In Canada in 2021, people with non-life-limiting health conditions and disabilities became eligible for medical assistance in dying (MAiD). New legislative safeguards include a ninety-day assessment period and a requirement that health professionals engage with the person requesting MAiD about ‘means available to relieve their suffering’ (MARS). Government communications about the MARS safeguards emphasise distinct policy objectives, that we illustrate by analysing two texts. We then report on an ongoing study with health professionals involved in MAiD. In interviews, participants described supporting patients to imagine possibilities for feeling differently, creatively devising interventions, and actively connecting patients with (and in some cases bringing about) services and resources. Drawing on literature on front-line policy making we show how discourses of expert communication, care, and advocacy animate a specific translation of the MARS safeguards, one that recognises social and relational as well as deliberative autonomy, and reflects a range of MAiD policy goals.

Advance care planning (ACP) is commonly recommended for persons living with dementia. Increasing age and uncertain disease trajectory add complexity to this process. A scoping review of the Canadian literature was completed to assess the feasibility and acceptability of ACP for seniors (≥ 65 years of age) diagnosed with dementia and to provide practice, policy, and research recommendations towards ACP as a critical aspect of care. Twenty-nine articles were grouped into five themes: (1) feasibility of patient engagement in ACP; (2) opinions regarding medical assistance in dying (MAiD) for incompetent patients; (3) knowledge translation to support persons living with dementia, professionals, and caregivers; (4) barriers to and facilitators of the delivery of holistic dementia care; and (5) Indigenous health considerations. Additional research should consider socio-demographic and social/cultural factors associated with older persons living with dementia’s engagement in ACP. Future policies warrant a multidisciplinary approach when reviewing legalities. Finally, ACP knowledge translation should become a routine aspect of dementia care.

In 2015, the Supreme Court of Canada struck down the criminal law prohibiting physician assisted death in Canada. In 2016, Parliament passed legislation to allow what it called ‘medical assistance in dying (MAID).’ The authors first describe the arguments the Court used to strike down the law, and then argue that MAID as legalized in Bill C-14 is based on principles that are incompatible with a free and democratic society, prohibits assistance in dying that should be permitted, and makes access to medically-assisted death unnecessarily difficult. They then propose a version of MAID legislation (‘Ideal MAID’) that gives proponents and opponents of MAID everything they can legitimately want, contend that it is the only way to legalize MAID that is compatible with a free and democratic society, and conclude that it is the way to legalize MAID in Canada and other similarly free and democratic societies.