Canada’s federal government says it will introduce legislation to indefinitely prevent people whose sole underlying health condition is mental illness from accessing medical assistance in dying, or MAID.
The announcement comes before an existing temporary exclusion was due to end in March. Justice Minister Sean Fraser said the government had not found a “perfect consensus” on the issue, but believed continuing the exclusion was the “correct” approach.
Why the rule is being extended
A government committee recommended expanding MAID access while continuing to exclude people whose only underlying condition is a mental illness. Its report also called for “increased and more equitable access” to mental health services.
The temporary exclusion was introduced in 2021 because of uncertainty surrounding mental illness. It was renewed in 2023 and 2024. The fact sheet does not specify the year in which the current pause was due to expire.
Advocates who support access in these circumstances argue that the exclusion violates constitutional rights and limits access to healthcare. A federal case led by Dying With Dignity Canada challenges the government’s earlier decision to delay eligibility.
How Canada’s MAID rules evolved
Canada’s assisted-dying laws followed a 2015 Supreme Court decision and initially applied only to people who were terminally ill. In 2019, a Quebec judge ruled that limiting eligibility to people whose death was “reasonably foreseeable” was unconstitutional.
Federal lawmakers subsequently amended the law. An update in 2021 allowed adults to receive MAID when two doctors confirmed an irremediable physical condition causing immense suffering that could not be relieved.
According to the latest government figures, 95.6% of MAID deaths involved people whose natural death was considered reasonably foreseeable. The remaining 4.4% involved people whose death was not considered reasonably foreseeable, including some people with multiple sclerosis or incurable neurological disease causing profound disability and immense suffering.
A separate debate over advance requests
The proposed legislation would also address advance requests, which could allow people with certain illnesses, such as Alzheimer’s, to request MAID before losing the capacity to consent. Quebec is currently the only Canadian jurisdiction that permits advance requests.
Fraser said provinces would decide whether to provide them. Alberta has said it will not permit advance requests.
The Liberal party’s legislation is also intended to counter a private member’s bill that would amend the Criminal Code to state that “a mental disorder is not a grievous and irremediable medical condition.” Fraser said the bill would seek to ensure that doctors providing MAID are not treated as criminals for doing so.
The government has not specified when the legislation will be introduced. Its final shape could also be affected by the federal court case.
AI tools were used to assist with the preparation of this article.
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