Medical Assistance in Dying (MAID) is a legal process in Canada that allows an eligible person to receive medications from a physician or nurse practitioner that intentionally end their life. The process involves a formal request, two independent medical assessments, mandatory waiting periods, and a final consent step before the procedure itself. In 2024, 16,499 people received MAID in Canada out of 22,535 requests.
Who Is Eligible
To qualify for MAID, you must be a Canadian resident (or eligible for health services in Canada), at least 18 years old, and mentally capable of making health care decisions. The core medical requirement is that you have a grievous and irremediable medical condition, meaning a serious illness, disease, or disability that is in an advanced and irreversible state, and that causes you enduring physical or psychological suffering that you find intolerable and that cannot be relieved in a way you consider acceptable.
You do not need to have a terminal diagnosis. Canada’s framework distinguishes between two tracks based on how close you are to a natural death. Track 1 applies when your natural death is reasonably foreseeable, meaning you have a condition that is likely to cause death in the not-too-distant future (there is no specific time limit like six months). Track 2 applies when your natural death is not reasonably foreseeable, which covers people living with chronic, debilitating conditions who are not near the end of life. Each track carries different safeguards.
How the Request and Assessment Work
The process starts when you make a formal written request to a physician or nurse practitioner. This request must be signed by one independent witness, someone who has no financial interest in your death and is not directly involved in your health care.
Two independent practitioners, either physicians or nurse practitioners, must then separately assess whether you meet all eligibility criteria. Independence means neither assessor can be the other’s supervisor or trainee. If neither of the two assessors has expertise in the condition causing your suffering, they are required to consult a specialist who does. This is especially important for Track 2 cases, where the law requires that a practitioner with relevant expertise be involved.
Medical students cannot perform assessments or provide MAID. Nurse practitioner students in training cannot assess eligibility or administer the procedure either, though they may assist in other nursing care.
Waiting Periods and Safeguards
The waiting period between approval and the procedure depends on which track you fall under. For Track 1 (death is reasonably foreseeable), there is no mandatory reflection period. Previously the law required 10 clear days, but that was removed in 2021 for people already near the end of life.
For Track 2 (death is not reasonably foreseeable), a 90-day reflection period is required. During this time, you must also be informed about available alternatives such as counselling, disability support services, and palliative care options. The intent behind the longer waiting period is to ensure that people who are not at the end of life have ample time and information to consider all options.
Regardless of track, you can withdraw your request at any point. No one is locked in once the process begins.
Final Consent and the Waiver Option
Immediately before the procedure, your practitioner must give you the opportunity to withdraw consent. If you wish to proceed, you affirm that consent. This is a deliberate, final check.
There is one important exception. If your natural death is reasonably foreseeable and you are at risk of losing mental capacity before the scheduled date (for example, due to advancing dementia or a brain tumor), you can arrange a written waiver of final consent with your provider. This means that if you lose the ability to communicate or make decisions on the chosen date, the practitioner can still proceed based on your earlier written instructions. This waiver is only available to Track 1 patients. People on Track 2 are not eligible for it.
What Happens During the Procedure
MAID is most commonly administered intravenously. The process typically involves a sequence of three types of medications, each with a specific purpose.
- A sedative to reduce anxiety. This is given first and helps you relax and gradually fall asleep.
- An anesthetic to induce deep unconsciousness. Once the sedative has taken effect, a large dose of an anesthetic is administered, placing you into a deep coma. You are completely unaware from this point forward.
- A medication that stops breathing or heart function. A neuromuscular blocker stops the muscles needed for breathing, or a cardiac medication stops the heart directly.
The experience from the patient’s perspective is falling asleep. The sedative takes effect within minutes, and unconsciousness follows shortly after. Death typically occurs within a relatively short window after the full sequence is administered, though the exact timing varies by person.
Where It Takes Place
MAID can be provided in several settings: your home, a hospital, a hospice, or a long-term care facility. Many people choose to receive MAID at home, surrounded by family. The practitioner comes to you with the necessary medications and equipment.
In a home setting, the process often begins with time for the patient to say goodbye to loved ones. The practitioner then administers the sedative, and the family can remain present throughout. The entire visit, including preparation and the procedure itself, may take an hour or more depending on the circumstances. In some cases, such as when a patient has chosen to donate organs, the procedure may need to take place in a hospital instead, since organ procurement must happen quickly after death. Some patients in the Netherlands have opted out of organ donation specifically because they wanted to die at home rather than in a hospital.
Who Receives MAID in Practice
The typical MAID recipient in Canada is older. The median age in 2024 was 77.9 years. For Track 1 patients it was 78.0, and for Track 2 patients, 75.9.
The vast majority of MAID provisions fall under Track 1. Cancer is by far the most common underlying condition, accounting for over 10,000 cases in 2024. Cardiovascular conditions like heart failure came next, followed by a range of other conditions. For Track 2 patients, the picture looks different: neurological conditions (such as ALS, multiple sclerosis, or Parkinson’s disease) were the most common reason, followed by cardiovascular conditions.
Not every request results in MAID being provided. Of the 22,535 requests reported in 2024, about 6,000 did not proceed, whether because the person withdrew, died before the procedure, was found ineligible, or changed their mind at any stage of the process.
Mental Illness as a Sole Condition
One of the most debated aspects of MAID is whether it should be available to people whose only medical condition is a mental illness. Canada’s Parliament has repeatedly delayed expanding eligibility to this group. The original target date was March 2023, then it was pushed to March 2024, and it has been delayed again. The concern is that mental illness can be harder to classify as irremediable, since treatment outcomes are less predictable and capacity assessments are more complex. As of now, a mental disorder as the sole underlying condition does not qualify someone for MAID.