Canada: Medical Assistance In Dying: Bill C-14 Has Passed But We Are Still Uncertain

Last Updated: July 7 2016
Article by Michelle Moldofsky

The new lawi provides exemptions to the Criminal Code to permit for medical assistance in dying, previously a crime in Canada.

A person cannot consent to have death inflicted upon them (culpable homicide is an offence with up to life imprisonment). It is an offence (up to 14 years' imprisonment) to either counsel a person to commit suicide or to assist them to commit suicide.

The new law provides exemptions to these sections of the criminal code for:

  • medical practitioners and nurse practitioners to provide assistance in dying for eligible patients in accordance with certain criteria now listed in the Criminal Code (s. 241.2);
  • for people who assist the medical practitioners or nurse practitioners as above, specifically including pharmacists who dispense the drugs;
  • for people who assist the patient, at the patient's explicit request, to self-administer a substance prescribed as above; and
  • for health practitioners who provide patients with information about lawful provision of medical assistance in dying.

These exemptions apply even if there is a reasonable but mistaken belief about a fact that is an element of the exemption.

How does it work?

There are eligibility criteria describing the patients for whom the exemption applies. There are safeguards describing the process requirements that medical practitioners and nurse practitioners must follow. New offences have been created:

  • Failure to comply with safeguards has up to a 5-year imprisonment;
  • Forgery or destruction of any document has up to a 5-year imprisonment;
  • Failure to provide information as required by the regulations has up to a 2-year imprisonment (comes into force on June 17, 2017); and
  • Failure to comply with guidelines on completing death certificates has up to a 2-year imprisonment (comes into force on June 17, 2017).

The practitioners are also subject to the requirements of their provincially regulated colleges which will have more detailed processes for practitioners to follow.

Eligibility Criteria

The eligibility criteria are that the patient must:

  • Be eligible for government funded health insurance in Canada (people who would be eligible for government funded health insurance but for a waiting period of residence are also eligible);
  • Be 18 years' old;
  • Be capable of making decisions about their health;
  • Have a grievous and irremediable medical condition, meaning a

    • Serious and incurable illness, disease or disability,
    • Advanced state of irreversible decline in capability,
    • Enduring physical or psychological suffering that is intolerable to them and cannot be relieved under conditions that they consider tolerable, and
    • Natural death has become reasonably foreseeable (prognosis as to specific length of time remaining is not required);
  • Make a voluntary request that is not made as a result of external pressure; and
  • Give informed consent after being informed of means available to reduce suffering such as palliative care.


The safeguards include requirements that the medical practitioner or nurse practitioner must ensure that the patient meets the eligibility criteria and that documentation contains the required signatures, including being signed and dated by two independent witnesses. Practitioners must obtain a written opinion from an independent second practitioner that the patient meets the eligibility criteria.

There must be an opportunity for the patient to withdraw the request and there must be 10 clear days between the date of signature of the request and the date that assistance in dying is provided (unless the patient's death or loss of capacity to consent is imminent).

There are other safeguards including who can be a witness to the consent, that witnesses need to understand the nature of the request, and what information needs to be provided to a pharmacist who is asked to fill a prescription for the purpose of assistance in dying.

But, what do health care institutions need to do?

There is uncertainty inherent in this implementation stage of the new law. As stated in my last LinkedIn post on the subject dated June 17, 2016, an excerpt of which follows, health care institutions can assist their patients and practitioners by clarifying certain matters in internal institutional policies.

Hospitals and health care organizations will need to consider updating their policies to deal with the following issues:

Patient access to medical assistance in dying at the institution

Hospitals, long-term care homes, hospices, palliative care facilities and other health care institutions should have a clear process to manage requests for medical assistance in dying. If there are limitations to access in a particular institution, it is important for patients to know so that they may make informed decisions.

The Ontario government is encouraging institutions to develop policies with respect to medical assistance in dying, especially with respect to ensuring that patients understand what access is available in the institution and with respect to arranging patient transfers for a consultation about palliative and end-of-life optionsii.

Institutions should indicate any requirements on physicians to notify the institution of a request.

Institutions will likely be asked by their nurses and pharmacists about the steps that should be taken in light of a request for medical assistance in dying. Both the College of Nurses of Ontarioiii and the Ontario College of Pharmacistsiv have posted guidelines for their members. In some cases, guidelines suggest that the individual health practitioner seek legal advice. As employees of health care institutions, they may be contacting their employer for assistance in this regard.

A policy from the College of Physicians and Surgeons of Ontariov sets out the responsibilities of physicians who conscientiously object to providing medical assistance in dying or consultations to that effect. Effective referrals are required and, as such, physicians will need their institutions to have procedures for the effective transfer of patients to access the referred physician.

The Ontario College of Pharmacists policy, Professional Obligations when Declining to Provide a Pharmacy Product or Service due to Conscience or Religionvi, sets out similar requirements.

There is a clinician referral service provided by the Ontario government (E-mail:; Phone: 1-844-243-5880).

Process for accessing medical assistance in dying

The CPSO policy statement #4-16, Physician-Assisted Deathvii, sets out the process map that physicians will need to follow, including two requests from the patient with a reflection period in between the requests, obtaining a consult from a second physician confirming that the criteria have been met, and a required notification to the coroner. Patients are to be informed that the coroner will investigate the death and that whether or not an autopsy will be included is not determined in advance.

Conscientious objection to medical assistance in dying

Medical practitioner and nurse practitioner involvement in medical assistance in dying with respect to eligible patients has been decriminalized. The new law does not compel anyone to provide medical assistance in dying. However, human rights legislation in each province still applies to the provision of health care services.

Conscientious objection by physicians in Ontario is governed by CPSO policy #2-15, Professional Obligations and Human Rightsviii, which does require an effective referral to a practitioner who is willing to provide the services to which the referring physician has objected. Health care institutions should consider the implications of an effective referral, including how patients seeking medical assistance in dying will be transferred to a willing physician.


[i] An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying), Assented to on June 17, 2016:

[ii] Ministry of Health and Long-Term Care and Ministry of the Attorney General, Medical Assistance in Dying: Update Stakeholder Presentation, June 6, 2016

[iii] Check the website. June 20, 2016 update:

[iv] Check the website. June 27, 2016 update:

[v] Policy #2-15, Professional Obligations and Human Rights,



[viii] Op. cite v. For news regarding an application to court that this policy violates the Canadian Charter of Rights and Freedoms, see CPSO News Release "Statement from the College of Physicians and Surgeons — Professional Obligations and Human Rights", Mar 24, 2015:

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.

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.