On Thursday, the government introduced legislation to delay allowing medically assisted deaths to people whose sole medical condition is mental illness until March 2027.
Until this week, the government was set to allow medical assistance in dying (MAID) for people whose sole condition is mental illness on March 17.
The three-year delay will allow provinces and territories to prepare for the change. It will also give more time to develop guidelines to help doctors determine patient eligibility for MAID, when mental illness is the sole condition, a statement from the Ministry of Health says.
The proposed legislation also says that a committee of Members of Parliament and Senators will be formed to study MAID eligibility for people whose sole medical condition is mental illness. That committee will begin its work two years after the legislation receives Royal Assent, the bill says.
On Monday, a joint committee of the House of Commons and Senate released a report recommending Canada delay allowing MAID for people whose sole condition is mental illness until the health minister and justice minister are “satisfied… that it can be safely and adequately provided.”
The committee was formed in October, shortly after a Conservative private member’s bill that would have banned MAID for mental illness was narrowly defeated by a vote of 150 in favour and 167 against. The Conservatives, New Democratic Party and Greens supported the bill, along with eight Liberals. Sixteen MPs — including 12 Liberals — abstained.
Health ministers, the Canadian Mental Health Association and the Centre for Addiction and Mental Health have all told the ministry that Canada is not ready to expand MAID for people whose sole condition is mental illness, Holland said.
In its report, the committee described a lack of consensus about whether mental illnesses are irremediable and differing reports about adequate training for doctors to assess a person’s eligibility for MAID. Determining if mental illnesses are irremediable is key. The Criminal Code says that someone can only be eligible for MAID if they have an illness, disease or disability that is “grievous and irremediable” — in other words, it can never improve.
The committee heard from 21 witnesses over three meetings in November. Some witnesses said the healthcare system is ready to allow MAID for people whose sole condition is mental illness. Others said Canada is still preparing for it. And “others felt that readiness… will never be attained,” the committee wrote in its report.
Witnesses disagreed about whether a request for MAID could be distinguished from suicidal ideation, the report says. The committee also noted that many doctors, including psychiatrists, object to MAID for people whose sole condition is mental illness.
Difficult issue
The committee’s recommendation to delay allowing MAID for mental illness was far from unanimous. Dissenting opinions from various committee members take up 17 of the report’s 51 pages.
“Prejudice and stigma against people with mental disorders has been reinforced by this committee’s majority report,” wrote Sens. Stan Kutcher, Marie-Françoise Mégie and Pamela Wallin.
The senators decried the majority’s recommendation and urged the government to reject it. They pointed to curricula developed by the Canadian Association of MAID Assessors and Providers to help doctors determine a patient’s MAID eligibility as evidence that doctors are prepared.
Both the majority opinion and the senators’ dissent referenced the hundreds of public briefs the committee received. As Canadian Affairs previously reported, the committee received nearly 900 briefs, but they were not used as evidence for writing the report because they were not translated in time.
The large number of briefs “demonstrates the great interest of Canadians in the difficult issue of MAID,” the majority of the committee wrote. On Friday, many of the briefs were posted to the committee’s website, although they were not used in writing the committee’s report.
The dissenting senators bemoaned that briefs were not used. Some of those briefs were from provincial and territorial experts that spoke about readiness for MAID. The majority report “wrongly dismisses them,” the senators write.
Another senator, Pierre Dalphond, wrote a separate dissenting opinion. He said that denying MAID for the sole purpose of mental illness is discriminatory and violates the Charter of Rights and Freedoms. He said the question of eligibility should be referred to the Supreme Court of Canada.
In 2021, while the government was debating changes to MAID eligibility, the Senate introduced amendments to allow MAID for mental illness.
The Conservatives and Bloc Quebecois also wrote supplemental opinions in the report released Monday.
The Conservative members of the committee called on the government to put an “indefinite pause” on allowing MAID for people with mental illnesses. It is “impossible” to determine if a mental illness is irremediable, the opinion says. Because irremediability is a requirement for receiving MAID, allowing MAID for the sole condition of mental illness “would be legally incoherent,” the opinion says.
The Bloc Quebecois, who have supported the Liberals’ past legislation about MAID, does support MAID for mental illness, but does not think Canada’s healthcare system is prepared for it right now. The committee was not given enough time to study the subject thoroughly, their opinion says.
In June, Quebec changed its provincial law about MAID to exclude requests when the sole condition is mental illness.
Poor and vulnerable
Public responses to the committee’s report mirror disagreements among the committee.
Cardus, a think-tank, praised the committee’s recommendations and the government’s announcement that it would delay allowing MAID for mental illness.
“The government’s priority should be measures that help Canadians live with dignity, including ensuring universally available, high-quality palliative care, as well as addressing needs like housing and supports for those with physical disabilities and mental disorders,” Rebecca Vochon, Cardus’ health program director said in a statement.
Dying with Dignity Canada, an organization that advocates for MAID access, urged the government to announce a clear plan for moving forward.
“For the people across the country who live with treatment-resistant mental disorders who have patiently waited for this change in Canada’s MAID law, Dying With Dignity Canada is disheartened and shares the frustration of the continued exclusion, stigmatization and discrimination based on diagnosis,” the statement says.
Dr. Sonu Gaind, a psychiatrist who spoke to the committee about his concerns about MAID for mental illness, said he was pleased by the government’s announcement.
There has been greater public concern about MAID being allowed for people who are poor or in vulnerable situations, he said.
Gaind hopes the public discussion will now shift to prioritizing helping people with mental illnesses live with dignity. He would like to see Canada create a national suicide prevention plan and have a government minister dedicated to looking at the health problem of loneliness, he said.
There have been 44,958 MAID deaths in Canada since it was legalized in 2016.
In 2022, there were 13,241 MAID deaths in Canada, accounting for four per cent of all deaths in the country.
This article was updated on Feb. 2 to include the government’s announcement that it would introduce legislation to delay MAID for people whose sole condition is mental illness until March 2027.
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