Alberta’s Bill 18 won’t protect the vulnerable—it’ll punish those who’re already suffering.
The province’s proposed restrictions on medical assistance in dying (MAID)—a procedure wherein a patient is given medication to intentionally and safely end their life—will turn a policy meant to safeguard vulnerable patients into one that unnecessarily limits the autonomy of Canadians enduring profound suffering. Currently, anyone can qualify for MAID if they’re at least 18 years old, mentally competent, and are living with a “grievous and irremediable” medical condition
Introduced on March 18, Bill 18, the Safeguards for Last Resort Termination of Life Act, restricts patients from accessing MAID if their death isn’t reasonably foreseeable. Bill 18 seeks to limit MAID eligibility to those whose death is reasonably foreseeable, meaning it’s likely to happen within 12 months, to prohibit MAID for mature minors, mental illness, and advance requests. If passed, it’d would be among some of the most constitutionally reckless pieces of healthcare legislation of late.
The language of protection is easy to weaponize, so it came as no surprise that when the Alberta government introduced Bill 18, on March 18, Premier Danielle Smith framed it as compassion.
“I think that we’re failing in our duty to give people hope,” Smith said to reporters at a press conference. “We believe MAID must be a compassionate option reserved only for those who will not recover from terminal illness.”
No one who has to watch a loved one die in agony would dispute the emotional pull of that framing. But a bad law wrapped up in sympathetic messaging is still a bad law, especially when it aims to strip a constitutional right from those suffering and silences the physicians meant to help them.
Among federal procedural safeguards for the MAID standard practice model is the classification of cases as either Track 1 or Track 2, referring to reasonably foreseeable natural death, which is defined as 12 months or less, and the lack thereof, respectively.
Bill 18 would restrict MAID eligibility to those whose death is reasonably foreseeable and therefore, eliminate Track 2 entirely. It would permanently ban MAID for those whose sole underlying condition is mental illness and remove future pathways for mature minors. It seeks to prohibit healthcare providers from initiating conversations surrounding MAID, bar referrals to out-of-province assessors, and would go as far as to require a family member to witness the procedure.
Curtailing clinical communication removes patients’ right to informed consent and autonomy. Those who’re suffering, who may not know they qualify, or who lack the language or confidence to bring it up, would be left without information about a legal right.
Smith was quick to cite a 136 per cent increase in Track 2 MAID provisions as justification for the Bill, but that isn’t the whole truth.
Of all MAID deaths in Canada within the last year, 95.6 per cent fall under Track 1, while only 4.4 per cent of provisions occur under Track 2 MAID. Growth in the use of a legal medical service isn’t in itself evidence of abuse and could very well reflect patients gaining access to a service that is their legal right.
The policy outlined by Bill 18 would significantly limit access to a relatively small group of patients without meaningfully changing the nationwide use of MAID.
At its core, Bill 18 is an encroachment on civil rights.
By restricting MAID to those within 12 months of death, the Bill essentially creates a two-tiered system. Under the new system, Albertans with terminal diagnoses retain access, while those enduring equally intolerable suffering from non-terminal conditions won’t. This includes early to mid-stage Amyotrophic Lateral Sclerosis, Huntington’s disease, or treatment-resistant chronic pain.
All Bill 18 does is tell some patients their suffering counts less than that of others. All Bill 18 does is invite constitutional challenge and prolong the suffering of those it claims to protect.
The genuine policy response to concerns about vulnerability is better supports—training assessors, funding palliative care, and mental health services—not creating additional barriers to MAID.
Restricting MAID from those who require it most won’t solve Canada’s mental health crisis or fix a lack of access to palliative care. Most of all, Bill 18 is anything but “compassionate”.
Ananya is a second-year Life Sciences student and one of The Journal’s Business, Science, & Technology Editors.
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Paul
Great article. One small correction. Track 1 MAiD, where death is reasonably foreseeable, is not restricted to a specific timeframe. There is no 12-minth limit of prognosis needed. Thank you.