This page outlines the safeguards and oversight that govern how medical assistance in dying (MAID) is provided in Canada.
Safeguards are a legal tool that helps ensure choices are free, voluntary and informed. They’re designed to protect people at a vulnerable time and support careful, consistent decision-making.
Oversight is the system that monitors and holds providers accountable for following the law and professional standards of care, helping ensure that MAID is provided safely and responsibly.
Procedural safeguards
Before MAID can be provided, several safeguards must be followed. The specific safeguards depend on whether the person’s death is considered reasonably foreseeable – or not. “Reasonably foreseeable” means a person is on a trajectory towards death. It does not mean that death is imminent or expected in a specific timeframe.
Track 1: Death is reasonably foreseeable
If a person’s natural death is reasonably foreseeable, their request is subject to several safeguards.
Before proceeding with MAID, MAID providers must:
- confirm the person has completed and signed a written request with the signature witnessed by an Independent Witness who also signed the form
- ensure the person received two independent medical assessments, with both assessors confirming all eligibility criteria have been met
- inform the person that they can withdraw their request at any time
- give the person a chance to withdraw their request immediately before receiving MAID – unless the person has lost capacity and a waiver of final consent is in place, which may allow MAID to proceed on or before a scheduled date if the person has lost decision-making capacity
- confirm the person’s final consent immediately before administering MAID – unless the person has lost capacity and a waiver of final consent is in place
Track 2: Death is not reasonably foreseeable
If a person’s natural death is not reasonably foreseeable, their request is subject to Track 1 safeguards as well as additional Track 2 safeguards.
Before proceeding with MAID, MAID providers must follow the safeguards that apply in Track 1, and they must also:
- ensure that an eligibility assessment period of at least 90 days has taken place. This period is often longer than 90 days, but it may be shortened when both assessors find the person is at risk of losing decision-making capacity and assessments can be completed sooner.
- ensure that at least one assessor has expertise in the condition causing the person’s suffering. If not, they must consult with a clinician who has that expertise and must share the results with the other assessor.
- inform the person of available options to relieve their suffering and offer consultations with relevant professionals, including those who offer palliative care, community services, counselling, and mental health or disability supports
- discuss the reasonable and available means to relieve suffering with the person, and confirm that the person and the other assessor have also had this discussion. All must agree the person has seriously considered the means to relieve their suffering.
- confirm the person’s final consent immediately before administering MAID. Unlike in Track 1, people on Track 2 are not eligible to sign a waiver of final consent.
Consent and advance requests
In most provinces and territories, a person must be capable of consenting to receive MAID at the time MAID is provided. They may be unable to make other decisions – such as managing finances or changing a will – but still be capable of consenting to MAID.
Consent is usually confirmed immediately before the procedure. If the person is unable to confirm consent at that time, MAID may not proceed, except in the following situations:
Track 1 with a waiver of final consent
In certain cases, when death is reasonably foreseeable and an individual has been assessed and found eligible, a waiver can be signed in advance of the scheduled date. This allows MAID to proceed even if capacity is lost before that date.
Advance consent
In cases where oral medication is chosen, advance written consent allows the provider to complete MAID intravenously if capacity is lost and oral self-administered medications do not work within a set time. Because fewer people choose self-administration, this type of consent is less common.
Advance requests in Quebec
In Quebec, advance requests allow MAID to be assessed and provided after capacity is lost, if certain conditions are met. Unlike a waiver of final consent, an advance request applies to a future situation, rather than an already assessed and approved MAID request. Learn more about advance requests on the Government of Quebec’s website.
Oversight and reporting
MAID is a legislated exemption to the law that prohibits taking someone’s life. It’s monitored at federal, provincial, and professional levels.
Government oversight
Professionals who assess eligibility or provide MAID must report key details about each case to federal and/or provincial health departments and/or chief coroners.
Health Canada gathers information about MAID and publishes an annual report. This reporting supports transparency and public understanding of how MAID is provided in Canada. Read Health Canada’s 2024 report.
Provinces and territories set policies and standards for MAID as well, and may review deaths through direct oversight or independent bodies.
Professionals involved in the MAID process who fail to follow MAID legislation could be prosecuted under the Criminal Code.
Professional requirements
Professional colleges oversee the nurse practitioners, physicians, pharmacists, and other professionals involved in the MAID process. Failing to meet professional standards could result in serious consequences, including loss of a license to practice.
Health care providers may choose not to or be unable to participate in MAID for personal, religious, or institutional reasons. But, depending on the province or territory, they may be required to provide a referral, or to direct patients to resources where they can find support.
MAID is a structured and accountable process
MAID in Canada is designed to balance personal autonomy with strong protections. The layered safeguards – legal, professional, and procedural – aim to ensure that decisions are informed, voluntary, and carefully assessed.
If you have questions about how safeguards apply in your situation, a health care provider or MAID care coordination service can provide guidance specific to your circumstances. Find contact information for your provincial or territorial care coordination team. For more general information, check out our Frequently Asked Questions.
