The potential policy changes raise questions about medical autonomy and whether such a system would lead to a different MAID regime in Alberta
The Alberta government is contemplating major changes to the province’s assisted suicide regime, including reforms that would allow family members to contest an approved plan to die.
In recent months, Canadian courts have struggled as grief-stricken family members seek a judicial halt on the deaths of their loved ones. In some instances, courts have sided with the person seeking death. In others, courts have ordered injunctions, preventing patients from dying via assisted suicide.
In November, Alberta’s governing United Conservatives announced a round of consultations around medical assistance in dying (MAID). While no policy proposals have been made, the government says possible changes could include a public agency to oversee the MAID process; a dispute mechanism for families; a framework to share confidential MAID-related medical information; provincial limits on MAID eligibility that differ from those set out by the federal government; and limitations on how, and when, health-care providers can share assisted suicide information with patients.
“I’m deeply concerned about abuses when it comes to assisted suicide and its regime within Alberta,” said Dan Williams, Alberta’s minister of mental health and addictions. “I want to make sure that especially those who are vulnerable — those who are disabled, those who have mental-health challenges — are protected, and I don’t want to see a class of citizens that are dispensable because they’re vulnerable.”
However, the potential policy changes raise questions about how they could affect medical autonomy and whether such a system would lead to a different MAID regime in Alberta compared to other provinces. Mickey Amery, the Alberta justice minister, said that despite the policies noted for consideration, to help prompt discussion, no decisions have been made.
“We want people to consider ideas that we as a province have jurisdiction over,” Amery said in an interview.
Since the Supreme Court of Canada ruled in 2015 that criminal prohibitions on assisted suicide were unconstitutional, the issue has been a lightning rod in political, legal and medical circles.
The federal government has pushed back legislative changes allowing those with mental illnesses to seek assisted dying until at least 2027.
“We need to be prepared, and we need to make sure that we’re ready for the challenges that may come at that time,” said Amery.
Chinenye Anokwuru, Amery’s press secretary, declined to say what scope the reforms could take, saying that the provincial government would not presuppose outcomes.
Premier Danielle Smith’s UCP government has long objected to the expansion to include the mentally ill.
In Canada, the decision to seek — and get approval for — assisted suicide is between doctors and patients. However, that hasn’t stopped family members from attempting to stop their loved ones from dying. Nor, for that matter, does it mean family are totally excluded.
“Most health-care practitioners kind of move heaven and earth to make sure that the families are knowledgeable and involved, but make sure it ends when a capable patient says, ‘You do not have my consent to discuss this with my family,’” said Bowman.
Hypothetical situations are easy to imagine: a person who seeks to die while a devoutly Catholic spouse or parents disagree. A person who feels they have exhausted all lines of treatment and wants a soft landing, while family believe they ought to try other therapies. The discussion is further complicated by cases where people have been approved for assisted suicide who are at the nexus of mental illness, physical ailment and socioeconomic distress.
Trudo Lemmens, a bioethicist and health-law expert at the University of Toronto said there ought to be some concerns about how MAID is practised in Canada, and pointed to a report from the Ontario coroner’s office that found trends among vulnerable Canadians seeking assisted suicide.
“It’s a wise initiative of the Alberta government to think about how to improve oversight,” Lemmens said.
“Bringing that up in a context where a patient is actually suicidal and is looking for for support, in a mental health context, these kind of suggestions are running, I would say, counter to standard medical practice,” said Lemmens.
In Calgary, a man known only as W.V. because of a publication ban, sought to stop his 27-year-old autistic daughter, M.V., from proceeding with the assisted suicide for which she had been approved in February 2024. After the approval was granted, W.V. sought a court injunction preventing his daughter’s death and a judicial review of the Alberta Health Services process that had approved her to die.
While the case was eventually abandoned, as M.V. stopped eating and drinking in order to die anyhow, the Alberta Court of King’s Bench sided with M.V., concluding that the courts should not review MAID approvals.
“Parliament has put its trust in doctors and nurse practitioners and it is not for this Court to second guess that choice,” wrote Justice Colin Feasby. “The choice to live or die with dignity is MV’s alone to make.”
One of the major questions that exists around assisted suicide approvals — especially in potential cases of mental illness — is whether a patient has the capacity to consent. A dispute-resolution process, Amery said, would allow for those questions to be addressed by family.
“The question that we have, certainly at a minimum, is whether or not that individual has the capacity to seek MAID,” he said.
One catch, said Bowman, lies in what actually means a patient is capable of making decisions about health care. Basically, by law, if a person is able to understand the decision and its consequences, they’re capable. A person being sick for a long time or extremely stressed does not mean they aren’t capable of making decisions. They might not know what month it is or who’s the prime minister — but that doesn’t mean they aren’t capable of making choices about their health care.
“When you work in a hospital, the amount of patients and families that are nowhere near their best, making big decisions is really, really high,” Bowman said. “So there is a big gap between people’s perceptions of what capacity, health-care capacity is, and what it really is by law.”
That said, there are areas in which similar determinations are made. In Ontario, the Consent and Capacity Board holds hearings to review involuntary psychiatric holds on patients.
“It’s not unreasonable, I think, that in the circumstances of the unusual nature of this procedure, which leads to (an) irreversible procedure, namely death, that there is at least some possibility to have a review of the reasonableness of the review procedure by the physicians,” said Lemmens.
Our website is the place for the latest breaking news, exclusive scoops, longreads and provocative commentary. Please bookmark nationalpost.com and sign up for our newsletters here.