The federal government plans to expand eligibility for Medical Assistance in Dying (MAID) in March 2027. Alberta’s Bill 18 may place stricter limits on MAID eligibility in the province.
In March 2024, I wrote an article titled “Canada is not yet Ready to Expand its Medical Assistance in Dying Legislation.” That article examined the federal government’s 2021 expansion of Medical Assistance in Dying (MAID) to include people whose death is not reasonably foreseeable (Track 2 MAID). It also looked at its decision to delay eligibility for those whose only underlying condition is mental illness until March 2027.
In 2024, 16,499 Canadians received MAID. Alberta Health Services reported 1,242 MAID deaths in Alberta in 2025, though without breaking down how those people were eligible. The province also said deaths under expanded eligibility increased by 136% between 2021 and 2025.
In March 2026, anticipating the 2027 expansion – which it does not support – the Government of Alberta introduced Bill 18: Safeguards for Last Resort Termination of Life Act. This bill aims to significantly restrict access to MAID. If passed, it would make Alberta the first province to take such a step. The government says Bill 18 is designed to protect vulnerable individuals, particularly those with mental illness, if the federal expansion proceeds.
An Overview of Bill 18
If passed, Bill 18 would:
- Prohibit MAID where mental illness is the sole underlying condition (section 4(2)(a)).
- Make MAID only available for adults (18+) (section 4(2)(b)).
- Eliminate Track 2 MAID in Alberta by limiting MAID to people whose death is reasonably foreseeable within the next 12 months (section 4(2)(c)).
- Require a family member to witness the provision of MAID (section 4(2)(e)).
- Require patients to have capacity to make decisions immediately before receiving MAID (section 4(2)(f)).
- Bar doctors and nurse practitioners from referring patients out of province for MAID assessments (section 5(4)).
- Ban requests made by patients in advance (before they are eligible for MAID). However, it would not apply to prior written requests for MAID, nor to health care professionals who already assess for or provide MAID (section 15(a)).
The bill would also:
- Allow practitioners and health-care facilities to refuse to assess for or provide MAID (section 8(1)(2)).
- Create a 150-metre “exclusion zone” around facilities that choose not to provide MAID services (section 9(1)).
- Ban public display of MAID information in health facilities (section 10(1)).
- Restrict health professionals from starting discussions about MAID unless the patient requests it (section 10(2)).
Support for Bill 18
Advocates, particularly organizations dealing with people with disabilities such as Inclusion Alberta and Inclusion Canada, support Bill 18. They argue that Track 2 MAID may strengthen harmful assumptions about the value of lives lived with disability.
Trish Bowman, CEO of Inclusion Alberta, said: “Track 2 MAID discriminates against persons with disabilities and reinforces dangerous stereotypes about the worth of their lives.” She added: “Bill 18 is a correction. It would protect Albertans with disabilities from discrimination by ensuring Alberta’s health system does not provide assisted suicide to people whose deaths are not reasonably foreseeable”.
Krista Carr, Chief Executive Officer of Inclusion Canada echoed those concerns, saying: “Canada’s assisted dying law currently allows people with disabilities who are not at end of life to receive assisted suicide. The United Nations has stated unequivocally that this practice violates the rights of persons with disabilities and should be repealed. We urge the Government of Canada to amend the Criminal Code to repeal Track 2 and remove eligibility for assisted death for people who are not at end of life, and ensure it is never extended to people with mental illness or mature minors.”
Mental health advocates have also expressed support, emphasizing that recovery from mental illness is possible and that more safeguards are needed.
Criticism and Legal Concerns
Critics argue Bill 18 takes away patient autonomy and may conflict with federal law.
The Canadian Civil Liberties Association (CCLA) said the bill restricts people’s ability to access legal medical services and make informed decisions.
Howard Sapers, Executive Director at the CCLA, said:
MAID is not about encouraging death — it is about respecting the choices of individuals who are enduring intolerable suffering and seeking control over how and when they die… Governments have a legitimate role in protecting vulnerable individuals and ensuring safeguards. However, such measures must respect fundamental rights and freedoms.
The CCLA also pointed to the Supreme Court of Canada’s decision in Carter v Canada. This case confirmed that competent adults going through intolerable suffering have a constitutional right to seek MAID. That right is not limited to those who are terminally ill.
Legal experts expect court challenges, particularly around possible conflicts between provincial power over health regulation and federal power over criminal law. According to University of Ottawa health policy professor Patrick Fafard, the legislation stays within provincial jurisdiction, but a legal challenge is likely. “It will be litigated. Partly to make a point, and partly because there may be a genuine conflict of laws,” he said.
Other critics, such as Dying with Dignity Canada and the ALS Society of Alberta, warn that restricting conversations about MAID could leave patients without full information about their options.
Summary
Bill 18 represents a major shift in Alberta’s approach to MAID. It aims to protect vulnerable people by limiting eligibility, strengthening safeguards, and preventing expansion to mental illness and mature minors.
At the same time, it raises important questions about autonomy, constitutional rights, and the balance between federal and provincial authority. If passed, Bill 18 is likely to face legal challenges and could spark a broader national debate over the future of MAID in Canada.
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DISCLAIMER The information in this article was correct at time of publishing. The law may have changed since then. The views expressed in this article are those of the author and do not necessarily reflect the views of LawNow or the Centre for Public Legal Education Alberta.
About Myrna El Fakhry Tuttle
