Alberta contemplates major changes to assisted suicide rules

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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.

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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.

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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.

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“We want people to consider ideas that we as a province have jurisdiction over,” Amery said in an interview.

The Alberta government is running a public consultation until Dec. 20, which gives Albertans the opportunity to fill out a brief survey, and Amery said the government will also consult with experts in the field on potential reforms to the MAID system.

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 criteria for assisted suicide has expanded since. While MAID was available initially only to those who were near to death, legislative changes have allowed for those with severe disabilities to seek to end their lives and the federal government has said it will begin consultations on so-called advance directives — essentially, a way for a person to decide in advance to die should they lose capacity due to a degenerative illness such as Alzheimer’s or dementia.

The federal government has pushed back legislative changes allowing those with mental illnesses to seek assisted dying until at least 2027.

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“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.

The expansion of MAID has been controversial among disability advocates and federal Conservative Leader Pierre Poilievre has said there will be no expansion of MAID for mental illness, should he become prime minister.

Premier Danielle Smith’s UCP government has long objected to the expansion to include the mentally ill.

But if Alberta adopts any — or all — of the potential reforms up for discussion, it could be a heavy lift for the province, logistically. The policies would also run into some significant ethical challenges if family were involved in these decisions or if confidential medical information was shared, according to University of Toronto bioethicist Kerry Bowman.

“The principle here is autonomy, and autonomy under the Canada Health Act is very powerful, and you’d have to move away from autonomy for that to occur,” Bowman told National Post.

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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.

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“It’s a wise initiative of the Alberta government to think about how to improve oversight,” Lemmens said.

In October, a Nova Scotia woman said she was offered assisted suicide while in hospital for cancer treatment. Others have spoken about being told about assisted suicide while actively seeking treatment for suicidal ideation. In some countries, doctors are explicitly forbidden from telling patients about assisted dying, unless they specifically ask. That’s not the case in Canada, where guidance documents for doctors suggest they bring it up in medically relevant situations. But the provincial government could offer up its own rules on when and how doctors are allowed to discuss MAID with their patients.

“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.

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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.”

In other instances, the courts have intervened to stop assisted suicide. In British Columbia in late October, a judge issued an injunction — while noting it was a “severe intrusion” into medical autonomy — stopping the assisted suicide of a 53-year-old Alberta woman at the request of her common-law partner, who had argued the current MAID rules were not applied properly in her case.

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.

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“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.

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