{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:27:50Z","timestamp":1753892870062,"version":"3.41.2"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T00:00:00Z","timestamp":1742169600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:p>To access medical assistance in dying (MAiD) in Canada, a person must have a \u201cgrievous and irremediable medical condition\u201d defined in part as \u201ca serious and incurable illness, disease, or disability\u201d. Thus, the clinical assessment of the incurability of a person\u2019s condition is central to determining MAiD eligibility. However, the clinical interpretation and operationalization of the term have been uncertain due to the absence of a clear legal definition and evolving legislation. This has led to confusion and controversy in the public and professional discussion of MAiD eligibility. In this paper, we examine various attempts to interpret and operationalize the term \u201cincurable\u201d, identifying the limitations of each approach. We aim to overcome these limitations by proposing a method for operationalizing the term. We argue that our approach: (1) is consistent with the current legal framework, (2) is consistent with the interpretations of the terminology used in the <jats:italic>Criminal Code<\/jats:italic>, and (3) reflects the clinical knowledge and reasoning about the full range of medical conditions that can lead to a request for MAiD. In our analysis, we show that incurability cannot be understood only as a feature of a person\u2019s medical condition but resides in the interplay between the nature of the pathology and the person\u2019s treatment decision-making. Our analysis should help with the ongoing operationalization of the incurability requirement in Canada. It may also be helpful to clinicians in other jurisdictions that either invoke or are considering invoking similar terms\/concepts.<\/jats:p>","DOI":"10.3389\/fpsyt.2025.1549289","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T14:45:12Z","timestamp":1742222712000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Interpreting and operationalizing the incurability requirement in Canada\u2019s assisted dying legislation"],"prefix":"10.3389","volume":"16","author":[{"given":"Mona","family":"Gupta","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jocelyn","family":"Downie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,17]]},"reference":[{"volume-title":"Interpreting Canada\u2019s Medical Assistance in Dying Legislation","year":"2018","author":"Downie","key":"B1"},{"volume-title":"Final Report of the Expert Panel on MAID and Mental Illness","year":"2022","author":"Gupta","key":"B2"},{"volume-title":"Model Practice Standard for Medical Assistance in Dying (MAID)","year":"2023","key":"B3"},{"volume-title":"Advice to the Profession: Medical Assistance in Dying (MAID)","year":"2023","key":"B4"},{"key":"B5","article-title":"Access to assisted dying on the basis of mental disorder","volume-title":"Research Handbook on Law and Assisted Dying","author":"Gupta","year":"2025"},{"year":"","key":"B6","article-title":"The Belgian Act on Euthanasia of May 28th 2002, Ethical Perspectives, 9 (2-3), 2002, 182-188"},{"key":"B7","article-title":"Voluntary assisted dying in Australia: a comparative and critical analysis of state laws","volume":"46","author":"Waller","year":"2023","journal-title":"UNSW Law J"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.53637\/JUWL9208","article-title":"Comparative and critical analysis of key eligibility criteria for voluntary assisted dying under five legal frameworks","volume":"44","author":"White","year":"2021","journal-title":"UNSW Law J"},{"volume-title":"the Construction of Statutes","year":"2022","author":"Sullivan","key":"B9"},{"key":"B10","first-page":"453","article-title":"End of life law and policy","volume-title":"Canadian Health Law and Policy","author":"Downie","year":"2017"},{"volume-title":"Canada at a Crossroads: Recommendations on Medical Assistance in Dying and Persons with a Mental Disorder - An Evidence-based Critique of the Halifax Group IRPP Report","year":"2023","key":"B11"},{"key":"B12","unstructured":"More Canadian Psychiatrists Respond: No MAID for Mental IIlness\n          \n          2023"},{"volume-title":"Where a Mental Disorder is the Sole Underlying Medical Condition. The State of Knowledge on Medical Assistance in Dying Where a Mental Disorder is the Sole Underlying Medical Condition","year":"2023","key":"B13"},{"first-page":"P. 25","volume-title":"Euthanasia Code 2022. Regional Euthanasia Review Committees. Euthanasia Code 2022","year":"2022","key":"B14"},{"volume-title":"Background Document: The Work of the MAID Practice Standards Task Group","year":"2023","key":"B15"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2016.16050503","article-title":"Treatment-resistant schizophrenia: treatment response and resistance in psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology","volume":"174","author":"Howes","year":"2017","journal-title":"Am J Psychiatry"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2023.104943","article-title":"Resistant and refractory migraine: clinical presentation, pathophysiology, and management","volume":"99","author":"Ornello","year":"2024","journal-title":"EBioMedicine"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1159\/000342243","article-title":"Staging of mental disorders: systematic review","volume":"82","author":"Cosci","year":"2013","journal-title":"Psychother Psychosom"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1549289\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T14:45:18Z","timestamp":1742222718000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1549289\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,17]]},"references-count":18,"alternative-id":["10.3389\/fpsyt.2025.1549289"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1549289","relation":{},"ISSN":["1664-0640"],"issn-type":[{"type":"electronic","value":"1664-0640"}],"subject":[],"published":{"date-parts":[[2025,3,17]]},"article-number":"1549289"}}