Legislation would also create advanced-request mechanism for incurable illness
Canada’s Justice Minister Sean Fraser said Wednesday that the federal government will indefinitely suspend plans to extend medical assistance in dying — known as MAID — to people whose sole underlying condition is a mental illness, halting an expansion that had been scheduled to take effect by March 2027. The government will introduce legislation in the coming weeks that formalizes the suspension and creates a new pathway allowing patients with a progressing incurable illness to consent to assisted dying before their health deteriorates to the point where they are unable to do so. That pathway, known as advanced requests, would leave the final decision to individual provinces.
Speaking to reporters, Fraser said “while there is not a perfect consensus on this issue, we believe this is the correct approach at this particular time.” He framed the decision around uncertainty within medicine. “When I hear that there is a lack of consensus in the medical community about the irremediable nature of certain mental illnesses, that gives me real cause for concern,” Fraser said. “These are not easy decisions but we believe they will be the correct ones.”
The suspension follows a parliamentary committee report earlier this year that concluded Canada should “indefinitely exclude persons whose sole underlying medical condition is a mental illness” from assisted dying. The committee also flagged what it called a “pressing need for increased and more equitable access to adequate mental health services.” Its conclusions came after members heard from doctors, advocates, and experts from countries that already permit assisted dying for people with mental illness alone, including the Netherlands and Belgium.
Not all committee members agreed. A dissenting report argued the committee’s process was “fundamentally flawed” and “biased.” Beyond the question of mental illness specifically, some experts have raised broader concerns that Canada’s assisted-dying program has become a tool to alleviate suffering that would be better addressed by improved access to affordable housing and health care, rather than functioning as an option of last resort.
The proposed advanced-request mechanism — under which patients with progressing incurable illnesses could consent to assisted dying before losing capacity — is not currently legal under federal law, though Quebec already permits it for patients with serious and incurable illnesses. The federal proposal would leave the final decision on implementation to individual provinces.
A federal court case remains active that had been challenging the government’s earlier decision to delay access to MAID for people with mental illness. Fraser acknowledged Wednesday that the question could ultimately be weighed by the Supreme Court.
Medically assisted dying became legal in Canada in 2016 for people with terminal illnesses, who still account for the vast majority of cases. Following a court case in Quebec, the program was expanded in 2021 to include people with incurable conditions whose death was not imminent, under a mechanism known as “track two” MAID. Canada was first scheduled to extend the program to people whose sole condition is a mental illness in 2023, but the government delayed doing so twice to allow further study of how such a change might be delivered.
Supporters of extending the program argue that the suspension violates their constitutional rights and access to healthcare, and that patients with mental illness alone should have the same rights as those with other types of illness. Claire Brosseau, who has treatment-resistant bipolar 1 disorder and is part of the federal case challenging Canada’s current law, told the BBC earlier this year that euthanasia would offer her “a safe death.” Polling cited by the BBC suggests the majority of Canadians support access to medically assisted death, but that support falls when the question is limited to patients with mental illness alone.