MAID debate must address access, not just eligibility

Much of the current discussion around Alberta’s proposed changes to medical assistance in dying (MAID) has focused on eligibility. Less attention has been paid to a more immediate question: how patients actually access care in practice.

Eligibility alone does not determine access.

The Alberta government introduced the legislation in March. The legislation is open for debate when the Alberta legislature resumes on April 13. Under the proposed framework, physicians would be prohibited from referring patients to MAID services outside Alberta. This represents a meaningful shift, moving beyond regulating how MAID is provided within the province into restricting how patients may pursue a federally legal medical service elsewhere.

In Canadian health care, there has long been an expectation that while providers or institutions may choose not to offer certain services, they do not obstruct patients from seeking care through other channels. Patients routinely travel across provincial boundaries for specialized or time-sensitive care. In those situations, physicians play a central role – providing referrals, sharing documentation and helping coordinate continuity of care.

The proposed restriction on referral departs from that approach. It does not simply limit local provision. It limits how patients can access care beyond the provincial system. This distinction matters in practice.

Patients rarely navigate complex health systems independently. Access often depends on physician involvement – identifying appropriate providers, facilitating referrals and ensuring that relevant clinical information is transferred. When that role is removed, the need for access does not disappear. Instead, the responsibility shifts to patients, many of whom are already dealing with serious illness and limited capacity to coordinate their own care.

In that context, access is shaped not only by what is legally permitted, but by what is practically achievable.

Interprovincial access is not a peripheral feature of Canadian health care. It is a mechanism that helps address uneven distribution of services across a large and decentralized system. While MAID is distinct in important ways, the underlying principle remains relevant: when care is legally available but not locally accessible, pathways to obtain that care are typically supported rather than restricted.

By limiting referral, the proposed changes narrow those pathways without removing the underlying demand.

The implications are particularly complex in the context of mental illness. Assessments in this area require careful consideration of capacity, treatment history and the potential for recovery. These are legitimate challenges. They do not, however, resolve the question of whether access to legally permitted care should be actively constrained through limitations on referral.

This is not an argument for expanding eligibility or reducing safeguards. Safeguards are essential. The issue is where those safeguards are applied. Policies that focus on eligibility and assessment define who may receive care. Policies that restrict referral shape whether patients can realistically pursue that care at all. That distinction is easy to overlook, but it has practical consequences.

If access to a legal medical service depends on a patient’s ability to independently navigate complex systems, then access is no longer determined solely by eligibility. It becomes influenced by factors such as health literacy, support networks and the ability to coordinate care across jurisdictions.

That is a different kind of barrier – one that operates quietly, but with real effects.

As the MAID debate continues, attention to eligibility will remain important. But access deserves equal scrutiny. When changes affect how patients move through the system – not just whether they qualify – those effects need to be considered explicitly.

Otherwise, the discussion risks focusing on who is eligible, while overlooking whether care can be reached in practice.