The Liberal government will introduce legislation this fall to ban medical assistance in dying (MAID) for individuals whose sole medical condition is a mental illness.
“Canada has made a decision to not move forward with the expansion that is in the Criminal Code of medical assistance in dying where mental illness is the sole basis,” Justice Minister Sean Fraser said Wednesday afternoon.
In June, a special joint committee of MPs and senators recommended MAID for mental illness be banned “indefinitely.”
However, the government’s proposed legislation will also allow for MAID to be administered when an individual has made an advance request for MAID, Fraser said.
Right now, the Criminal Code requires individuals to consent to MAID in most cases before it is administered. In an advance request, an individual who is able to consent sets out the conditions under which they would like to receive MAID in the future, if they have lost the ability to consent.
Such requests are illegal under the Criminal Code, but have been allowed in Quebec since 2024 for individuals diagnosed with diseases like dementia.
The legislation is being drafted and should be introduced in coming weeks, Fraser told reporters.
His comments came hours before the Liberals voted against a Conservative private member’s bill that would have permanently excluded MAID solely based on mental illness.
The bill, sponsored by Conservative MP Tamara Jansen, was defeated by a vote of 141-187. The Tories, NDP and Green Party supported the bill. Most Liberals and all of the Bloc Quebecois voted against it.
Speaking after the vote, Jansen said she was “gobsmacked” that MPs based their vote on a government press conference and not a completed legislative proposal.
“We have no idea what’s going to be in that bill,” she said.
“I’m hoping that we can protect those with mental health challenges, and do it well. And I’m afraid that what they’ve done here is political games.”
Ongoing controversy
MAID for mental illness has been controversial in Canada and abroad.
When MAID was first legalized in 2016, it was only available to people with “irremediable and grievous” medical conditions who were suffering intolerably and had “reasonably foreseeable” deaths.
In 2021, Parliament removed the “reasonably foreseeable” death criterion. That legislation also allowed MAID for the sole purpose of mental illness to be available beginning in March 2023.
However, that part of the legislation was delayed first until 2024, and then again until 2027.
The United Nations recommended in 2025 that Canada not allow MAID for mental illness or advance requests for MAID.
The Parliamentary committee that studied MAID for mental illness recommended Canada not move forward with MAID for mental illness, while some members disagreed and wanted the Supreme Court to provide a legal opinion on the matter.
But on Wednesday afternoon, all seven Liberal MPs on that committee voted against Jansen’s private member’s bill — despite the bill repeating what the committee had recommended.
Jansen was also a member of the committee.
“We’ll get to the same conclusion,” Marcus Powlowski, a Libearl MP and co-chair of the committee, said after the vote.
As committee co-chair, Powlowski authored a personal supplementary opinion where he explained his opposition to MAID for mental illness.
In it, he expressed concern about people choosing MAID because of unmet social and occupational needs. Offering “death as an alternative to addressing these issues” is the “opposite” of compassion, he wrote at the time.
His view has not changed, he said Wednesday.
“I have faith that we’re addressing the issue as we need to,” said Powlowski.
However, he says he has concerns about advance requests and said he “would not oppose” the government introducing two pieces of legislation: one banning MAID for mental illness, and a separate one allowing advance requests for MAID.
Mixed reactions
Reaction to the government’s announcement was mixed, among MAID supporters and critics alike.
In a statement, Dying With Dignity Canada, a charity that advocates for MAID access, said it was a “disappointing day” for MAID.
“We’re not totally surprised to see this, but very, very disappointed on behalf of those individuals living with an irremediable mental illness who may wish to apply for MAID at some point,” Helen Long, the organization’s CEO, said in an interview.
Dying With Dignity Canada launched a constitutional challenge to the mental illness exclusion in 2024, saying it discriminates against those with mental illnesses. That case is before the courts and the federal government has until December to file its response.
Dying With Dignity has advocated for advance requests for years. Yet Long said the government’s announcement today fell short.
“Best case scenario, this is a patchwork of systems across the country that creates inequitable access,” said Long. “Worst case, some people may never get the ability to access an advance request.”
Fraser offered few details about what advance requests would look like in his announcement. He said it was up to provinces and territories to legislate “vigorous safeguards” about advance requests.
The federal government is not telling provinces about how to provide health care, he said. Its goal is to amend the Criminal Code so doctors who provide MAID according to advance requests are “not treated like criminals,” he said.
“We believe this is the correct path forward to create space for provinces to determine whether they wish to extend access to medical assistance in dying in these circumstances,” he said.
While Quebec allows advance requests, Alberta passed legislation earlier this year to ban them, as well as MAID for mental illness. That law is not yet in force.
Georges L’Espérance, a Quebec MAID provider and former neurosurgeon, says that he does not expect that every province will agree to have advance requests.
But L’Espérance, who is a past president of the Quebec Association of the Right to Die with Dignity, says that many patients want advance requests for MAID.
In Quebec, advance requests for MAID are currently limited to people who are diagnosed with an irremediable disease that will lead to a loss of capacity, such as dementia or Alzheimer’s.
Long says the Quebec law could provide a good model for a federal framework for advance requests.
In 2025, Health Canada released a report on a national consultation about advance requests. Most survey respondents — 69 per cent — approved of advance requests for MAID for people diagnosed with diseases that lead to a loss of capacity.
However, some say advance requests endanger people with dementia.
In a statement, the charity Dementia Justice warned about how coercive control and elder abuse could contribute to dementia patients’ advance requests for MAID.
“We urge Parliament to examine how the risks of coercive control and elder abuse will be identified, assessed, and responded to in practice,” the statement says.
Separate legislation?
Critics of the government’s MAID laws said the government should introduce two pieces of legislation: one to ban MAID for mental illness and another to create advance requests.
“These two issues are complex,” said Trudo Lemmens, a health law professor at the University of Toronto who opposes MAID for mental illness.
The two issues need to be studied separately, he said. “Introducing advance requests for MAID crosses the line between clear consent and no consent, and so it’s certainly no longer a practice where clear consent is the basis for MAID.”
Disability organizations also said the government should not proceed with advance requests.
Jasmin Lemieux-Lefebvre, co-ordinator of the Quebec organization Living with Dignity, said including both issues in one piece of legislation “is a political maneuver that is not serving both issues.” Advance requests should be addressed in a separate piece of legislation, he said.
Inclusion Canada, a national organization that represents people with intellectual disabilities, said in a statement that it is pleased about the plan to ban MAID for mental illness.
But advance requests should not be legalized, the statement says. People do not know how they will respond to a future disability, the statement says.
“Advance requests move Canada closer to letting someone else decide when a person’s life should end,” the statement says.
At Wednesday’s press conference, Fraser said the government has no intention of introducing two pieces of legislation.
