People whose only medical condition is mental illness should not be eligible for assisted suicide, an international suicide prevention organization says.
The International Association for Suicide Prevention, a research organization that works with the World Health Organization, made the statement in a December position paper.
“We should not allow access to [euthanasia and assisted suicide] for persons whose suffering is solely associated with a mental illness,” the association wrote.
Research shows the “inability … to predict which persons with a mental illness have a poor or hopeless prognosis, and which will substantially improve, with or without treatment,” it said.
Right now, Canadians whose sole medical condition is a mental illness are not eligible for medical assistance in dying (MAID). That ban is set to expire in March 2027.
To qualify for MAID, patients must have an “irremediable and grievous medical condition.” Many Canadian psychiatrists have raised concerns that it is impossible to accurately determine whether mental illnesses are irremediable.
Dr. Jitender Sareen, a professor and head of the psychiatry department at the University of Manitoba, said it would be an “error” for the government of Canada to ignore such warnings.
“Suicide prevention is one of our obligations as a health community and MAID for mental illness goes against suicide prevention,” he said.
Parliamentary review
The Carney government has not indicated it plans to halt MAID for mental illness.
A parliamentary review of MAID for mental illness is set to begin Feb. 28, Health Canada confirmed in an email to Canadian Affairs.
“The findings of this review will help to guide provincial, territorial and the federal governments as they prepare for the lifting of the exclusion clause in 2027,” Health Canada said in its statement.
The most recent committee that studied the issue recommended in 2024 that MAID for mental illness be delayed until the federal government is “satisfied … it can be safely and adequately provided.” In response, Parliament passed a law delaying MAID for mental illness until March 2027.
On March 26, members of Parliament are set to resume debating Bill C-218, a Conservative private member’s bill that would ban MAID for mental illness. The bill, which is at second reading, is the same as a previous Conservative private member’s bill that was narrowly defeated at second reading in October 2023.
‘International body of literature’
The International Association of Suicide Prevention is not the only organization to have raised concerns about assisted suicide for mental illness.
In July, the American Psychiatric Association approved a statement opposing assisted suicide for people whose sole condition is a mental illness. Assisted suicide is not legal in any U.S. states for patients suffering only from mental illnesses or disorders. But psychiatrists might be asked to help determine if patients qualify for physician-assisted suicide, the statement says.
“There is a notable lack of consensus on the concept of terminal mental illness and the complexities of predicting long-term prognosis of mental disorders,” the statement says.
“In addition, some mental conditions involve temporary alterations in a patient’s preferences that reflect the underlying disorder.
“Finally, central to the psychiatrist-patient relationship is the foundational value of sustaining hope for improvement and reducing suffering.”
Last March, a United Nations committee also told Canada to not allow MAID for people whose sole medical condition is a mental illness.
Sareen, at the University of Manitoba, says Ottawa needs to heed these organizations’ warnings.
“When you’re trying to create interventions in medicine, you usually look at what the international body of literature is on a topic,” he said.
Most Canadian psychiatrists also disagree with allowing MAID for people solely suffering from mental illness, Sitender says.
‘Overlap between suicide’
The December statement from the International Association for Suicide Prevention also raised concerns about people living with chronic conditions whose “deaths are not imminent” being permitted to access physician-assisted death.
In Canada, this practice is known as Track 2 MAID and has been legal since 2021.
In these situations, there is a “strong potential for overlap or equivalence between suicide” and assisted suicide, the organization said.
The association said jurisdictions that legalize physician-assisted suicide “must ensure that other means to alleviate a person’s physical and emotional suffering … are systematically offered and provided.”
This could include providing better psychosocial support, mental health services and palliative care, the statement says.
“Death should never be a substitute for adequate care and support.”
Patient autonomy
Canadian Affairs asked Health Canada to respond to the International Association for Suicide Prevention’s concerns.
The department said the government continues to listen to advice from health-care providers and “those with lived experience.”
Ottawa is committed to ensuring MAID laws support individual autonomy and protect vulnerable people, Health Canada added.
Dying With Dignity Canada, a national charity that advocates for greater MAID access, said it is possible for suicide prevention and MAID to both exist in the health-care system.
“Dying With Dignity Canada shares the view that suicide prevention, palliative care, mental health services, and social supports are essential components of a compassionate and responsive health-care system in Canada. Medical assistance in dying (MAID), legal in Canada, exists alongside these supports,” Helen Long, the organization’s CEO said in a statement.
In her statement, Long said that MAID assessors and providers are thoughtful in their work and follow strict legal safeguards.
Numerous reports, including those from the Ontario chief coroner’s office, have noted concerns about how safeguards are being followed. These include cases where it is unclear if patients gave final consent before MAID is administered and several cases where mental illness may have contributed to a patient’s request for MAID.
Asked about what makes Canada’s MAID safeguards strict, Long noted that MAID is legislated by the Criminal Code and that health-care professionals report all MAID requests and cases to the federal government.
But MAID is primarily about patient autonomy, she added. MAID assessors are not just looking at a patient’s medical diagnosis or symptoms, but also on their “ability to live their life in ways that are meaningful to them.”
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