Out of the spotlight and away from controversies over a teachers’ strike and Alberta’s energy development, Premier Danielle Smith’s government is dealing with another significant issue: medical assistance in dying (MAID).

The premier’s recent mandate letter to the justice minister prioritizes the creation of “appropriate safeguards” for MAID and preventing medical professionals from ending patients’ lives when their MAID requests are “based solely on a mental illness.”

The provincial government should seize the opportunity to make Alberta a genuine leader in protecting Canadians through enhanced MAID safeguards. No other provincial government has prioritized this.

But the need is great.

When MAID was legalized, courts and federal politicians set public expectations that MAID would include robust protections for vulnerable Canadians. They dismissed evidence that MAID could make vulnerable populations even more vulnerable. Yet, today, we have the fastest-growing euthanasia and assisted suicide program in the world, and the second-highest rate of MAID deaths as a percentage of total death. Nearly five per cent of total deaths in 2023 were MAID deaths. This puts vulnerable Canadians in particular danger of a premature death.

Why? Because our existing safeguards have not provided rigorous scrutiny of MAID requests. Almost eight in 10 MAID requests are approved in Canada, according to a recent Cardus report that reviewed data from Health Canada and various provincial government bodies. And from 2019 to 2023, 42 per cent of all MAID deaths involved people needing disability supports, including more than 1,017 who never received those supports.

And when it comes to mental illness, a study of MAID deaths between 2016 and 2019 at a tertiary care centre in Toronto found that 39 per cent of those requesting MAID had a documented psychiatric condition, most commonly depression. It’s not hard to imagine that MAID requests in Calgary or Edmonton similarly involve persons with psychiatric illness.

The federal government is set to allow mental illness as the sole underlying condition for MAID requests beginning in March 2027. Banning the practice in Alberta would be an important step to protecting Albertans with mental illness. But Alberta can go further, setting a higher standard for MAID safeguards overall.

Getting clear data about who is dying by MAID and under what circumstances can be difficult in Canada. Alberta should address this situation by setting up its own monitoring and review body with regular and accessible public reporting of data, as well as a mandate for enforcing compliance.

The province also needs to ban medical professionals from raising MAID unsolicited. Canadian MAID providers report that almost half the patients they helped die in 2023 reported feeling they were a burden on others — up 10 per cent from the previous year. When a doctor raises MAID as a possibility to people who already feel they are burdening others, it easily comes across as a recommendation or, worse yet, pressure for a premature death.

Alberta should also require MAID requests to establish a substantial history of treatments and services patients have actually tried before their requests are approved. The law has never required this, though many Canadians believe it is required. Even among Canadians who support legal MAID, most do so with the caveat that MAID should be a last resort.

But Alberta shouldn’t stop with improved safeguards. It should also enhance support for those who are suffering, isolated, lonely or struggling.

In addition to MAID reform, the province and civil society groups should work together to ensure Albertans have the support they need to live well. This includes co-ordinating across various departments to ensure that all Albertans have timely and effective access to disability supports, mental health care and palliative care.

Will Alberta step forward as a leader in protecting the most vulnerable?

The mandate letter to the justice minister is a positive signal. Now it is time for action.

• Rebecca Vachon is health program director at Cardus and Andreae Sennyah is director of policy.