Alberta Premier Danielle Smith speaks to the media at the Legislature in Edmonton in December, 2025.AMBER BRACKEN/The Canadian Press
Alberta is attempting the difficult feat of climbing back up a slippery slope with a wide-ranging bill that would significantly restrict the provision of medically assisted deaths in the province.
Since the 2015 Supreme Court decision that opened the door to medical aid in dying, or MAID, the legal framework has continually expanded in scope, from the original intent to provide relief from intolerable suffering for those suffering from terminal illnesses to those without a reasonably foreseeable death and now under pending legislation, those whose only underlying condition is mental illness.
Broadly speaking, Alberta’s legislation is a needed corrective that addresses numerous shortcomings that have emerged over the last decade. Although the bill overreaches in some areas, the United Conservative Party government deserves credit for tackling those problems.
The government has proposed a batch of changes, most notably an elimination of “Track 2″ of MAID, where a person does not have a reasonably foreseeable death. Instead, the Alberta bill would limit MAID to those whose death is reasonably foreseeable within 12 months. In addition, the bill would stiffen penalties for medical professionals who breach the laws and rules governing MAID, restrict the provision of MAID near facilities declining to provide such procedures and require “reasonable” efforts to have a family member attend a relative’s medically assisted death.
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Most important, the legislation would prohibit MAID for reasons of mental illness, not yet authorized under the Criminal Code, as well as for advance requests, for minors, and for those unable to provide consent.
And, the bill prohibits provincial health professionals from referring MAID cases to other jurisdictions. That measure looks to be a way of both asserting provincial control over the administration of its healthcare system and a way of preventing Albertans from getting approval for a MAID procedure from practitioners from outside the province.
Clearly, Alberta is looking to head off further expansion of MAID, although some of those measures look to be more political than practical. Children are not eligible for MAID under federal law, for instance.
The 150-metre exclusion zone around facilities declining to provide MAID also seems rooted in posturing. Why should a Catholic-run hospital care be allowed to determine if a facility across the street provides MAID services, so long as it is not forced to do so on its own premises? Still, the practical effect should be minimal. And the bill does require such facilities to forward patients to a “resource” on MAID options.
More substantive is the prohibition of Track 2 MAID requests (which, to be clear, account for less than 5 per cent of state-assisted deaths in Alberta and across Canada). The prohibition is overly broad and unwise. Requiring months of suffering before a death becomes foreseeable within the next year is arbitrary, and because it is arbitrary, it is cruel.
We suspect that the measure is linked to the province’s outright prohibition on MAID in which mental illness is the underlying medical condition. Allowing state-assisted death for a physical ailment, but not a mental illness, where a death is not foreseeable might increase the vulnerability of that provision to a constitutional challenge, if a court sees that as arbitrary distinction.
However, there are strong grounds to argue that mental illness should be treated differently. Prominent and experienced psychiatrists say it is extraordinarily difficult to determine if mental illness is truly irremediable, as is required under the Criminal Code exemption. Quebec has banned MAID for reasons of mental illness, without an accompanying prohibition on Track 2. (And, we note, without the criticism that has accompanied Alberta’s proposal.)
Parts of Alberta’s bill are needed; parts are unwise. But the legislation as a whole can provide legal clarity to the entire country. A single lower court judgment in Quebec, Truchon v. Canada, was the legal springboard that Ottawa used to broaden the Criminal Code exemption to Track 2. The federal government chose not to appeal that decision, so the Supreme Court has not spoken on the issue. As a result, that precedent is not binding in the rest of the country.
The inevitable court challenge of Alberta’s bill is a chance for clarity, and an opportunity for the Supreme Court to articulate coherent – and national – legal principles for medically assisted death.