medical assistance in dying
in review
2 min read
Updated 2026-08-27
medical assistance in dying
Canadian MAID eligibility criteria, Track 1 vs Track 2 safeguards, and the obligation of non-participating physicians to provide an effective referral.
eligibility — all 5 criteria required
- eligible for publicly funded Canadian health services
- ≥18 years and capable at time of request
- voluntary request, free from external pressure
- informed consent after being told of alternatives (including palliative care)
- grievous and irremediable medical condition:
- serious and incurable illness, disease, or disability
- advanced state of irreversible decline
- enduring and intolerable physical or psychological suffering that cannot be relieved under conditions acceptable to the patient
track 1 vs track 2
| Feature | Track 1 (natural death reasonably foreseeable) | Track 2 (natural death NOT reasonably foreseeable) |
|---|---|---|
| reflection period | waived if both assessors agree loss of capacity is imminent | minimum 90 days |
| independent witnesses | 1 | 1 |
| assessors | 2 independent physicians or NPs | 2, at least 1 with expertise in the condition |
capacity and exclusions
- consent must come from a capable patient — POA/SDMs cannot consent to MAID on behalf of an incapacitated patient
- mental illness as the sole underlying condition remains excluded (federal legislation)
- advance requests (waiver of final consent) available only for Track 1 patients at risk of losing capacity before their chosen date
role of the non-participating physician
Physicians who choose not to provide or assess for MAID retain an obligation under CPSO policy:
- provide an effective referral — a referral made in good faith to a physician, NP, or agency that does not impede access
- do not delay, obstruct, or provide inaccurate information about eligibility
- Ontario: referral to the provincial Care Coordination Service is an accepted pathway
effective referral
CPSO requires an effective referral even from conscientiously objecting physicians. Failure to refer is a regulatory, not solely ethical, issue.