Canada: Physician-Assisted Dying Part 4: Patient Perspectives

Last Updated: March 7 2016
Article by Erika Lambert

The right to determine what should be done with one's own body is a fundamental right in our society. In Carter v. Canada (Attorney General), 2015 SCC 5, the Supreme Court of Canada confirmed that, for a competent adult suffering from a grievous and irremediable medical condition, this right includes a right to die with assistance from a physician.

What is presently unclear, and what is of particular import to those who seek access to physician-assisted dying, is:

  1.  which criteria must be met to access physician-assisted dying;
  2. who will assess whether those criteria have been met;
  3. who will administer end-of-life drugs;
  4. what support services will be available for patients and their families at the end-of-life; and
  5. whether life insurance claims will be paid for deaths resulting from physician-assisted dying.

On February 25, 2016, the federal government's Special Joint Committee on Physician-Assisted Dying (the "Joint Committee") released a report with recommendations about how the federal government should respond to the Carter decision. The Joint Committee's recommendations with respect to the issues outlined above can be summarized as follows:

Eligibility criteria

The Joint Committee recommended that physician-assisted dying be available to any person who satisfies the following criteria:

  1. Medical condition - The person must have a "grievous and irremediable medical condition" that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition. As "grievous and irremediable medical condition" will not be defined, such a condition can be physical condition, a mental condition or some combination of both. Ultimately, whether a specific condition constitutes a "grievous and irremediable medical condition" will depend, at least in part, on the subjective assessment of the assessing physicians. Notably, the Joint Committee specifically rejected the imposition of a requirement that the condition be "terminal".
  2. Age and capacity - The person must be 18 years of age and must be capable of providing informed consent to physician-assisted dying. Capacity to provide informed consent should be assessed using existing medical practices, emphasizing the need to pay particular attention to vulnerabilities in end-of-life circumstances. The Joint Committee recommended that the federal government immediately commit to studying whether "mature minors" (i.e. persons under 18 years of age who are capable of providing informed consent to health care decisions) should be permitted to access physician-assisted dying.
  3. Clear consent - The person must clearly consent to the termination of their life. Where possible, a request for physician-assisted dying should be made in writing and should be witnessed by two people who have no conflict of interest.
    •  Advance consent - The Joint Committee recommended that advance requests for physician-assisted dying be allowed but only after a person has been diagnosed with a condition that is reasonably likely to cause loss of competence or after a diagnosis of a grievous or irremediable condition but before the suffering becomes intolerable. In effect, this draws a legal distinction between the withdrawal of life-saving medical services (which can be consented to before a person becomes ill) and the provision of life-ending medical services (which can only be consented to after a person becomes ill).
    • Waiting period - The Joint Committee recommended that the federal government work with the provinces and territories and their medical regulatory bodies to ensure that any period of reflection for physician-assisted dying that is contained in legislation is flexible and based, in part, on the rapidity of progression and nature of the patient's medical condition as determined by the patient's attending physician.
  4. Eligibility for publicly-funded health care services - The person must be eligible for publicly-funded health care services in Canada (i.e. no medical tourists allowed).

Assessment of eligibility criteria

The Joint Committee recommended that a request for physician-assisted dying only be carried out if two physicians who are independent of one another have determined that the person meets the eligibility criteria for physician-assisted dying. While the Joint Committee did not clarify this point, "independent" likely means that, at a minimum, the two assessing physicians cannot be in the same practice group, as recommended by the College of Physicians and Surgeons of British Columbia in its Interim Guidelines on Physician-Assisted Dying. It remains unclear whether this requirement will act as a barrier to access in smaller communities, which may have fewer physicians willing to provide physician-assisted dying.

Administration of end-of-life drugs

The Joint Committee recommended that physicians, nurse practitioners, and registered nurses working under the direction of a physician, be permitted to administer end-of-life drugs. It also recommended that pharmacists and other health care practitioners who provide services relating to physician-assisted dying be exempted from the criminal prohibition against aiding or abetting a person to commit suicide. The Joint Committee did not make any recommendation with respect to whether patients should be permitted to self-administer end of life drugs. In its report, the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying recommended permitting self-administration. However, in our view, that recommendation likely warrants further consideration, particularly in light of the risk that complications and adverse events may occur without a health care professional present at the end of life.

End-of-life support services

The Joint Committee noted the need for improved supports and services to accompany the provision of physician-assisted dying, particularly for individuals with psychological conditions and for Indigenous patients. To this end, the Joint Committee recommended that the federal government:

  1.  support the pan-Canadian mental health strategy, Changing Directions, Changing Lives, developed by the Mental Health Commission of Canada and work with the provinces, territories and civil society to ensure that appropriate mental health supports and services are in place for individuals requesting physician-assisted dying;
  2.  work with the provinces, territories and civil society organizations to develop a pan-Canadian strategy to improve the quality of care and services received by individuals living with dementia, as well as their families; and
  3. work with the provinces and territories, and their medical regulatory bodies, to ensure that culturally and spiritually appropriate end-of-life care services, including palliative care, are available to Indigenous patients.

Life insurance

The Joint Committee stated that physician-assisted dying should not affect life insurance. We agree. Life insurance payments can be critically important to beneficiaries after a patient has died. Provinces and territories should ensure that beneficiaries do not have life insurance claims rejected solely on the grounds of the benefactor receiving physician-assisted dying.

At present, it's not clear whether federal and provincial regulators will act on the Joint Committee's recommendations. At a minimum, regulators should carefully consider the recommendations, which were based on oral testimony and written submissions provided by  a wide variety of Canadians, with different views on physician-assisted dying.

This post concludes our four part series on physician-assisted dying. However, we will continue to monitor this important issue and update you as the law in this area develops.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on

Click to Login as an existing user or Register so you can print this article.

Erika Lambert
In association with
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Check to state you have read and
agree to our Terms and Conditions

Terms & Conditions and Privacy Statement (the Website) is owned and managed by Mondaq Ltd and as a user you are granted a non-exclusive, revocable license to access the Website under its terms and conditions of use. Your use of the Website constitutes your agreement to the following terms and conditions of use. Mondaq Ltd may terminate your use of the Website if you are in breach of these terms and conditions or if Mondaq Ltd decides to terminate your license of use for whatever reason.

Use of

You may use the Website but are required to register as a user if you wish to read the full text of the content and articles available (the Content). You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these terms & conditions or with the prior written consent of Mondaq Ltd. You may not use electronic or other means to extract details or information about’s content, users or contributors in order to offer them any services or products which compete directly or indirectly with Mondaq Ltd’s services and products.


Mondaq Ltd and/or its respective suppliers make no representations about the suitability of the information contained in the documents and related graphics published on this server for any purpose. All such documents and related graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or its respective suppliers hereby disclaim all warranties and conditions with regard to this information, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. In no event shall Mondaq Ltd and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use or performance of information available from this server.

The documents and related graphics published on this server could include technical inaccuracies or typographical errors. Changes are periodically added to the information herein. Mondaq Ltd and/or its respective suppliers may make improvements and/or changes in the product(s) and/or the program(s) described herein at any time.


Mondaq Ltd requires you to register and provide information that personally identifies you, including what sort of information you are interested in, for three primary purposes:

  • To allow you to personalize the Mondaq websites you are visiting.
  • To enable features such as password reminder, newsletter alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our information providers who provide information free for your use.

Mondaq (and its affiliate sites) do not sell or provide your details to third parties other than information providers. The reason we provide our information providers with this information is so that they can measure the response their articles are receiving and provide you with information about their products and services.

If you do not want us to provide your name and email address you may opt out by clicking here .

If you do not wish to receive any future announcements of products and services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to view the free information on the site. We also collect information from our users at several different points on the websites: this is so that we can customise the sites according to individual usage, provide 'session-aware' functionality, and ensure that content is acquired and developed appropriately. This gives us an overall picture of our user profiles, which in turn shows to our Editorial Contributors the type of person they are reaching by posting articles on Mondaq (and its affiliate sites) – meaning more free content for registered users.

We are only able to provide the material on the Mondaq (and its affiliate sites) site free to site visitors because we can pass on information about the pages that users are viewing and the personal information users provide to us (e.g. email addresses) to reputable contributing firms such as law firms who author those pages. We do not sell or rent information to anyone else other than the authors of those pages, who may change from time to time. Should you wish us not to disclose your details to any of these parties, please tick the box above or tick the box marked "Opt out of Registration Information Disclosure" on the Your Profile page. We and our author organisations may only contact you via email or other means if you allow us to do so. Users can opt out of contact when they register on the site, or send an email to with “no disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate registration form. This is a personalised service where users choose regions and topics of interest and we send it only to those users who have requested it. Users can stop receiving these Alerts by going to the Mondaq News Alerts page and deselecting all interest areas. In the same way users can amend their personal preferences to add or remove subject areas.


A cookie is a small text file written to a user’s hard drive that contains an identifying user number. The cookies do not contain any personal information about users. We use the cookie so users do not have to log in every time they use the service and the cookie will automatically expire if you do not visit the Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to personalise a user's experience of the site (for example to show information specific to a user's region). As the Mondaq sites are fully personalised and cookies are essential to its core technology the site will function unpredictably with browsers that do not support cookies - or where cookies are disabled (in these circumstances we advise you to attempt to locate the information you require elsewhere on the web). However if you are concerned about the presence of a Mondaq cookie on your machine you can also choose to expire the cookie immediately (remove it) by selecting the 'Log Off' menu option as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies and we are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement, and gather broad demographic information for aggregate use. IP addresses are not linked to personally identifiable information.


This web site contains links to other sites. Please be aware that Mondaq (or its affiliate sites) are not responsible for the privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of these third party sites. This privacy statement applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose any information requested. Information requested may include contact information (such as name and delivery address), and demographic information (such as postcode, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the functionality of the site.


If a user elects to use our referral service for informing a friend about our site, we ask them for the friend’s name and email address. Mondaq stores this information and may contact the friend to invite them to register with Mondaq, but they will not be contacted more than once. The friend may contact Mondaq to request the removal of this information from our database.


This website takes every reasonable precaution to protect our users’ information. When users submit sensitive information via the website, your information is protected using firewalls and other security technology. If you have any questions about the security at our website, you can send an email to

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode), or if a user no longer desires our service, we will endeavour to provide a way to correct, update or remove that user’s personal data provided to us. This can usually be done at the “Your Profile” page or by sending an email to

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will post those changes on our site so our users are always aware of what information we collect, how we use it, and under what circumstances, if any, we disclose it. If at any point we decide to use personally identifiable information in a manner different from that stated at the time it was collected, we will notify users by way of an email. Users will have a choice as to whether or not we use their information in this different manner. We will use information in accordance with the privacy policy under which the information was collected.

How to contact Mondaq

You can contact us with comments or queries at

If for some reason you believe Mondaq Ltd. has not adhered to these principles, please notify us by e-mail at and we will use commercially reasonable efforts to determine and correct the problem promptly.