Canada introduces bill allowing advance requests for euthanasia after loss of mental capacity

On October 27, 2026, Justice Minister Sean Fraser introduced Bill C-41, amending Canada's Criminal Code to permit advance requests for medical assistance in dying (MAID) for adults diagnosed with capacity-limiting illnesses while permanently barring access where mental illness is the sole underlying condition. The legislation requires two independent medical confirmations, sets a mandatory 30-day pause if a patient resists, and leaves regional implementation to individual provinces, drawing criticism from advocates like Inclusion Canada CEO Krista Carr.

Safeguards for advance requests

• ▪Bill C-41 establishes penalties of up to five years in prison for medical practitioners or nurse practitioners who knowingly fail to comply with statutory advance request safeguards.
• ▪Under Bill C-41, an advance request for medical assistance in dying requires written confirmation from two independent medical or nurse practitioners verifying that the applicant meets all eligibility criteria.
• ▪Bill C-41 requires advance requests for medical assistance in dying to specify individual execution criteria using observable clinical manifestations prepared alongside a medical or nurse practitioner.
• ▪Bill C-41 requires practitioners to halt medical assistance in dying if a patient demonstrates refusal or resistance by words, sounds, or gestures, and mandates a 30-day waiting period before reassessment.

Ban on sole-condition mental illness MAID

• ▪Bill C-41 explicitly amends the Criminal Code to bar individuals from receiving medical assistance in dying when mental illness is their sole underlying medical condition.
• ▪Government officials cited difficulties in assessing decision-making capacity in mental illness cases as a key reason for introducing the permanent ban on sole-condition mental illness MAID.

Timeline for mental illness eligibility

• ▪In February 2024, the Canadian federal government delayed the planned expansion of medical assistance in dying to individuals with mental illness until March 17, 2027.
• ▪Bill C-41 must pass both the House of Commons and the Senate before March 17, 2027, when the temporary pause on mental illness eligibility is set to expire.

Provincial role in advance requests

• ▪Bill C-41 allows advance requests for assisted dying only in provinces and territories that choose to establish their own legislative regimes to regulate and deliver the service.
• ▪Quebec authorized advance requests for medically assisted dying in October 2024 for patients with serious and incurable illnesses, while Alberta passed legislation prohibiting them.

Proposed federal MAID legislation

• ▪The Canadian government introduced Bill C-41 to allow adults diagnosed with serious and incurable capacity-limiting illnesses to make advance requests for medical assistance in dying
• ▪Bill C-41, titled the Medical Assistance in Dying Safeguard Act, amends the Criminal Code to shield physicians from prosecution when providing assisted death under advance directives.

International advance request laws

• ▪Belgium permits advance requests for euthanasia only when a patient becomes irreversibly unconscious, excluding conscious patients who lose decision-making capacity due to dementia.
• ▪International jurisdictions including the Netherlands, Belgium, and Spain recognize advance requests for euthanasia under varying statutory conditions.

History of Canada's MAID regime

• ▪Canada updated its medical assistance in dying legislation in 2021 following a Quebec court ruling that allowed patients with incurable conditions to seek assisted death.
• ▪Canada legalized medical assistance in dying in 2016 for terminally ill patients with reasonably foreseeable death, expanding the regime in 2021 to include incurable non-terminal conditions.