Dr. Francois de Wet dreads March 2027, when Canada plans to allow adults suffering only from mental illness to qualify for medically assisted deaths.
“I’m very, very worried about it,” he said.
De Wet — a family doctor with 30 years of experience — worries about how this expansion could impact his patients who struggle with mental health.
De Wet is the chief of staff at the Qikiqtani General Hospital in Iqaluit, Nvt., the territory’s only hospital. In June, Nunavut declared suicide a continuing crisis, repeating a declaration from 2015.
“[Suicide] is a high burden of disease in [the] territory, and this is just going to add another complicated layer to it,” he said.
De Wet does not oppose medical assistance in dying (MAID). He began doing MAID assessments and provisions shortly after it was legalized in 2016. In all cases, the individual’s death was reasonably foreseeable and reflected their desires, he says.
But he is one of many experts with concerns about the government’s plans to offer MAID solely for mental illness — when little is being done to ensure it can be practised safely.
“We trust that [MAID assessors] are going to be doing the right thing. … And I think that for [mental illness cases] it has to be very clear that there’s very tight criteria where this would be appropriate, and whether it would not be,” de Wet said.
‘Path to death’
Ottawa has delayed MAID for the sole condition of mental illness twice. In 2021, it changed the Criminal Code to allow MAID for mental illness in 2023. Days before it was to take effect, Parliament passed a law delaying it for a year.
In 2024, it passed another law, delaying it until 2027. The government said it was motivated by concerns from psychiatrists, provinces and territories that health-care systems were not ready.
But the political debate continues.
Tamara Jansen, a Conservative MP from B.C., recently introduced a private member’s bill that would prevent people from qualifying for MAID based solely on their mental illness.
Jansen’s bill is identical to one introduced by now-retired Conservative MP Ed Fast. His bill was narrowly defeated in October 2023, although the New Democrats, Greens and some Liberals supported it.
“MAID for mental illness does not protect the vulnerable. It targets them,” Jansen said at a July 9 press conference in Langley, B.C.
“Canadians struggling with their mental health deserve care and support, not a state-sanctioned path to death.”
Michael Cooper, a Conservative MP from Alberta, wants the bill to pass. “It is absolutely imperative that this radical and dangerous expansion of MAID for mental illness is permanently scrapped,” he said.
Cooper was part of the committee that recommended Ottawa delay MAID for mental illness until the federal government is satisfied it can be provided safely.
A Health Canada spokesperson told Canadian Affairs in an email that the government is “carefully considering” Jansen’s bill. “It will table its response to the bill through the Parliamentary process,” the spokesperson said.
Dying with Dignity Canada, a charity that advocates for access to MAID, denounced the bill.
“We stand with the few but significant people across the country who are being excluded, stigmatized and discriminated against based on their diagnosis,” the charity wrote in a statement to Canadian Affairs. “Suffering caused by mental illness is no less ‘real’ than suffering caused by a physical illness, injury, or disability.”
Dying with Dignity is part of a lawsuit claiming that not allowing people to qualify for MAID because of their mental illness violates their Charter rights.
‘Indefinite pause’
Most provinces have said they want MAID for mental illness stopped. In January 2024, health ministers in 10 provinces and territories wrote the federal government asking for an “indefinite pause” on the expansion. Manitoba, Quebec and Newfoundland and Labrador did not sign the letter.
In an email to Canadian Affairs, Saskatchewan’s Ministry of Health said it “will continue to advocate for an indefinite pause” on MAID for the sole reason of mental illness.
Alberta also opposes MAID based solely on mental illness, Heather Johnson, press secretary for the province’s minister of justice wrote in an email. The province held a public consultation last year about how MAID impacts vulnerable people. Legislation may follow, Johnson said.
B.C.’s ministry of health said it supports the delay until 2027 and said additional safeguards are needed when mental illness is the sole cause for MAID. The province did not say whether it thinks MAID for mental illness should be paused indefinitely.
P.E.I.’s health ministry said it had prepared guidelines for the 2024 expansion of MAID for mental illness, and will review those guidelines as needed. Nova Scotia said it continues its own preparations.
Numerous provincial health ministries told Canadian Affairs the federal government has not provided additional guidance on this topic.
In an email to Canadian Affairs, Health Canada said it is not funding any research about MAID for the sole condition of mental illnesses.
Psychiatrists disagree
In Nunavut, de Wet says the territory plans to introduce a requirement that, in cases where mental illness is the sole condition, one of the MAID assessors is a psychiatrist.
That raises other concerns. “A lot of psychiatrists do not support this, so it’s difficult to find someone that has the adequate skills to be able to assess [for MAID],” he said.
Dr. Sonu Gaind, chief of psychiatry at Sunnybrook Health Sciences Centre in Toronto, says concerns are growing among psychiatrists about whether MAID requests can be distinguished from a desire for suicide.
Reports from Ontario’s chief coroner’s office have shown that people with a history of suicidal ideation have been approved for MAID.
Reports from Health Canada show many people who request MAID report suffering because of loneliness or feeling like a burden on others. Individuals who request Track 2 MAID — for people without reasonably foreseeable deaths — are more likely to live in socially disadvantaged neighbourhoods.
These factors can put people at risk for suicide, Gaind says.
“When people are particularly at risk of suicidality, and it’s fueled by social isolation or marginalization, feeling [like] a burden is really concerning,” he said.
Not every person who requests MAID is motivated by social isolation, he says. But some are.
“It’s essential that people are aware that the social factors that do lead to suffering and are traditional suicide risk factors, are not able to be filtered out properly [in MAID requests]. They simply aren’t.”
Some psychiatrists doubt that loneliness contributes to MAID requests. In a January blog post for Dying with Dignity, Alberta psychiatrist Dr. Alexandra McPherson listed loneliness and despair as motivations for suicide, but not MAID. Instead, people who request MAID are motivated by a desire to preserve their dignity and control their life, she wrote.
But de Wet says there are similarities between requests for MAID and suicide.
“Inherently, every MAID procedure is technically a suicide,” he said. “The person decides that this is what they want.”
Yet, he says it is important to respect patient autonomy. “I firmly believe in people’s autonomy to decide about aspects of their life.”
He thinks legalizing MAID in 2016 was the right thing to do. But the planned expansion in 2027 gives him pause.
“You have to wonder, ‘Where is the border? How far do we move the goalposts with MAID?’”
I have always resented the likes of a politician telling me when or if I’m capable of determining if I should live or die…and that he is. This is a private matter between me, my closest loved ones, and the medical professional—supposing I have one—who is attending me. That I, and many people I know, do not have a doctor is another colossal political failure causing no end of grief that never should have happened in this country.
We desperately need to find a very different ilk of politician, both provincially and federally, and we need to do it smartly for the suffering and deprivation the existing public servant and their neoliberal ideology has caused their constituents, their responsibilities, their charges, is a crime!
Thank you for being concerned for people with mental illness. My family has a history of dementia and Alzheimer’s. All my uncles and aunts (15 in total) have a form or another of dementia or Alzheimer’s (my mother with dementia and my father with Alzheimer’s). I am 66 years old and starting to exhibit signs of memory issues. I saw my mother confined to a long term care home for 7 years before she decided she had had enough and stopped eating and drinking so she would die. I accompanied her on this journey for 7days or until she passed away. That was 2008. Six years later, my dad, who was in hospital because I had tricked him into going there to be assessed (he was driving without a permit and causing all sorts of issues in other areas of his life) knew his next home was a long term care facility and didn’t care for that after having seen my mom. He now knew the trick and did the same,; refused to eat and drink. Since he had just been diagnosed with kidney failure and had refused dialysis, it took only 5 days.
As you may suspect, I am terrified of these mental illnesses. I would really like the case for dying with dignity in Canada to more forward on mental issues. I want to be able to legitimately ask for MAID, or have my assigned caregiver ask for me if I am incapable of deciding for myself. There is no quality of life at all once you reach that stage.
I want to thank you from the bottom of heart for advocating in our favour.
Susan, I am totally with you. I do not have a family history of either dementia or Alzheimers but have been fighting with MS, long Covid and other health issues for years.
There urgently needs to be an “Advanced Consent Form” for people who do wish to die with dignity. I am a self sufficient woman with no children or siblings. My plight would be a long term care facility with no one coming in to monitor my condition or needs. Should I however show signs of loss of ability to care for myself, I do not want a stranger looking after me. Dying with Dignity is exactly what it refers to.
Time for Society to stop trying to protect those of us who would prefer a quick exit through advanced consent and assistance to go the way we wish.
I agree with you! If I have dementia and reach the point where I no longer recognize my close family members, I should be allowed to use my legally documented preference for MAID. My feeling is that, once I reach that stage I am;
1. An unnecessary drain on Canada’s medical system.
2. A financial drain on my family and heirs.
3. An emotional drain on my family.
4. A potential safety risk to medical associates. (many documented cases of this)
5. No longer able to enjoy living.
Hats off to the government of Quebec for allowing pre-registration for the above wishes.
Canada’s medical system exists to support people. People in need of care are its purpose and are not a drain. Ending one’s life because one believes they are burden or drain on their families can destroy families in the aftermath. Advance requests put your life into someone else’s hands based on some imagination of how you might feel under imagined future conditions. We simply cannot know what we might want at the time, so someone might end your life when you don’t want to die (and maybe are unable to communicate this to the doctor or nurse there to kill you), but you will have signed away that right not to be killed years before. That’s why the Criminal Code regards it as murder.
I live every single day in unrelenting mental pain from treatment-resistant illness. I have tried the medications, the hospitalizations, the therapies, the neuromodulation options that are currently available. For years (almost 2 decades since my first “episode”) I’ve endured unbearable symptoms — constant agitation, paralysis, racing thoughts, and suicidal despair — without meaningful or lasting relief.
Unlike physical illnesses, psychiatric suffering is often dismissed as if it isn’t ‘real enough’ to justify MAiD. But for those of us living it, it is just as relentless, just as disabling, and just as destructive to our ability to live a meaningful life.
Continuing to force people like me to stay alive in a state of perpetual torment, with no effective treatments left to try, is not compassion — it is prolonging suffering. I believe people with severe, treatment-resistant mental illness deserve the same dignity, autonomy, and choice as those with physical illnesses when it comes to MAiD.
I think what often gets lost in these debates are the voices of the people who would actually be requesting MAiD. I’m someone who has lived for years with severe, treatment-resistant mental illness. I’ve tried countless medications, therapies, hospitalizations, even neuromodulation treatments — and still I wake up every day to unbearable suffering.
This isn’t about a temporary crisis or avoiding discomfort. It’s about enduring constant torment with no meaningful relief and no realistic prospect of recovery. For people like me, forcing us to keep going ‘just in case’ another treatment works feels cruel. It ignores the reality that we’ve already tried, for years, to get better.
MAiD for mental illness isn’t about giving up too soon. It’s about acknowledging that psychiatric pain can be just as unrelenting, disabling, and intolerable as physical illness — and that people living it deserve the same dignity and autonomy in deciding when enough is enough.
I am a 74 yr. Old woman who has structural damage to both feet.I have not been able to walk without pain for 35 yrs. I have broken my ankle, broken my leg and my hip. Each time I have had to learn how to walk all over again. My feet now go crooked as well as hurt and burn all the time. I do not qualify for M.A.I.D AS I am not close to dying. However, I am dying mentally and emotionally and have tried suicide multiple times. I can say that medicine is not helping with my emotional anguish. I can only pray that in Ontario they will allow M.A.I.D. to cover severe mental illness in or before March 17, 2027.
I do really wonder why they can’t take into consideration that a combo of physical disability and the mental anguish that often comes with it can’t be taken into consideration even before March 17,2027.