Canadian government introduces major changes to MAID law

The federal government is changing Canada's medical assistance in dying law. New legislation, if adopted, will allow people to make advance directives on accessing MAID. It's also ruled out expanding access to people with mental illness. The CBC's Karina Roman is on the story. She joins us live from Ottawa. So, Karina, what is in this new proposed legislation? So, it does have these two goals. One is to make it not a crime for doctors or nurse practitioners to assist and do a medically assisted death for someone in the case of an advance directive. Right now, the only province where that's being done and where it wasn't technically federally legal to do so is in Quebec. And an advance directive is when someone says, hey, listen, I'm going to I've been diagnosed with a disease that's going to make me incapacitated later in life. And I want to say now that under these circumstances, I want to have MAID, even though at that point, I will no longer have the capacity to make that decision. And it really would allow for MAID for people who right now, if you're diagnosed with dementia, for example, let's say early onset dementia, and you know that eventually you're going to become incapacitated, you can access MAID, but long before you're actually ready to go. And so this allows that hard decision not to have to be made so much earlier. The other goal, as you mentioned, Andrew, is to exclude mental illness as a reason for MAID. The government insisting that there's been a fulsome conversation and consultation about this, and the Canadian health care system is just not prepared to be able to do that, and that there isn't consensus on whether mental illness is truly incurable. But as I sort of laid out, most of the proposed bill deals with this advance directive goal. And it sets out national standards and criteria that would have to be met for it not to be a crime. And that includes that the person requesting does so voluntarily, that they're 18, that they're capable of making the decision. They have to be eligible for government health services, which indicates that you can't have someone coming from another country to do this. And that you can only make the advance request after you've been diagnosed with such an illness that is expected to lead to permanent loss of capacity. There's also safeguards about needing two medical professionals involved, that they have to be told, the patient, about how their possible future symptoms could be relieved as another option instead of made. and obviously there is also a proposed provision for what should be done in the case that a person changes their mind when they're no longer able to really make a decision they don't have the capacity to do that but they're still refusing to go through it what what steps need to be followed to make sure that you're balancing the reality of that person's capacity with the way that dementia manifests itself, for example. And there are rules about storage of these documents, of these advanced directives, and retrieval of them, who can get them to execute them. So these are national standards. There's nothing to say that if a province decides to enact its legislation that it won't add standards, but the big thing is if. So provinces are not going to be mandated to do this, but it's only not going to be a crime if the provinces do enact legislation and this is definitely a question that was put to the Justice Minister. Have a listen. We've not decided to force provinces into this conversation, but we'll leave it to them to determine the extent to which they wish to embrace the next frontier on medical assistance in dying. We've cleared that space. We expect the conversations will start taking place in earnest. This is going to be the start of a national conversation that will largely play out at the provincial level around the extent of access. So what should Canadians take away from what is being proposed? Well, this does set up a potential unequal access in terms of a certain aspect of health care across the country. Because you could have some provinces saying, yes, we're going to do this, and other provinces say they won't. And in fact, one of those provinces, Alberta, recently passed legislation establishing certain safeguards and including not allowing advanced requests. And now we have a statement from Alberta today saying, with the federal government now proposing to allow advance requests in provinces that choose to permit them, we will carefully review the proposed changes and consider what further consultation may be needed in Alberta. But to be honest, that's not like a ringing endorsement of jumping on board with this. Although Minister Fraser did say he is aware of provinces that are interested, the fact that there might be this unequal access could land before the courts, as could the exclusion for mental health, for mental illness. So this is not sort of done and dusted even if and when this bill passes as is. And politically, yes, they have a majority, but it'll be interesting to see how the opposition lands because there might be some support for the mental health exclusion, but not the advanced directives, but they're both combined in one bill. And does the federal government back off if provinces back out? I mean, this is all interesting. Karina, thank you. CBC's Karina Roman in Ottawa.