Content warning: This story deals with death and dying in plain language, including the process used in assisted death.
Medical Assistance in Dying (MAID) became legal in Canada in 2016 and underwent legislative review and changes again in early 2021.
While many in B.C. are familiar with it, others may not be, at least until they or a relative considers it.
What is it
MAID is when a doctor or nurse practitioner provides medication that causes the death of the person who has requested it or when they give the patient the medication that they can self-administer to cause death.
There are several criteria to be able to qualify for assisted death in B.C. and Canada, including having a grievous and irremediable condition. This means, among other things, that the person is in an advanced state of decline that cannot be reversed.
Also, the condition the person suffers from can not be relieved in ways that the person considers acceptable.
Further, right before MAID is provided, the practitioner must give the person an opportunity to withdraw their request and ensure that they are still able to express consent.
A person requesting MAID falls into one of two so-called tracks.
According to Health Canada, Track 1 applies to those whose natural death is reasonably foreseeable. Track 2 is for folks whose natural death is not reasonably foreseeable.
In simple terms, there are more obstacles for those who are in Track 2.
According to recently released federal government data, in 2023, 95.9% of MAID cases were people whose death was reasonably foreseeable (Track 1), and 4.1% were individuals in Track 2.
Steps to access MAID
Alex Muir, chair of the Metro Vancouver chapter of the charity Dying With Dignity Canada, notes that in B.C., each of the five regional authorities, plus the First Nations Health Authority, have MAID teams set up within them.
"They are really good at helping people navigate the system and navigate through the whole procedure and how it happens," he said.
The ill person who wants assisted death has to fill out a request form, which has to be witnessed by someone. The form then goes to the regional health authority.
For folks in the Sea to Sky Corridor, that would be Vancouver Coastal Health Authority (VCH)
Then, the applicant has to have two independent medical assessments done to prove eligibility.
"These assessors basically have to make sure that the person meets the criteria," Muir said.
"Once you're approved, then you can set the date ... which you can also change at any time."
Track 2 folks, as noted, have to reach a much higher bar to be approved for MAID.
"You have to go through an assessment, and one of the two doctors has to have expertise in the condition that you're suffering from, and then they have to go through all the different supports that the person may not have considered," Muir said, adding, for example, mental health supports or other services that haven't yet been tried.
There's a 90-day minimum waiting period.
"To make sure that the person has had access to these different resources, which may change their mind," Muir said.
It should be noted that some people suffering solely from a mental illness may be able to access MAID as of March 17, 2027, but this allowance will not include neurocognitive and neurodevelopmental disorders or other conditions that may affect cognitive abilities.
Vancouver Coastal Health
For its part, a spokesperson for VCH said the health authority “recognizes the deeply personal nature” of a decision by any individual to seek assisted death.
“We do everything we can to support patients through their medical care journey,” the spokesperson said.
VCH works with the provincial government through the Medical Assistance in Dying Travel and Training Assistance Program (MAIDTTAP), which provides funding to assist health authorities in providing services to residents in rural communities such as in the Sea to Sky.
“VCH Assisted Dying Program works with local medical practitioners to support their local clients, of which there are some in the Sea to Sky Corridor,” the spokesperson said.
“Through that program, VCH has several physicians and nurse practitioners who travel to the Sea to Sky region on an as-needed basis to provide MAID services.”
The number of providers was not given.
What actually happens during a MAID death?
"It's a very peaceful death," said Muir, of having witnessed the process.
First, an IV line is put into the person's arm, and a sedative or calming drug is put in.
"Some people actually fall asleep right then from the first drug," Muir said.
Then, lidocaine, a numbing agent, is provided.
"It goes through your veins so that the person won't feel the other drugs going through," Muir explained.
Next, anaesthesia, similar to what is used in surgeries but about five times the dosage, is injected.
"That puts them into a deep coma," Muir said.
The very last drug stops the lungs and heart muscles from working.
(More on the drugs used can be found on the Dying With Dignity Canada website.)
Dementia and MAID
Currently, someone with dementia can access MAID, but it is tricky, said Muir.
The person applying must be able to understand what they are agreeing to, not only when they request it, but also during their eligibility assessments.
"It is very, very tricky because, at the time of consent, they can't lose mental capacity, right? So, they have to catch them at a time when the assessors say, 'Yes, your condition is grievous and ... you're basically on the downward slope. You're not going to get better.' But you can't be so far along that you've actually lost the capacity to make medical decisions for yourself," he said.
"And so some people have been able to qualify because they've caught it at just the right point, but there are so many people that have missed it because it's just so tricky catching that window. That's why we need advanced requests. So that people aren't caught in this. So it is not luck of the draw, which is what it is right now, quite honestly,” he said.
(See this fact sheet on dementia and MAID.)
What does Dying with Dignity want?
The organization wrote to the newly minted Minister of Health, Josie Osborne, noting the desire for the ability for people with neurodegenerative disorders and dementias to be able to request MAID in advance.
This would mean a change in legislation.
Thus, Dying with Dignity is asking the B.C. legislative assembly to pass an amendment to the Health Care and Care Facility Act to add an advance request option for MAID.
"This change would benefit those with early-stage dementia and other degenerative disorders, furnishing them with a mechanism to defer MAID until the occurrence of future triggering conditions, without risking the inability to proceed at that time should the applicant lose capacity in the interim," reads the letter to the health minister, which was forwarded to The Squamish Chief.
Muir said advance requests for dementia are the "number one" question the organization gets asked about.
MLA response
West Vancouver-Sea to Sky MLA Jeremy Valeriote is relatively supportive of the move to add advanced requests.
"Noting this is a federal area of legislation and responsibility, I do support the measure of advance directives for medical assistance in dying," he told The Squamish Chief. "I understand there is concern that MAID has proceeded quickly since the Supreme Court order to provide for it and agree we need to be very conscious of the possibilities of it being used improperly. It should be carefully regulated and never be more accessible than essential supports like health care, mental health care, or housing," he added.
"In the case of degenerative cognitive decline, it should be possible for a person to set their conditions in advance if they expect to at some point be deemed mentally unfit to make such a decision. I fundamentally agree with the right of all people to die on their own terms and at a time of their choice, and this request from Dying with Dignity Canada is a reasonable extension of the current framework."
Muir said that he often hears the concern that MAID could be applied to vulnerable populations, like the unhoused.
That concern is misplaced, he said.
"They have to meet the medical criteria," he stressed. "That's the most fundamental thing, is you have to have a grievous and irremediable medical condition to qualify for MAID. No assessor is going to approve you without that. You see these stories out there about people who are able to access it, who are in those situations ... they have to have a grievous and irremediable medical condition. That's what qualifies them. It's not the fact that they're poor."
Provincial government position
Asked if the provincial government would be willing to change the legislation to allow for advanced requests, a spokesperson for the Ministry of Health said, basically, not until the federal government changes the Criminal Code.
“All provinces and territories in Canada must adhere to the federal legislation for MAID to provide this service, as mentioned on Health Canada’s website,” the spokesperson said in an email to The Squamish Chief.
“The federal legal framework for MAID is set out in the Criminal Code, which outlines the eligibility criteria and stringent safeguards that apply across Canada, including with respect to consent for MAID … In Canada, the provision of MAID based on an advance request is not allowed at this time.”
Muir notes that Quebec residents do have access to the option of prior, written advance requests for assisted death, even though the federal government still needs to change the Criminal Code to allow for advance requests.
"We want to make sure that people don't suffer at the end of life," said Muir.
Asked about going the route of Quebec, the Ministry of Health spokesperson didn’t respond directly to what was possible for B.C.
“The province of B.C. supports the federal government’s consultation with the public. It is essential that any expansion of the eligibility criteria for MAID fully considers the well-being and rights of individuals, as well as additional legislated safeguards that may be required,” the spokesperson said.
“B.C. looks forward to the results of the consultations and further discussions with federal, provincial and territorial partners to ensure the safe as well as appropriate delivery of MAID in our province.”
By the numbers
The Fifth Annual Report on Medical Assistance in Dying in Canada, 2023, notes that last year, 19,660 requests for MAID were made to Health Canada, with 15,343 people dying with it; the remaining cases include 2,906 people who died before receiving MAID, 915 individuals were deemed ineligible, and 496 individuals withdrew their request.
Dementia was reported as a medical condition in 241 people who received MAID in 2023. Dementia was the only medical condition in a little less than half of those.
In 2023, the median age of MAID recipients was 77.6.
Requests from British Columbia accounted for 18% of those provided.
The top reason for being denied MAID in 2023 was a ‘no’ to the question: "Was the person capable of making decisions with respect to their health?"
The federal government is currently seeking input on the issue of advance requests.
Go to: Share your thoughts: Advance requests and medical assistance in dying to participate.
The survey opened this month and will close to new input on Feb. 14, 2025.
