Second assisted dying international comparison paper considers request and assessment processes.

(August 31, 2026) With Canada home to world’s fastest growing euthanasia and assisted suicide regime, it’s fair to ask: how do Canada’s laws and policies governing Medical Assistance in Dying (MAiD) compare to other jurisdictions internationally?

The first paper in a series from Cardus found that Canada had one of the most permissive eligibility requirements of any MAiD programs where it is legal.

The second paper, released today, is entitled “Safeguards for Requests and Assessments” and compares Canada’s approach to patients requesting and being assessed for MAiD to that of other jurisdictions. 

“Canada’s safeguards around requests and assessments place it somewhere between the more restrictive approaches of Australia, New Zealand, and various American states, and that of more permissive European jurisdictions,” says Rebecca Vachon, PhD, Program Director for Cardus Health. “Importantly, however, Canada is much more permissive on assisted dying eligibility than Australia, New Zealand, and American states that have legalized MAiD, as we found in our first paper in this series focused on patient eligibility. This context impacts how safeguards around requests and assessments work in Canada compared to other jurisdictions.”

The paper looked at factors such as how a MAiD conversation is initiated, the request and witness processes, how assessors are selected and how disagreements between them are handled, the eligibility and expertise of assessors, patient residency requirements, and how families and existing health care providers are notified. 

The comparisons highlight significant safety gaps for Canadians, which can lead to cases of MAiD under questionable circumstances. For instance, Canada’s assessment process is such that patients who are found ineligible for MAiD can continue to seek out assessors until they find those willing to provide them with MAiD – even if it means travelling to a different province.  Families of MAiD recipients have raised concerns about the capacity and consent of their loved one who died by MAiD, which also highlights gaps in the assessment process. So too do cases of how mental illness may impact decisions to receive MAiD.

Other concerns include the guidance by Health Canada’s Model Practice Standard which recommends that physicians raise MAiD as an option to patients who may be eligible, whereas some international jurisdictions require the patient to initiate the MAiD conversation in order to protect them from being influenced or feeling pressured. 

The safeguards are not uniform across the country, however. Alberta has passed a law to strengthen the assessment process and has banned all regulated health professionals from providing unsolicited information about MAiD during their provision of health services.

“We encourage both provincial and territorial governments as well as the federal government to consider whether Canada’s current rules offer the best protection for at-risk Canadians,” adds Dr. Vachon. “Ultimately, the best safeguard is ensuring that Canadians also have access to a good life and dignified care for their conditions so that they have real options when they encounter serious illness or other challenges.”

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