Alberta proposed sweeping reforms to medical assistance in dying (MAID) Wednesday, introducing a bill that would restrict MAID to people who only have a year or less to live.
If passed, the legislation would also prohibit MAID for people whose only condition is a mental illness, as well as mature minors and advance requests.
At a press conference, Premier Danielle Smith said the province’s goal is to protect vulnerable Albertans.
“The consequences of the decision [to pursue MAID] are permanent and irrevocable, and because of this, we have an obligation to consider MAID with the utmost care and caution,” she said.
Alberta wants to pass its bill, The Safeguards for Last Resort Termination of Life Act, before the federal government further expands MAID eligibility, Smith said.
“We believe MAID must be a compassionate option reserved only for those who will not recover from terminal illness.”
MAID for mental illness
The Alberta government has “profound misgivings” about Ottawa’s plan to allow MAID for the sole purpose of mental illness in March 2027, Smith said.
“There is a serious risk that vulnerable individuals living with a mental illness may choose this most final of actions when other treatment options are available to them,” she said.
The province wants to focus on hope and recovery, where recovery is possible, she says.
“MAID should not become a permanent response to a moment of crisis or despair.”
To be eligible for MAID, a person must have what the Criminal Code calls an “irremediable and grievous medical condition.” Psychiatrists have long raised concerns that it is impossible to determine whether a patient will recover from a mental illness. International suicide prevention organizations have also spoken against allowing MAID for the sole purpose of mental illness.
A committee of MPs and Senators is currently studying whether Canada’s health-care system is ready to allow MAID for mental illness.
Ottawa is waiting for the committee’s study before making further decisions, Justice Minister Sean Fraser’s office told Canadian Affairs in a statement.
“Provinces and territories are responsible and have jurisdiction over health-care delivery, including end-of-life services, and have the right to develop their own frameworks around MAID,” the spokesperson said.
“We will be guided by [the committee] process and its findings before any decisions are made about next steps.”
Track 2 MAID
During Wednesday’s press conference, Smith and Alberta Justice Minister Mickey Amery were asked repeatedly if they are willing to defend the legislation against possible constitutional challenges.
Laws about MAID are in the federal Criminal Code. But health-care services are regulated by the provinces.
Alberta’s bill also proposes greater restrictions on what is already allowed in federal law.
Canada allows MAID for people with “reasonably foreseeable” deaths, known as Track 1 MAID, and those without “reasonably foreseeable deaths,” known as Track 2 MAID. Track 2 MAID was legalized in 2021 after a Quebec judge found that restricting MAID to those whose deaths are reasonably foreseeable is unconstitutional.
Alberta is proposing to define “reasonably foreseeable” as those with 12 months or less to live. It also proposes to completely ban Track 2 MAID in Alberta.
In March 2025, a United Nations committee recommended Canada repeal Track 2 MAID and stop future expansions, including for mental illness, mature minors and advance requests.
Alberta’s proposals about Track 1 and Track 2 MAID could raise constitutional questions, says Gerard Kennedy, a law professor at the University of Alberta.
The Criminal Code does not define reasonably foreseeable death, so Alberta’s definition could be seen as complementing the federal law, he says.
“It’s meant to give guidance to Alberta health-care providers,” he said.
The ban on Track 2 MAID could also be seen as valid if it is about regulating health care, he says.
“The provincial government can restrict a practice that is legal under the federal law,” he said. “If this is truly a good faith regulation of health care, these two laws could operate alongside each other.”
However, provinces cannot ban something because they think it is morally wrong, because that is what the criminal law is for, he says.
If passed, the legislation could be “vulnerable” to a constitutional challenge that Alberta is overstepping its jurisdiction, he added.
In the press conference, Smith repeated that the Charter of Rights and Freedoms allows for governments to place reasonable limits on individuals’ rights.
“We think that these [restrictions] are reasonable and justified,” she said.
“Sometimes, the courts disagree and they offer to strike down our bills, at which point we have of way of engaging in conversation by invoking the notwithstanding clause,” she said, referring to a clause in the constitution that allows governments to override certain constitutional rights for limited periods.
“The courts will do what the courts will do and I guess we’ll see what kind of judgement they make on that.”
‘Dismayed’
Alberta is also proposing to impose greater requirements on MAID assessors, who assess whether a patient meets all legal eligibility criteria for MAID.
The bill says that MAID assessors must try to consult with primary health-care providers who have seen a patient in the year before they request MAID. It also says assessors cannot refer patients for out-of-province MAID assessments.
A family member must also witness a patient’s request for MAID, unless a health-care provider deems that not possible.
The bill also bans posting information about MAID in hospitals and gives hospitals the ability to refuse allowing MAID assessments and provisions on-site.
Doctors would also be forbidden from discussing MAID with patients who have not asked about it.
For MAID advocates, these restrictions raise concerns.
In a statement to Canadian Affairs, Helen Long, CEO of the advocacy group Dying With Dignity Canada, said she is “dismayed” by Alberta’s proposed legislation.
“What this legislation does is create additional barriers for individuals who are suffering and who wish to exercise choice,” the statement says.
“Limiting the provision of information related to MAID by trusted health care professionals impacts an individual’s ability to provide informed consent. People must be made aware of all available options so they can make a decision that aligns with their values.”
Long also criticized Alberta’s attempt to further define Track 1 MAID and to eliminate Track 2 MAID.
“Limiting the definition of reasonably foreseeable to 12 months prior to death means that some individuals living with dementia or other capacity-diminishing conditions may lose capacity prior to that and will no longer be able to access MAID.”
‘Basic suicidality’
Some supporters of Alberta’s proposals still say they do not go far enough to protect vulnerable people.
Dr. Ramona Coelho, an Ontario family doctor, also spoke at the press conference. Coelho is a member of a committee at Ontario chief coroner’s office that reviews concerning MAID cases.
In one case, a man with cerebral palsy was approved for Track 1 MAID after he decided to stop eating and drinking.
Alberta should “tighten” its bill by clarifying that someone cannot be said to have a reasonably foreseeable death because they refuse to eat, drink or take antibiotics, she told the press conference.
“You cannot make yourself sick enough [for MAID], because basically that’s suicidality.”
Ending life “should always remain the last option,” she said later in an interview.
Putting the definition of natural death at a six-month prognosis instead of 12 would also be better, she says.
“[A patient’s] prognosis becomes less reliable the further out in time you move,” she said.
Krista Carr, CEO of national disability group Inclusion Canada, also said Alberta needs to ensure patients are not counselled to stop eating and drinking so they can qualify for MAID.
Overall, she is happy with Alberta’s proposals.
“We’re extremely pleased,” she said, noting disability groups’ years of opposition to Track 2 MAID. Carr said that she expects a Charter challenge to the bill.
“There’s nothing we can do to stop that,” she said. “That shouldn’t be stopping any government, including the federal government, from doing the right thing.”
But while she supports this bill, she wants the Alberta government to do more to support individuals living with disabilities.
“It behooves the government of Alberta to invest heavily in supporting people with disabilities to have really good lives. This is not a mutually exclusive action.”
