This article originally appeared in The Hub.
By Shawn Whatley, March 26, 2026
Alberta Premier Danielle Smith’s Bill 18 is an effort to put common-sense limits on MAiD in Canada. These measures are sorely needed. More than 100,000 Canadians will have died by injection within a decade of Ottawa’s Medical Assistance in Dying bill coming into effect under the Trudeau Liberals in 2016.
The proposed Alberta legislation would ban patients from accessing MAiD for mental illness. Canadians have expressed serious concern about this element in federal legislation, forcing several delays in implementation, the latest one until 2027. Bill 18 would also prohibit in Alberta all other forms of Track 2 MAiD, which is for patients whose death is not reasonably foreseeable and was legalized by Ottawa in 2021. The Alberta bill defines a reasonably foreseeable death (Track 1 MAiD) as one that is expected to occur within 12 months.
Bill 18 would also mandate the presence of a family member when MAiD takes place, which might be the biggest change to its actual delivery. Beyond this, Bill 18 does not touch the clinical aspects of MAiD delivery itself.
It’s less obvious what the impact of Bill 18’s proposed adjustments to patient eligibility criteria and clinician behaviour will be. No question, these will shift the norms and culture around MAiD, but it is hard to see how they will measurably decrease services.
For example, Bill 18 would ban initiating a conversation with patients about whether they had considered MAiD or telling patients that they should consider MAiD. These are good to see, but it is hard to imagine how they would be enforced in all but the most obvious and egregious cases, for example, veterans being offered MAiD when they cannot access a medical lift for their residence. Bill 18 also bans advertising for MAiD and creates more protection against forcing clinicians to participate.
Overall, Bill 18 offers mature, measured limits on what has been a runaway train. It tempers several years of enthusiasm for MAiD without limits that seemed to animate discussions to date, for example, the Quebec College of Physicians arguing for expanding MAiD to infants with severe illness.
Bill 18 might be the best any province can do at this point. The main reason Canada has world-leading rates of MAiD seems to come from our combination of self-administered assisted suicide with doctor-assisted death (euthanasia) under one legislative umbrella. This has made assisted suicide, or self-administered MAiD, virtually non-existent. Health Canada reports that “MAID was administered by a practitioner in all cases that occurred in 2024.” Bill 18 doesn’t touch this.
If the Supreme Court of Canada had stopped at removing Canada’s ban on assisted suicide, it would have simply opened the door for patients to end their own lives. California made a similar decision in 2015. Patients in that state can now access the means to end their own lives, but the only role played by physicians is to prescribe the medication, not help carry out the procedure. California has seen 14 times fewer deaths in a population of similar size to Canada.
Instead, the Supreme Court invented the right to physician-assisted death (euthanasia) with its 2015 Carter ruling, which first struck down Canada’s ban on assisted dying. In response, the medical establishment simply absorbed assisted death into the larger basket of medical services. Advisory committees got to work creating pre-printed medical orders, patient-information leaflets, consent forms, and all the other expectations set by the rules and regulations governing medical facilities. MAiD became just another thing to administer, another service patients could expect.
This is where the tension may emerge between Alberta and Ottawa on Bill 18.
The Supreme Court’s 1988 Morgentaler decision accomplished something similar to Carter by striking down the criminal prohibition on abortion and establishing what amounts to a negative constitutional protection under the Charter. In practical terms, governments cannot impose barriers to abortion that violate Section 7’s guarantee of life, liberty, and security of the person. But it remains open to regulation and may be subject to reasonable limits under Section 1 of the Charter. This is the proper purview of provinces, given their jurisdiction over health-care delivery.
Following Morgentaler, abortion became a publicly funded medical procedure, although variability in access existed across provinces. At the time, provinces worked with physicians to find ways to provide access to abortion services, while defending physicians’ conscience and religious rights. The same applied to institutions.
The assumption was that, if the province wanted to provide the service, then it needed to create a way for patients to access it, which did not include forcing clinicians to be involved in any way, including making referrals for abortion. Although provinces did not pursue term limits or other restraints, the federal government did not dictate details about the scope or scale of implementation one way or the other.
All that has changed. By the time Justin Trudeau became prime minister, core assumptions about patient rights to access services and the implementation of those services were fundamentally different. The federal government’s perspective was that services should be funded by any clinic willing to offer them. In 2021, Trudeau informed New Brunswick that it was withholding federal health-care transfer payments because that province refused to fund Clinic 554 in Fredericton. New Brunswick had already been offering abortion services at three of its hospitals, but Trudeau thought that was not good enough.
With the Supreme Court now having declared there is a constitutional right not to be absolutely prohibited from accessing MAiD, it seems reasonable to assume that federal governments—depending on their political inclinations—may view MAiD as an essential service, much like abortion. Activist groups may lobby any federal government of the day to take such a view—and there are perhaps no better lobbyists with more funding than those with the pro-MAiD group Dying with Dignity Canada.
In light of Trudeau’s treatment of New Brunswick—as well as a 2019 Ontario Court of Appeal ruling on conscience rights which found that physicians who object to performing MAiD must still provide a referral to another practitioner—it does not seem unreasonable to expect lobbyists will pressure Ottawa to, in turn, press Alberta to relax Bill 18’s restraints.
Alberta has exemplified where the provinces are meant to fit into this conversation. Just like most rights in the Charter, assisted dying is subject to reasonable limits. Alberta is regulating and operationalizing the right, putting reasonable limits on it that can be demonstrably justified in a free and democratic society.
We should congratulate Alberta for expressing a clear opinion on how medical services are managed in its own province. Despite what the federal government says, Section 92 of the Constitution Act still situates medical care under provincial jurisdiction. Provinces have a constitutional right and duty to dictate the scope, scale, and limitations of medical services, whether they choose to devolve it to professional associations or take it on themselves in limited cases like assisted dying, as perhaps they should. Let’s see if the feds leave them alone.
Shawn Whatley is a physician, past president of the Ontario Medical Association, a senior fellow at the Macdonald-Laurier Institute.
