Alberta is launching a public consultation on its medical assistance in dying (MAID) laws amidst heightened public scrutiny over the law’s impact on vulnerable people.
On Nov. 18, the province launched an online survey that seeks Albertans’ views on MAID and whether its current safeguards are adequate.
“I’m surprised every province isn’t surveying people to find out … ‘How comfortable are you with the safeguards?’,” said Donna Wilson, board vice-chair of the Alberta Hospice Palliative Care Association.
The survey includes questions on whether current MAID safeguards are adequate, whether patients with both physical and mental illnesses need additional safeguards, and whether family members should be able to challenge MAID assessors’ decisions or access their relatives’ medical records.
The government is also meeting with individuals and organizations involved with MAID, including those in the health-care, disability, Indigenous and religious sectors.
“We are reviewing how MAID is regulated to ensure there is a consistent process as well as oversight that protects vulnerable Albertans, specifically those living with disabilities or suffering from mental health challenges,” Alberta Justice Minister Mickey Amery told Canadian Affairs in an emailed statement.
MAID for mental illness
Alberta’s public consultation comes on the heels of some high-profile cases of Canadians being approved for MAID in contentious circumstances.
Last month, a B.C. judge stopped a B.C. MAID provider from administering MAID to an Albertan woman with bipolar disorder who had been denied MAID in Alberta.
In March, a Calgary judge ruled a 27-year-old woman who reportedly had autism and ADHD could receive MAID, despite her father seeking a court order to stop it.
Alberta was already prioritizing a review of MAID before these cases arose. In her 2023 mandate letter to Amery, Premier Danielle Smith instructed the justice minister to recommend regulations for Alberta’s medical profession regarding MAID for mental illness.
Amery said the Alberta government does not agree with allowing MAID for people whose only medical condition is a mental illness — a practice Ottawa is set to legalize in 2027.
But the government is seeking Albertans’ views on whether they think these individuals should be eligible. Wilson, of the Alberta Hospice Palliative Care Association, says asking Albertans this question is “quite proactive.”
Even though MAID was legalized by changes to federal law, provinces can still pass their own laws about medical aspects of MAID, says Eric Adams, a law professor at the University of Alberta.
Provinces can pass laws about where MAID can be administered, or how medical professionals who object to it can refuse to participate, he says. Provinces could also choose to define terms like “mental illness” with more precision.
“What they cannot do is define those terms in such a way that frustrates the purpose of the federal law,” he said. If Canada legalizes MAID for mental illness, provinces cannot recriminalize it or ban MAID outright, he says.
‘Need in that moment’
MAID deaths are rising in Alberta. According to the Alberta Health website, 977 Albertans died by MAID in 2023, the most in any year since it was legalized in 2016.
Nationally, a majority of Canadians report having concerns about vulnerable Canadians seeking MAID because they cannot access social support or health care, according to a Nov. 21 Angus Reid poll, conducted in partnership with Cardus, a think-tank that opposes MAID.
The data show 62 per cent of Canadians are “worried about financially or socially vulnerable people considering MAID because they can’t access adequate, quality care.”
Nearly half — 49 per cent — of respondents with disabilities that severely affect their daily lives said they “strongly agreed” they were worried about vulnerable Canadians accessing MAID because they could not access quality health care.
Despite these concerns, public support for MAID remains high.
Three-quarters of poll respondents said they support MAID under the eligibility criteria set out when the practice was legalized. At the time, MAID was restricted to people suffering intolerably from an incurable disease, illness and disease whose deaths were reasonably foreseeable.
In 2021, the government removed the requirement that a person’s death be reasonably foreseeable, creating what is called Track 2 MAID. According to the Angus Reid poll, 63 per cent of people support Track 2 MAID.
Trish Bowman is chief executive officer of Inclusion Alberta, an organization that supports individuals with intellectual disabilities. She estimates that six individuals have called the organization in the last year saying they were considering MAID. Inclusion Alberta was able to help them find disability supports and none opted for MAID, she says.
“We have been able … [to] get supports in place and continue to be present with them,” she said. “[O]ften, if people know there’s somebody there who will try to figure [their supports] out — that’s what they need in that moment.”
Inclusion Alberta is affiliated with Inclusion Canada, a national organization representing people with intellectual disabilities. Inclusion Canada, along with other disability organizations, launched a Charter challenge in September arguing Track 2 MAID should be repealed altogether.
Bowman supports the Charter challenge.
“[Track 2 MAID] further marginalizes, stigmatizes and devalues the lives of people with disabilities as not worth saving,” she said. “They already live with a tremendous disadvantage, and this reinforces an unconscious belief that it’s literally better not to be alive than to live with a disability.”
Bowman said she hopes Alberta’s consultation leads to a dispute resolution mechanism for families challenging MAID decisions and increases oversight for MAID.
But she also wants supports for people with disabilities to increase.
“You need to ameliorate the conditions that people find themselves in where they feel like [MAID] is the only alternative,” she said.
‘Too paternalistic’
Dying with Dignity Canada, a charity that advocates for increased access to MAID, said it hopes Alberta’s consultation confirms that Alberta’s MAID system is working and that health institutions — particularly religiously affiliated hospitals — cannot refuse to participate in MAID, said Helen Long, the organization’s CEO, in an email.
“What we hope does not happen is additional barriers to assisted dying that are too paternalistic and do not support patient choice,” Long’s statement says. “The process cannot assume that everyone is vulnerable; it must continue to be based on compassion and patients must be assessed case by case.”
Wilson, from the Alberta Hospice Palliative Care Association, says she appreciates the government acknowledging the importance of conversations about death and dying.
“So many people avoid talking and thinking about the end of life, and then it’s a huge shock and crisis, and it shouldn’t be,” she said. “All of us are going to meet our end at some point.”
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