What We're Asking For — Autonomy, Capacity, and the Right to Exit

The Short Version

Three Changes. One Standard.

The full packet runs to hundreds of pages. The legislative ask reduces to three concrete changes and one governing principle.

1

Replace the eligibility criteria

Remove terminal diagnosis and demonstrable suffering as requirements for MAiD eligibility. Replace both with a single standard: decisional capacity — the demonstrated ability to understand the permanent nature of death, demonstrate informed awareness of alternatives, express a stable preference across the assessment period, and be free from acute distorting states. A history of psychiatric diagnosis does not constitute disqualification. Stability is assessed at the time of evaluation.

2

Require a two-stage capacity assessment with a 90-day minimum

Stage 1 assesses decisional capacity across four functional criteria. Stage 2 assesses whether the applicant understands why the safeguards exist — this both filters impulsive decision-making and functions as a component of genuine capacity. A minimum 90-day assessment period applies to all non-terminal applications. Multiple independent evaluations are required within that period. Applications may be withdrawn at any point without prejudice. No "death day locked-in" mechanism is permissible.

3

Mandate the socioeconomic driver report

Where an applicant identifies inadequate housing, income, disability supports, or social connection as a primary or contributing basis for their preference, the administering authority must transmit a formal signed report — attested by the provider, the applicant, and an independent witness — to the Ministries of Health and Social Services and the Regional Coroner. This is not optional. Failure to report is a violation of the Act. This is the mechanism by which the structural accountability mechanism operates.

Model Statutory Language

Proposed Provisions

Draft model language for legislative consideration. Not jurisdiction-specific — requires adaptation to local constitutional and statutory frameworks.

Provision	Proposed Language
Eligible Person	Any adult who demonstrates decisional capacity as assessed under this Act. Terminal diagnosis and proof of suffering are not required.
decisional capacity	The demonstrated ability to: (a) understand the permanent and irreversible nature of death; (b) demonstrate informed awareness of available alternatives including medical, psychiatric, financial, and social supports; (c) express a preference stable across the assessment period; and (d) be free from acute psychotic or crisis states that materially distort comprehension. A history of psychiatric diagnosis does not constitute disqualification. Stability is assessed at the time of evaluation.
Informed Refusal	An applicant need not have utilized any alternative prior to application. Documented informed awareness of alternatives and reasons for declining them shall satisfy this element. Evaluators shall assess comprehension of alternatives, not compliance history.
Assessment Period	A minimum of 90 days from first application for non-terminal provisions. Multiple independent evaluations are required within this period. Applications may be withdrawn at any point without prejudice.
Coercion Screening	Every application shall include: (a) confidential assessment by an independent social worker or patient advocate unaffiliated with the care team; (b) structured review of financial and dependency circumstances; (c) mandatory offer of independent legal assistance for advance planning.
Socioeconomic Documentation	Where an applicant identifies inadequate housing, income, disability support, or social connection as a primary or contributing basis for their preference, the administering authority shall transmit a formal report to the relevant ministry documenting these conditions as a driver of the provision.
Revocation	The right to revoke is absolute, available without condition or explanation until the moment of provision, and has no adverse effect on future access to services or applications.
Clinician Conscience	No clinician is required to participate in MAiD assessment or provision. Conscientious objectors must provide timely referral to a willing provider. Refusal to refer constitutes patient abandonment.

Full statutory language with commentary and jurisdictional adaptation notes is included in the Legal Foundations document and the Master Policy Packet.

Scope

What This Framework Does Not Require

Clarity about what isn't being asked is as important as clarity about what is.

Not required: prior utilization of alternatives

An applicant does not have to have tried an antidepressant, attempted a housing application, or completed a psychiatric program before they are eligible. The standard is comprehension of what alternatives offer, not compliance history. Informed refusal — following full documented disclosure — must be respected without condition.

Not required: clinician participation

No physician, nurse practitioner, or other clinician is compelled to participate in MAiD assessment or provision. Conscientious objection is preserved. The only obligation on objectors is timely referral to a willing provider — failure to refer constitutes patient abandonment.

Not required: proof of suffering

Demonstrable, unbearable, or irremediable suffering is not a criterion under this framework. A person need not be in pain, near death, or visibly distressed to qualify. The operative question is capacity, not condition.

Not required: approval of reasons

Evaluators assess capacity — not whether the reasons for the request are ones the assessor, the institution, or the state considers adequate. A person with intact decisional capacity who has understood the alternatives and declined them has satisfied the standard, regardless of whether those reasons are legible, sympathetic, or conventionally sufficient.

Jurisdictional Context

Where This Reform Applies

The framework is designed for adaptation across jurisdictions with existing or emerging MAiD frameworks.

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Canada — Primary Jurisdiction

Canada has the most developed non-terminal MAiD framework (Track 2 under Bill C-7). The structural accountability mechanism and socioeconomic reporting mechanism are designed specifically around Canada's single-payer system and existing Health Canada reporting infrastructure. Legislative reform targets the Criminal Code provisions governing MAiD eligibility.

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United States — State Level

Thirteen U.S. states and the District of Columbia have Death with Dignity statutes, all currently limited to terminal illness with a six-month prognosis. Reform would proceed state-by-state. The capacity standard and two-stage assessment protocol are directly portable. The socioeconomic reporting mechanism would require adaptation to the fragmented U.S. payer system.

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Belgium & Netherlands — Comparators

Both jurisdictions have operated broad eligibility frameworks including psychiatric cases for over two decades without the predicted collapse of safeguards. Their experience provides the primary empirical counterevidence to the slippery slope objection. The proposed framework incorporates their procedural refinements.

🇨🇭

Switzerland — Non-Resident Access

Switzerland's Dignitas model permits assisted dying for non-residents, creating an offshore safety valve that exposes the arbitrariness of jurisdictional restrictions. The existence of this mechanism undermines the protectionist claim that restriction prevents death — it largely redirects it, at cost and without safeguards.

The Governing Principle

"Bar the exit and you don't save a life. You take ownership of one."

This is not advocacy for death. It is a refusal to treat adult sovereignty as conditional on suffering thresholds, clinical legibility, or social utility. The argument does not require that exit be easy; it requires that exit be possible — and that the conditions under which people choose to remain are documented, legible, and subject to political accountability.

Bar the exit, and presence is conscription: silent, coerced, stripped of moral weight. Unlock it, and presence becomes deliberate affirmation. Every person who remains does so as a choice, not a default. That is the only condition under which the choice means anything.

Legislative Brief (PDF) Legal Foundations Model Form MD-06 (PDF)