Question Period Note: MEDICAL ASSISTANCE IN DYING (MAID) – SAFE IMPLEMENTATION OF BILL C-7

• Work is underway to implement a number of federal commitments as a result of new legislation on medical assistance in dying that passed in March 2021. The new law removes the eligibility requirement for a person’s natural death to be reasonably foreseeable and includes additional safeguards for these new types of requests. The law also mandates a Parliamentary Review of the legislation and an independent review of MAID for persons suffering from mental illness.

KEY MESSAGES

• The new law introduces significant changes in Canada’s framework for medical assistance in dying (MAID). It removes the requirement that an individual’s death must be reasonably foreseeable in order to be eligible, while including additional safeguards for this broader group of individuals. Data collection for the federal monitoring system has been enhanced to provide more comprehensive picture of who is requesting and receiving MAID.

• While these changes arise from a Court decision, they respond to the wishes of Canadians expressed through public consultations and debated fully in the House of Commons and the Senate.

• The Government continues to work closely with provincial and territorial governments, medical experts and other stakeholders to support the safe implementation of Bill C-7.
IF PRESSED ON THE PARLIAMENTARY REVIEW PROCESS …

• The Government of Canada recognizes that other important issues related to MAID remain to be explored.

• As set out in the legislation, a parliamentary review of the MAID legislation will consider areas such as the eligibility of mature minors, advance requests, mental illness, palliative care and the protection of Canadians living with disabilities.

• The Government will do whatever is required to support this work.
IF PRESSED ON THE IMPACT OF THE NEW LEGISLATION ON PROVINCES AND TERRITORIES …

• We recognize that the changes to the MAID regime present new challenges for provincial and territorial governments and practitioners.

• We are working in close collaboration with provinces and territories to help ensure safe, sensitive and consistent interpretation and application of the law in health systems across the country.

IF PRESSED ON THE TOPIC OF MAID FOR PERSONS WITH A MENTAL ILLNESS…

• The Government of Canada recognizes the concerns and the challenges associated with allowing MAID for individuals suffering solely from mental illness.

• That is why the new legislation included a 24-month sunset clause on the exclusion of MAID requests where mental illness is the sole condition. This was accompanied by a requirement for the Ministers of Health and Justice to initiate an independent review to consider protocols, guidance and safeguards that would be applied to MAID requests from persons who have a mental illness.

• In July 2021, members of the Expert Panel on MAID and Mental Illness were appointed and began their work. A final report containing the panel’s conclusions and recommendations must be completed by March 17, 2022 and tabled in Parliament shortly thereafter.

• Parliamentarians and health professional regulatory bodies and associations will have a year to consider and act on the advice of the Expert Panel.

BILL C-7, AN ACT TO AMEND THE CRIMINAL CODE (MEDICAL ASSISTANCE IN DYING)
On September 11, 2019, the Superior Court of Quebec ruled in favour of two plaintiffs (Jean Truchon and Nicole Gladu) who had challenged the Criminal Code eligibility requirement that an individual’s natural death be reasonably foreseeable and the more stringent provincial requirement for a person to be at the end of life. The governments of Canada and Quebec did not appeal the decision.

On February 24, 2020, the federal government tabled proposed amendments to the 2016 Criminal Code provisions on MAID (Bill C-7) in response to Truchon. The Bill was terminated with the prorogation of Parliament but was re-introduced on October 5, 2020 (its content was unchanged). It received Royal Assent on March 17, 2021.

The new MAID legislation:
• removes the requirement for a person’s natural death to be reasonably foreseeable in order to be eligible for MAID
• introduces a two-track approach to procedural safeguards based on whether or not a person’s natural death is reasonably foreseeable
o existing safeguards are maintained and, in some cases, eased for eligible persons whose natural death is reasonably foreseeable
o new and strengthened safeguards are introduced for eligible persons whose natural death is not reasonably foreseeable
• temporarily excludes eligibility for individuals suffering solely from mental illness for 24 months, and requires the Ministers of Justice and Health to initiate an expert review tasked with making recommendations within the next year on protocols, guidance and safeguards for MAID for persons suffering from mental illness
• allows eligible persons whose natural death is reasonably foreseeable, and who have a set date to receive MAID, to waive final consent if they are at risk of losing capacity in the interim
• requires expanded data collection and analysis through the federal monitoring regime to provide a more complete and inclusive picture of MAID in Canada

PARLIAMENTARY REVIEW OF MAID LEGISLATION
The new legislation also required that a Parliamentary Review be initiated within 30 days following Royal Assent. The review is expected to address (but not necessarily be limited to) the topics of mature minors, advance requests, mental illness, the state of palliative care in Canada, and the protection of Canadians with disabilities.

Members of the Special Joint Committee on Medical Assistance in Dying were named in April 2021 in accordance with the distribution among parties in the House and Senate as stipulated in Bill C-7. The Committee held just 3 meetings before dissolution. It is anticipated that the Committee will be reconstituted in the new Parliament, either this Fall, or early in the new year. Although the new legislation put a 1-year time frame on the completion of its work, Parliamentarians can extend that time frame if all parties agree.

MENTAL ILLNESS: SUNSET CLAUSE AND INDEPENDENT REVIEW
The new legislation included a 24-month sunset clause on the exclusion of MAID requests from individuals where mental illness is the sole underlying condition prompting their request for MAID. The exclusion clause in the legislation sunsets in mid-March 2023, after which time individuals with a mental illness as their sole condition will be able to request and receive MAID, providing they meet all other eligibility criteria including those that define a grievous and irremediable medical condition.

The sunset clause is accompanied by a legislative requirement that an independent review be initiated to consider protocols, guidance and safeguards to apply to MAID requests by persons who have a mental illness as their sole condition.

The Expert Panel on MAID and Mental Illness was launched in July 2021 to undertake this work. It includes experts from a range of disciplines and perspectives, including clinical psychiatry, MAID assessment and provision, law, ethics, health professional training and regulation, mental health care services, as well as lived experience with mental illness. A report containing the conclusions and recommendations of the Expert Panel must be submitted no later than 12 months after the day Bill C-7 came into force (i.e., by March 17, 2022), and tabled in Parliament very shortly thereafter.

MAID STATISTICS AND MONITORING REGIME
Under the original MAID legislation passed in 2016, the federal Minister of Health was obligated to develop regulations for the collection data and annual public reporting on MAID in Canada. The first report was released in July 2020. The second annual report was released in July 2021 summarizing data collected for the 2020 calendar year.

The second annual report indicates that, in 2020, there were 7,595 reported cases of MAID, accounting for 2.5% of all deaths (this percentage is in the median relative to other permissive jurisdictions). This represents an increase of 34.2% over 2019 when there were 5,631 reported cases of MAID. All provinces have experienced a steady year over year growth in the number of MAID cases since 2016. When all data sources are considered, the total number of medically assisted deaths reported in Canada from the enactment of federal legislation in 2016 to December 31, 2020 was 21,589.

CHANGES TO DATA COLLECTION
Now that Bill C-7 has received Royal Assent, Health Canada officials are working on amendments to the regulations to align with the revised eligibility criteria and safeguards as well as other data collection requirements set out in the new legislation. Bill C-7 requires that data be collected with respect to race or Indigenous identity and disability (with the consent of the individual). Expanding the MAID monitoring regime in this way will help to determine whether there are any inequalities or disadvantages based on these or other characteristics in the provision of MAID. The process of regulatory amendments will take 18 to 24 months. The Government is consulting with a broad range of stakeholders, including groups representing persons experiencing inequalities, to help identify the information that needs to be collected and how collection can be undertaken in a way that is respectful, inclusive and does not impose an unreasonable burden on clinicians who are legally obligated to provide the data.

FUNDING FOR MAID INITIATIVES
Expanded access to MAID (as codified in Bill C-7) increases the complexity of eligibility assessments and requires the administration of stronger safeguards aimed at protecting vulnerable people who might be induced to seek an assisted death. Budget 2021 provided $13.2 million to Health Canada over five years, beginning in 2021-22, with $2.6 million per year ongoing, to support the development of training and guidance materials for practitioners, as well as a policy driven research agenda. This investment will contribute to an enhanced knowledge base to support safe, sensitive and consistent implementation of the MAID legislation and safeguards across the country.

KEY FACTS

• In April 2021, a Special Joint Committee on MAID was struck to conduct the Parliamentary Review; it met three times prior to the dissolution of Parliament. The Committee is expected to resume its work once Parliament is re-established, and submit its recommendations by May 2022.

• In July 2021, Ministers of Justice and Health initiated an independent expert panel tasked with making recommendations on protocols, guidance and safeguards for MAID for persons suffering from mental illness. The Panel’s report must be completed by March 17, 2022.