Carter v. Canada: Assisted Dying, Charter Rights, and Bill C-7

In Carter v. Canada (Attorney General), 2015 SCC 5, the Supreme Court of Canada unanimously struck down the Criminal Code’s ban on assisted dying, ruling that a total prohibition violated the Charter rights of competent adults with grievous and irremediable medical conditions who wanted help to end intolerable suffering. The decision, released on February 6, 2015, reversed more than two decades of precedent and forced Parliament to build the legal framework for medical assistance in dying (MAiD) that governs the practice in Canada today.¹

What the Court Actually Decided

The heart of the ruling sits at paragraph 127. The Court declared that sections 241(b) and 14 of the Criminal Code were of no force or effect to the extent that they prohibited physician-assisted death for a competent adult who clearly consents to ending their life and who has a grievous and irremediable medical condition (including an illness, disease, or disability) causing enduring suffering intolerable to that individual.¹

That language set a constitutional floor. Parliament could add safeguards and procedural requirements when it drafted legislation, but it could not push eligibility below the parameters the Court had laid out without inviting another challenge. The definition of “intolerable” was deliberately placed in the patient’s own hands rather than measured against an objective medical yardstick.

Rather than let the criminal provisions collapse immediately, the Court suspended its declaration for 12 months so Parliament and the provinces could design a regulatory scheme. On January 15, 2016, with the deadline approaching and no legislation yet in place, the Court granted a further four-month extension. The prohibition became inoperative on June 6, 2016.²

The Criminal Code Provisions That Fell

Two Criminal Code sections created the blanket prohibition the plaintiffs attacked. Section 241(b) made it an indictable offence, punishable by up to 14 years in prison, to aid a person in dying by suicide.³ Section 14 stated that no person could consent to having death inflicted on them, so even a clear, voluntary request from a suffering patient gave no legal cover to anyone who helped.⁴

Together, the two provisions meant that a physician who administered a lethal substance at a patient’s request could face prosecution, and family members who arranged end-of-life assistance risked criminal charges. Canadians who wanted this option either had to leave the country, as the Carter family did when they travelled with Kay Carter to Switzerland in 2010, or suffer without recourse.

Why the Ban Failed the Charter

The Court’s reasoning centred on section 7 of the Canadian Charter of Rights and Freedoms, which guarantees the right to life, liberty, and security of the person, and the right not to be deprived of those interests except in accordance with the principles of fundamental justice.⁵

The justices found all three interests engaged. The right to life was implicated because some people might take their own lives prematurely while still physically able, rather than risk losing that ability later. Liberty was restricted because the law prevented people from making fundamental personal choices. And security of the person was violated because the prohibition forced individuals to endure suffering they found intolerable.

Overbreadth

The constitutional problem came down to overbreadth. Parliament’s purpose was legitimate: protecting vulnerable people from being pressured into ending their lives in moments of weakness. The Court accepted that objective as pressing and substantial. But the total ban swept in far more than the vulnerable population it aimed to protect. It also captured competent adults who had made clear, informed, voluntary decisions free of any outside pressure, and denying those people their rights had no connection to the law’s protective purpose.²

Having found the law overbroad, the Court did not need to decide whether it was also grossly disproportionate. It then turned to section 1 of the Charter, which allows reasonable limits on rights if they are demonstrably justified. The government could not clear that bar. A properly designed system with safeguards, the Court held, could protect vulnerable people without an absolute ban, meaning the total prohibition went further than reasonably necessary.²

How Carter Departed from Rodriguez

Carter was not the first time the Supreme Court had looked at assisted dying. In 1993, Sue Rodriguez, a woman living with ALS, challenged the same Criminal Code provision. The Court in Rodriguez v. British Columbia (Attorney General) upheld the ban by a 5-4 margin, concluding that although the restriction affected personal autonomy and security of the person, it did not contravene the principles of fundamental justice.⁶

For more than twenty years, Rodriguez was the definitive answer. The Carter plaintiffs, joined by the British Columbia Civil Liberties Association, asked the Court to revisit that ruling on the basis that the legal framework and the evidentiary record had changed substantially since 1993. The Court agreed, and its unanimous 2015 decision effectively overturned Rodriguez.

What Parliament Built in Response

Bill C-14

Parliament passed Bill C-14, which received Royal Assent on June 17, 2016. The legislation added new Criminal Code provisions creating legal exemptions for medical practitioners and nurse practitioners who provide MAiD, along with detailed eligibility criteria and procedural safeguards. To qualify, a person had to be at least 18 and capable of making health care decisions; have a grievous and irremediable medical condition, defined as a serious and incurable illness, disease, or disability with an advanced and irreversible decline in capability; be enduring physical or psychological suffering intolerable to them and not relievable under conditions they consider acceptable; make a voluntary request without external pressure; give informed consent after learning about available means to relieve suffering, including palliative care; and be eligible for publicly funded health services in Canada.⁷

Bill C-14 went beyond the Carter declaration in one significant way. It required that the person’s natural death be “reasonably foreseeable,” taking into account all their medical circumstances. That additional restriction was not part of the Court’s criteria, and it drew constitutional challenges almost immediately.

Bill C-7 and the Two-Track System

In 2019, the Superior Court of Québec struck down the reasonably foreseeable natural death requirement as unconstitutional in the Truchon decision. Parliament responded with Bill C-7, which came into force on March 17, 2021, removing that requirement and creating a two-track system based on the patient’s prognosis.⁸

Track 1 applies when natural death is reasonably foreseeable. The safeguards include a written request signed before one independent witness, confirmation of eligibility by two independent physicians or nurse practitioners, and the right to withdraw the request at any time. The original 10-day reflection period was removed.

Track 2 applies when natural death is not reasonably foreseeable and carries additional protections. The eligibility assessment must take at least 90 days, though it can be shortened if the person is about to lose capacity and both assessments are complete. The person must be informed about available counselling, mental health and disability support services, community services, and palliative care, and must be offered consultations with professionals who provide them. Both the patient and the assessing practitioners must agree that the person has seriously considered those alternatives. If neither assessing practitioner has expertise in the condition causing the suffering, they must consult one who does.⁸

Where the Law Stands Now

The eligibility criteria now codified in section 241.2 of the Criminal Code reflect both Carter’s constitutional floor and the legislative additions built on top of it. A person qualifies for MAiD only if they are at least 18, capable of making health care decisions, have a grievous and irremediable medical condition, make a voluntary request free from external pressure, and give informed consent after learning about available means to relieve their suffering. A grievous and irremediable medical condition means a serious and incurable illness, disease, or disability, an advanced state of irreversible decline, and suffering that is enduring, intolerable to the person, and not relievable in a way they find acceptable.⁹ The person must also be eligible for publicly funded health services in Canada, which effectively excludes visitors and most temporary residents.

One boundary is worth flagging. MAiD is not currently available when a mental illness is the sole underlying condition. The Criminal Code excludes mental illness from the definition of a qualifying illness, disease, or disability, and Bill C-62, which received Royal Assent on February 29, 2024, extended that temporary exclusion until March 17, 2027.⁸ A person who has a mental illness alongside other qualifying medical conditions can still be eligible, provided they meet all the standard criteria; the exclusion applies only when mental illness stands alone.¹⁰

Why Carter Still Matters

Carter did more than remove a criminal ban. It established that the Charter protects the right of competent adults to make deeply personal end-of-life decisions, and it set constitutional boundaries Parliament must respect when regulating MAiD. Every subsequent legislative change, from Bill C-14’s original framework through Bill C-7’s two-track system to the continuing debate over mental illness eligibility, traces back to the principles the Court articulated in February 2015. The declaration at paragraph 127 remains the constitutional benchmark against which any future restriction on assisted dying in Canada will be measured.¹

1
Supreme Court of Canada. Carter v Canada (Attorney General) – 2015 SCC 5
2
Department of Justice Canada. Legislative Background: Medical Assistance in Dying (Bill C-14) – Introduction
3
Government of Canada. Criminal Code – Section 241
4
Government of Canada. Criminal Code – Section 14
5
Department of Justice Canada. Section 7 – Life, Liberty and Security of the Person
6
Supreme Court of Canada. Rodriguez v British Columbia (Attorney General)
7
Department of Justice Canada. Legislative Background: Medical Assistance in Dying (Bill C-14) – Bill C-14 Details
8
Department of Justice Canada. Canada’s Medical Assistance in Dying (MAID) Law
9
Government of Canada. Criminal Code – Section 241.2
10
Government of Canada. Medical Assistance in Dying: Overview