This article originally appeared in the National Post.
By Ramona Coelho, March 20, 2026
Alberta’s Safeguards for Last Resort Termination of Life Act signals a fundamental policy and ethical correction: medical assistance in dying must remain an exceptional, end-of-life intervention and should not become routine or replace the provision of proper medical, disability, and social care. Alberta’s proposed bill seeks to restore this principle within Canada’s assisted dying framework.
This approach aligns with recommendations from the United Nations Convention on the Rights of Persons with Disabilities, which has called on Canada to reform its euthanasia and assisted suicide framework, including repealing Track 2 MAiD (where death is not “reasonably foreseeable”), avoiding expansion of eligibility where mental illness is the sole underlying condition, and strengthening independent oversight to better protect persons with disabilities from coercion or structural pressures to die.
Since 2016, Canada’s MAiD framework has expanded rapidly. What was framed as an exceptional measure for those nearing death now includes MAiD for persons with disabilities who are not dying. Further MAiD expansion, where mental illness is the sole underlying condition, remains suspended until 2027.
Canadian oversight remains retrospective, relying on self-submitted reporting by MAiD clinicians. Real-time clinical review mechanisms are absent. Families who raise concerns have little recourse beyond costly court proceedings that are unaffordable for most Canadians.
Meanwhile, individuals have been driven to MAiD by isolation, loneliness, poverty, caregiver burnout, untreated depression, and inadequate access to palliative care and other services.
The issue is not whether safeguards exist on paper. It is whether they can be rigorously upheld in practice.
Alberta’s bill would require a prognosis of less than 12 months before natural death before MAiD could proceed. This moves the regime back toward what many Canadians originally understood, and many still believe it to be: an option for those at the end of life.
Current federal language, such as “reasonably foreseeable natural death,” “irreversible decline,” and “intolerable suffering,” lacks well-defined medical translation. In practice, these terms have been interpreted broadly, as acknowledged even in recent research from the MAiD advocacy community itself. Case reviews show how refusal of treatment, psychosocial distress, fluctuating cognitive states, or systemic failures can be folded into eligibility determinations.
Reintroducing a clear proximity-to-death requirement helps narrow that ambiguity. It reinforces the ethical principles that coercive influences to die should never drive MAiD eligibility.
The proposed Act requires in-person witnessing by a family member, where available, mandates thorough review of relevant health information before MAiD approval, and strengthens disciplinary consequences for contraventions. It also restricts clinician-initiated and public promotion of MAiD within facilities.
These provisions respond to documented concerns. Coroner reviews and case analyses across the country have identified instances where capacity assessments were brief or poorly documented, family concerns were sidelined, patients were assessed virtually without comprehensive chart review, and palliative care was minimal or absent.
When the outcome is death, the process must withstand the highest scrutiny.
The bill also affirms that health-care facilities and practitioners may refuse to provide MAiD and establishes exclusion zones around facilities that opt out.
In a pluralistic society, patients must be able to seek life-affirming care without fear that death will be introduced as a solution. For many disabled, elderly, and marginalized patients, trust in the system is fragile, and discrimination risks are real. MAiD-free spaces are not an attack on autonomy. They recognize that safety and trust matter, and that people have the right to access care in a facility and with a clinician they believe will value and protect their life and safety.
Perhaps most importantly, the legislation ties contraventions of safeguards to mandatory professional sanctions.
Canada’s current federal framework places MAiD under the Criminal Code but relies heavily on good faith and self-reporting. In practice, accountability is rare. Breaches must carry real consequences if MAiD is to remain exceptional.
Alberta’s proposal forces a necessary nationwide debate: Should assisted death ever be easier to access than palliative care, disability supports, mental health services, or housing?
Many patients who request MAiD report feeling like a burden and lacking adequate supports. Autonomy is only meaningful when people have real choices. Death sought in the absence of care is not freedom. It is abandonment.
Ending a life is irreversible. Health systems are imperfect. Assessments can be rushed. Bias exists especially against those who are elderly and disabled. When these realities intersect with a legal pathway to death, safeguards must be more than aspirational.
They must be clear. They must be enforceable. They must ensure that care comes first.
Ramona Coelho, MDCM, CCFP, is a senior fellow at the Macdonald-Laurier Institute, an adjunct research professor of family medicine at the University of Western Ontario’s Schulich School of Medicine and Dentistry, and the co-editor of Unravelling MAiD in Canada: Euthanasia and Assisted Suicide as Medical Care.
