The Canadian government has introduced a bill amending the rules on medically assisted dying (MAiD). Bill C-41, the MAiD Safeguards Act, was presented on 27 October 2026 by the Minister of Justice, Sean Fraser.
The bill permanently halts the planned extension in March 2027 of MAiD to people for whom mental illness is the sole underlying condition, but it does allow for advance consent; this means that an adult diagnosed with an incurable illness expected to lead to a loss of decision-making capacity may give advance consent for MAiD to be carried out at a later date. Examples cited include forms of dementia.
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According to the government, advance consent should not automatically lead to euthanasia. The person must still meet the usual criteria for MAiD at the time the procedure is to be carried out, including ‘intolerable suffering’. In addition, the proposal includes a provision stating that MAiD must not be carried out if the person resists through words, sounds or gestures. It will also be up to the provinces and territories to decide whether they wish to introduce the scheme locally.
Supporters of the change believe that many people do not wish to continue living in a condition which they currently regard as unacceptable, even if they are at some point unable to express their wish to be killed.
Doubts about the safeguards
The Campaign Life Coalition believes that the proposal undermines the fundamental requirement for consent. They argue that it opens the door to people with dementia having euthanasia carried out without being able to confirm or withdraw their wish at that particular moment. The organisation has described the proposal as a threat to vulnerable groups and has called on parliament to split the bill, so that the ban on MAiD in cases of mental illness alone can be passed without the controversial section on advance consent.
There are a number of documented examples of problematic issues surrounding consent, pressure and the practice of MAiD in Canada – cases that cast doubt on whether existing and future safeguards are working and will continue to work. The provision for advance requests introduced by Bill C-41 has not allayed the sceptics’ concerns.
Only death is cost-effective
Roger Foley is one of the best-known examples. He has lived for years in a hospital in Ontario whilst campaigning for better home care. He says that staff have repeatedly raised the subject of MAiD, even after he has clearly said no. He has released audio recordings in which staff raise the subject, including in the context of the costs of keeping him in hospital. Foley describes this as pressure and trauma, and says that the offer of death comes instead of a genuine offer of help to live.
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Several war veterans have reported that they were offered MAiD by case workers at Veterans Affairs when they applied for assistive devices, wheelchair ramps, treatment for PTSD or other support. A former Paralympian, Christine Gauthier, received the offer in writing. Official investigations confirmed several such cases. Critics argue that this shows the system is presenting death as an alternative to address a lack of resources.
An 83-year-old grandmother with stomach cancer died by MAiD in July 2026. Her family claim that she repeatedly said no (“I don’t want the death shot”), that she tore out a port that was to be used for the injection, and that she did not give her final consent on the day of her death. They believe that she lacked full capacity, that her power of attorney was set aside, and that the process was rushed. The case is under investigation.
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An elderly woman withdrew her request for MAiD on religious grounds. After her husband, who was exhausted as her carer, requested a new, rapid assessment, she was nevertheless approved and died the same day. The oversight committee expressed concern about possible pressure, a rushed process and the fact that not all aspects had been adequately investigated.
A number of reports indicate that MAiD is offered unsolicited in A&E departments and hospitals – for example, in cases of back pain or hip fractures; patients are told about MAiD before medical treatment has been assessed; and cases where people have tried to change their minds but have not been listened to and their wishes have not been documented.
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Cases such as this undermine confidence that the safeguards function as the authorities claim they do. When the system already today – with requirements for simultaneous consent – has instances of:
- unsolicited offers
- pressure from the system
- situations where patients are not listened to when they change their minds
- capacity problems in an underfunded health service
it is difficult to trust that things will improve when the system switches to advance consent and the requirement for simultaneous consent is removed.
The system may pressure healthcare staff to save resources
In the case of advance consent, for example in cases of dementia, the person in the hospital bed may not be able to express themselves clearly. The law states that treatment must be stopped in the event of ‘resistance’ in the form of words, sounds, gestures, etc., but in reality it can be difficult to distinguish genuine resistance from confusion, pain or habitual reactions. Patients requiring care place a strain on resources, and healthcare staff may feel pressured by the system to economise. There is also a risk that prior consent may have been influenced by momentary despair, a lack of care alternatives or pressure – something the patient can no longer rectify once their mental capacity has been impaired or has vanished.
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These examples show that the gap between the law’s intention and practice is already noticeable. Extending this to situations where the person is no longer able to confirm or withdraw consent to be killed increases the risk of blurring the boundaries between standard medical treatment and state-supported end-of-life procedures. These are the main reasons why pro-life organisations, certain medical circles and sections of organisations representing people with disabilities are strongly critical of the part of Bill C-41 concerning advance consent.
There is speculation on social media that Bill C-41 is the Liberals’ way of ‘getting their own back’ for failing to push through euthanasia for those suffering from mental health conditions.
– The Liberals are trying a cheap trick with Bill C-41. The aim is to radically expand MAiD and allow people to be killed on the basis of advance consent they may have signed many years ago – without now being able to verify that consent:
The Liberals are trying a cheap trick with Bill C-41. Their aim is to radically expand MAID and allow people to be killed at a time when they may not be able to give consent and without being asked first. (Based on an advance directive they may have signed years ago).
Call your MP and encourage… pic.twitter.com/8FHBF0DcSa
— Garnett Genuis (@GarnettGenuis) 7 November 2026
Bill C-41, the MAiD Safeguards Act, must be passed before March 2027 to prevent the planned extension to include mental illness from automatically coming into force.
