessible as only 30% to 50% of Canadians have access, with those who are poor, Indigenous, homeless, or living in rural areas least likely to receive it — the same populations the UN committee identified as most vulnerable to coercion. If many Canadians cannot access palliative care, then MAiD is not a meaningful last resort.

As I reported in The Breach, the federal government has made no meaningful effort to publicly respond to these recommendations.

These concerns are not hypothetical. Provincial review committees in both Ontario and BC have documented cases of inappropriate MAiD provisions.  Worryingly, practitioners who failed to uphold their duties as laid out by federal legislation, faced no criminal charges.

In 2023, Ontario Chief Coroner’s Office noted 178 MAiD compliance problems, with one in four providers in the province having at least one compliance issue. In six percent of these cases, practitioners who received a compliance notice for providing Track 2 MAiD noted that they were not experts in the illness causing the person's suffering and had not consulted an outside expert on the condition — as mandated by federal law.

The bill addresses other gaps in federal legislation as well. It bans referring patients out-of-province for assessments, and requires that patients themselves initiate any conversation about MAiD — meaning healthcare practitioners can no longer raise it unsolicited. Facilities are also prohibited from displaying MAiD information, a measure aimed at reducing undue influence.

Before formally becoming a new patient, Peters now has to make sure that they will not bring up MAiD in their appointments. “We’re going to have this conversation once, and we are never having this conversation again,” she tells them. “I have to do this with every specialist and every doctor I see so that I’m not sucker punched while possibly already upset dealing with whatever health issue I’m facing at the moment.”

Disability Filibuster has also heard from people who said they would no longer go to the hospital because they didn’t want to be offered MAiD unsolicited.

On the practitioner side, the bill mandates professional training for anyone providing or assessing MAiD, requires providers to contact every primary care provider from the past year and review the patient's full records, and establishes licensing sanctions for those who break the law.

Dr. Ramona Coelho, an Ontario physician who sits on the independent MAiD Death Review Committee and fellow at the Macdonald-Laurier Institute told the Canadian Health Sentinel that one of the shortcomings of the bill is the 12 month period for Track 1, which she believes should be shortened as life expectancy is difficult to project that far out, even among those with terminal illness.

“I wish they had defined natural death as not being self induced,” said Coelho. Some individuals, she said, could state their intention is to refuse care like antibiotics or refuse to eat or drink precipitating the natural death.

Same-Day MAiD Provisions

While it isn’t explicitly stated, Coelho said the restrictions and safeguards in the bill would make it almost impossible for same-day MAiD. Though federal legislation establishes a ten day wait period, that can be waived. Because it isn’t federally reported, the exact number of same day MAiD deaths across the country is unknown.

In 2024, 154 people in Ontario accessed Track 1 within the same day that they applied. The Ontario MAiD Death Review Committee, an independent group of experts established by the Office of the Chief Coroner, highlighted one such troubling case.

A woman in her 80s, referred to as Mrs. B, met with a MAiD assessor after experiencing complications from an artery bypass surgery. During the assessment, she said she wanted to continue at-home palliative care. The next morning, Mrs. B and her spouse visited an emergency room and were later discharged after determining she was fine.

Her spouse said they were experiencing caregiver burnout, so Mrs. B’s doctor requested she be moved to palliative care. The request was denied because the burnout did not make her eligible. Mrs. B’s spouse called the provincial MAiD team and requested an urgent assessment.

The new MAiD assessor found she was eligible although the one from the previous day expressed concerns. As a result, they found a third MAiD assessor that conducted a virtual assessment, approving the provision. Mrs. B died of MAiD later that evening.

Challenging the Federal MAiD Law

If the bill goes through legislation, it may lead to a showdown in Ottawa. It is unclear whether a federally permitted practice could be contested within a province. But there is precedent for allowing individual provinces to deviate from federal MAiD legislation without consequences.

Isabel Grant is a professor at the Peter A. Allard School of Law, The University of British Columbia, told the Canadian Health Sentinel she doesn’t believe that the legislation contradicts federal law because provinces have jurisdiction over health care. “There’s going to be room for provincial differences as there is in other healthcare contexts,” she said. Other legal scholars share similar views.

Meanwhile, Quebec which also deviates from federal MAiD law has largely been left alone. “What Quebec has done is more extreme because they have expanded the exemption from murder in aiding suicide,” said Grant.

In May 2024, Justice Minister Arif Virani responded to an e-petition requesting an amendment to allow MAiD advance requests, writing that they violate the Criminal Code and that the government has no plans to amend it.

Yet in October 2024, Quebec allowed people with dementia or Alzheimer’s to make an advanced request for euthanasia, while the federal government acquiesced, in contradiction to the e-petition response. Ottawa said they would not charge practitioners that break the law and would consider potential expansion. 

“I have no doubt there will be a federalism challenge to this bill,” said Grant. Individuals in Alberta might challenge the law on the grounds that it contradicts federal legislation. “The constitutionality of this bill will depend on whether there is a Charter Right for Track 2 MAiD.” Grant does not believe it does.

Bill 18 isn’t a panacea. It won’t improve access to healthcare, lift disabled Albertans out of legislated poverty, or even stop the province from clawing-back the Canada Disability Benefit. But, it provides tangible protections in line with some of the recommendations from the UN Committee on the Rights of Persons with Disabilities that have gone ignored, filling the gaps in federal legislation.

“Both Catherine Frazee [of Disability Filibuster] and I applaud the Alberta government for understanding the urgency and putting forward this life-saving Bill,” said Peters. “We look forward to its passing and expect other provincial and territorial governments to follow Alberta’s example.”

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I'm a science and health journalist who is disappointed and fed up with the lack of news coverage surrounding Long COVID, ME/CFS, chronic illness, and disability issues in Canada. I decided to start this newsletter to provide a home for the news stories that don’t get coverage in Canada’s news ecosystem, which lacks outlets for good, science-based reporting.