April 2021

Changes to MAID

Recent changes to Medical Assistance in Dying (MAID) may affect your practice.

On March 17, 2021, the federal government passed Bill C-7 to amend the Criminal Code to expand eligibility for MAID. The key changes of the bill are:

Eligibility criteria

The bill removes the restriction that MAID is available only for patients whose natural death is reasonably foreseeable. It is now available for reasonably foreseeable and not reasonably foreseeable natural death. However, it excludes cases where mental illness is the sole underlying medical condition. The government will re-examine this with an expert panel by March 2023.

Witness requirements

Individuals whose primary paid occupation is to provide care can now act as witnesses. This change will have implications for RNs and RPNs involved in the MAID process. Nurse Practitioners providing MAID or NPs doing the eligibility assessment cannot act as witnesses.


The bill provides two sets of safeguards to protect patients and health care providers based on the foreseeability of death:

  • For people whose natural death is reasonably foreseeable, the safeguards have been eased. For example, individuals no longer need to wait for a 10-day reflection period to pass before receiving the service.

  • There are new safeguards for people whose natural death is not reasonably foreseeable. One is requiring a minimum of 90 days between the beginning of the first assessment and the day MAID is provided.

Advanced consent

The bill waives the requirement for final consent at the time of the MAID procedure in specific circumstances. Therefore, when advanced consent has been given, MAID can be administered for patients whose natural death is reasonably foreseeable and who have been assessed and approved, if they lose capacity to consent before their preferred date for MAID and they have a written arrangement with a practitioner.

It also permits advanced consent for administering MAID by a practitioner if self-administration fails.

Monitoring and reporting requirements

The bill enhances reporting requirements. For example, any time an eligibility assessment takes place for MAID, it must be reported to Health Canada.

We will post an updated Guidance on Nurses’ Roles in Medical Assistance in Dying to www.cno.org/docs later in April 2021. We are also developing other practice resources.

If you have questions about MAID or your accountabilities, visit our MAID trending topics page or email our Practice Quality team.

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