Health Professionals

Accessing Medical Assistance in Dying

Frequently asked questions

What did the Supreme Court of Canada rule in Carter v. Canada (Attorney General)?

The Supreme Court decided that the law (Criminal Code) making it a crime for a physician to assist another person to commit suicide, in certain specific circumstances, violated the right to life, liberty and security of the person under the Charter.

What is the status of the law on medical assistance in dying?
The Supreme Court of Canada struck down the prohibition on medical assistance in dying on February 6, 2015. The federal government was instructed to create legislation regarding medical assistance in dying. This legislation came into effect June 17, 2016. According to this legislation, the specific circumstances which must exist in order for a physician to assist a person in dying include that the person meet all the following criteria:
  1. Be a mentally competent adult (18 years or older)
  2. Be eligible for health services funded by a government in Canada
  3. Have a grievous (serious) and irremediable (incurable) medical illness, disease or disability that:
    • is in an advanced state of irreversible decline
    • causes enduring suffering that is intolerable and cannot be relieved under conditions that they consider acceptable
    • natural death has become reasonably forseeable
  4. Make a voluntary written request to receive medical assistance in dying that is not the result of external pressure
  5. Give informed consent. Meaning, the person requesting medical assistance in dying:
    • has been informed of the options available to relieve their suffering, including palliative care
    • is aware death is the intended result
    • is aware of the potential risks and complications
    • is aware that the request can be withdrawn any time
    • has met with each of the required two (2) physicians alone at least once
    • has reflected on and is consistent in making the request for at least ten days (unless death or loss of capacity is imminent)
    • provides written consent (through a proxy if physically unable)

Under the new legislation, a court order is no longer required to initiate the MAID process. It is still recommended that all health-care providers seek legal advice prior to engaging in the provision of the service.

What is the difference between euthanasia and physician assisted suicide? Are they the same as physician assisted dying or medical assistance/aid in dying?
After consultation, a joint Senate‐Commons committee changed the term “physician assisted dying” to medical assistance/aid in dying, or “medical assistance in dying.” The Supreme Court of Canada considered the terms “physician assisted dying, medical assistance in dying and medical assistance/aid in dying” a situation where a physician either provides (commonly referred to as “physician assisted suicide”) or administers (sometimes referred to as “euthanasia”) medication that intentionally brings about the patient’s death, at the request of the patient. The Court held that not having medical assistance in dying available violated an individual’s rights.
How is medical assistance in dying different from withholding or withdrawing life sustaining treatment?
Where medical assistance in dying involves actions intended to cause death, withholding and withdrawing life sustaining treatments are decisions made to stop or not start interventions that would prevent an individual from dying. Withholding/withdrawing life sustaining treatments has occurred for many years in Manitoba and is not affected by this decision.
How does this decision affect medical practice?
If a patient wants to pursue medical assistance in dying, we ask all staff to refer these cases up to the chief medical officer/nursing officer of their site (through a manager or supervisor) who will connect with the chief medical officer of the WRHA. The CMO of the WRHA will work with the MAID team, the patient and their health care team. The MAID team can also provide the patient and their family information about MAID.

What role do regulatory bodies and governments play in ensuring access to services?
Parliament has enacted legislation to amend the Criminal Code with regards to medical assitance in dying. In addition, regulatory bodies have outlined expectations or standards for their members in position statements or other documents such as a professional guideline for health providers.
Federal legislation
College of Physicians and Surgeons of Manitoba
Statement from the College of Registered Nurses of Manitoba
Statement from the College of Pharmacists of Manitoba
I work at a faith‐based facility and I don’t believe our faith‐based mandate aligns with the practice of medical assistance in dying – how will the WRHA address that?
The WRHA respects the position of faith‐based facilities and will continue to work collaboratively with those sites as partners now that legislation has been passed. The WRHA has no intention of obliging or compelling any one person or facility to participate in medical assistance in dying.
While you or your hospital may object to medical assistance in dying discussions, conversation around the end of life are a normal part of the medical professional-patient interaction and may lead to better care for the patient. These conversations can be had outside of the formal medical assistance in dying process.
We do expect any and all staff and physicians who consider themselves to be conscientious objectors to refer patients to the following resources so that they may obtain the information they need to make their decision: the CMO/CNO of their site or maid@wrha.mb.ca
What should I say to patients and families who ask me to assist them in dying?
WRHA has asked that staff have conversations with patients to explore why they want medical assistance in dying and explore all other options that may address their suffering. If a patient wants to pursue medical assistance in dying, we ask staff to refer these cases up to the chief medical officer/nursing officer of their site (through a manager or supervisor) who will connect with the chief medical officer of the WRHA. The CMO of the WRHA will work with the MAID team, the patient and their health care team. The MAID team can also provide the patient and their family information about MAID.
I am completely against medical assistance in dying and consider myself a conscientious objector, what are my options if I am asked to assist in or provide information about medical assistance in dying?
No one will be compelled to participate in the process of or discussions around medical assistance in dying. We do, however, expect that all patients be provided access to resources and information on medical assistance in dying. If approached by a patient seeking information on medical assistance in dying, please reach out to the CMO or CNO at your site (through a manager/supervisor or other leadership as appropriate) who will connect with CMO for the WRHA OR refer them to the following email address to find out more information on their own: maid@wrha.mb.ca.
It is important to remember, providers can still explore the reason for a request for medical assistance in dying as it may reveal opportunities to discuss other ways of relieving an individual’s suffering.
I feel that medical assistance/aid in dying can fit into my practice. What are my options?
All health care providers interested in providing medical assistance in dying should contact the MAID team.
Have we had any requests within the WRHA to offer medical assistance in dying?
Yes. There have been, and continue to be, requests for MAID.
We continue to work with patients and their families to address patient suffering as best we can and will comply with legislation in force when requests are made for medical assistance/aid in dying.
Who should I contact with more questions?
Call 204-926-1380 or email maid@wrha.mb.ca.