Few issues in medicine are as ethically complex and important as medical assistance in dying, (MAiD). Reasonable people can disagree about where eligibility should begin and end, how at-risk individuals should be protected, and what safeguards are necessary before an irreversible decision is made. But Alberta’s Bill 18, the Safeguards for Last Resort Termination of Life Act, moves the conversation in the wrong direction.
Passed into law on May 14, Bill 18 significantly restricts access to MAID in Alberta. Among its most critical changes are limiting eligibility to people whose natural death is reasonably foreseeable within 12 months, preventing MAiD for mental illness alone, restricting referrals and stopping health-care professionals from starting conversations about MAID with patients.
The legislation, which has not yet received proclamation, would effectively eliminate Track 2 MAiD in Alberta, despite its legality under the federal government’s Bill C-7. Track 2 MAiD was established following the 2019 Truchon decision, in which the Quebec Superior Court ruled that restricting MAiD only to individuals whose deaths were reasonably foreseeable unjustifiably infringed on Charter rights. In response, Parliament created a separate pathway for competent adults experiencing enduring and irremediable suffering even when their natural death is not reasonably foreseeable.
Track 2 remains a relatively small component of MAiD in Canada. According to Health Canada’s 2024 report, approximately 95 per cent of MAiD provisions occurred under Track 1, where death was reasonably foreseeable, while fewer than 5 per cent occurred under Track 2. Parliament also attached additional safeguards to Track 2 requests, including a minimum 90-day assessment period, consultation with clinicians and requirements that patients be informed of available support.
Supporters of Bill 18 argue that these added changes in Alberta are necessary to protect vulnerable individuals. That concern needs to be taken seriously. No patient should pursue MAiD because of inadequate social support, untreated mental illness, poverty, discrimination or a lack of access to quality palliative care. The consequences of an error are irreversible, and safeguards are required.
Yet Bill 18 rests on a flawed premise: that restricting access is the same thing as protecting patients.
For years, Danielle Smith’s government has pushed personal autonomy in health care. During debates surrounding vaccines, medical treatment and bodily autonomy, Albertans were repeatedly told that individuals should be empowered to make deeply personal medical decisions. MAiD is no less personal. Once a patient has been assessed by qualified clinicians, found capable of making decisions, informed of available alternatives and determined to meet the criteria established under law, it is difficult to justify why politicians should substitute their judgment for that of patients and physicians.
The most troubling part of Bill 18 is not that it seeks safeguards. It is that it conflates vulnerability with incapacity. Many Albertans living with severe illnesses, disabilities or chronic suffering are capable of making informed decisions about their own lives. To suggest otherwise risks undermining the very autonomy that this government seeks to protect.
If policymakers are genuinely concerned about vulnerable Albertans, the focus should be on ensuring that no one seeks MAiD because alternatives are unavailable. Canada continues to lag many comparable countries in access to palliative care. According to the Canadian Hospice Palliative Care Association, about 85 per cent of Canadians who could benefit from palliative care do not receive early access to these services in the community.
The Canadian Society of Palliative Care Physicians has previously warned that Canada lacks the specialists required to meet the needs of patients seeking end-of-life care. Rather than restricting eligibility for MAiD, Alberta should prioritize expanding end-of-life care, increase home-care capacity and ensure timely access to specialized services. Given that most hospice beds are in Calgary or Edmonton, there is an urgent need to expand palliative care capacity to rural communities. Patients should never feel compelled to choose MAiD because they cannot access appropriate care. The solution to vulnerability is not fewer choices, but better ones.
The debate over MAiD has been framed as a choice between compassion and caution. In reality, good policy requires both. Safeguards should protect patients from coercion, abuse and preventable suffering. They should not prevent competent adults from making deeply personal health-care decisions.
Albertans deserve protection. They also deserve autonomy. Bill 18 risks sacrificing the latter in pursuit of the former. That is a trade-off we should be far more hesitant to make.
The debate surrounding MAiD is unlikely to end with Bill 18. As Ottawa continues to consider expanding eligibility to include mental illness as a sole underlying medical condition, Alberta’s restrictive approach raises important questions about how provincial and federal policies will coexist.
