The Canadian government has indefinitely postponed plans to expand medical assistance in dying to people whose only condition is a mental illness. People with a mental illness as their only condition were expected to be eligible for assisted dying in March 2027, but the government will instead introduce a bill that suspends this expansion indefinitely.
The government cites a lack of consensus on who should be eligible for the right as the reason for the delay. The parliamentary committee previously recommended that medical assistance in dying, known as MAID, should not be expanded. In its report, the committee noted conflicting views on the issue but recommended that Canada indefinitely exclude people whose only underlying medical condition is a mental illness from assisted dying. The committee added that there is an urgent need for increased and fairer access to appropriate mental health services. The conclusions were reached after committee members heard from doctors, advocates, and experts from countries that allow assisted dying for people with only a mental illness, such as the Netherlands and Belgium. Not all committee members agreed with the recommendation, and some published a dissenting opinion in which they argued that the process was fundamentally flawed and biased.
A case is pending before the federal court challenging the government's previous decision to delay access to MAID for people with mental illness. Advocates for expanding the programme to people with mental illness as their only condition argue that the non-expansion violates their constitutional rights and access to healthcare, and that they should have the same rights as patients with other types of illness. The advocacy group Dying with Dignity described the government's decision as deeply disappointing. Helen Long, the group's executive director, said she expected a very small number of people with severe and persistent mental illness to be eligible for MAID under that criterion, but that their suffering was no less real than that of people with physical illnesses.
Claire Brosseau, a woman with treatment-resistant type 1 bipolar disorder who is part of the federal case challenging Canada's current laws, told the BBC earlier this year that assisted dying would offer her a safe death. Her lawyer, Michael Fenrick, told the BBC on Wednesday that he expected a long legal battle over the issue, and that people would continue to suffer unbearably while the case went through the courts.
Concern has been expressed about whether medicine currently understands mental illnesses well enough to determine appropriate eligibility. Some experts have expressed concern that the Canadian programme for assisted dying has become a tool for alleviating the suffering of people who would be better served by improved access to affordable housing and healthcare, rather than a last resort. Polls suggest that a majority of Canadians support access to medically assisted death, but that support drops when it comes to patients with only a mental illness.
The proposed bill will also allow patients with progressive, incurable illnesses to consent to assisted dying before their health deteriorates to the point where they are unable to give consent. The final decision on this will be left to the individual provinces. The previous requirement is currently not legal under federal law, but is permitted in Quebec for people with serious and incurable illnesses. Medical assistance in dying became legal in Canada in 2016 for people with terminal illnesses, who still make up the vast majority of cases. After a court case in Quebec, it was expanded in 2021 to cover people with incurable conditions whose death was not imminent. Canada was first due to expand its laws on assisted dying to people with mental illness as their only condition in 2023, but this was postponed twice to allow time for the study of potential implementation.
