A parliamentary committee is expected to issue recommendations on whether to expand access to MAID to people whose sole underlying condition is a mental illness.David Joles/The Associated Press
Parliament’s Special Joint Committee on Medical Assistance in Dying has had five years to come up with regulations for the provision of MAID for people whose sole underlying condition is a mental disorder (MAID MD-SUMC).
By all accounts, it’s going to recommend prolonging the ban. Delaying a decision is not acceptable – legally, ethically, or politically.
Court rulings – including the landmark Carter decision in 2015 – have clearly stated that: a) medical assistance in dying is legal; b) a death does not have to be “reasonably foreseeable” for MAID to be granted; and c) governments cannot discriminate by denying MAID to people with disabilities.
At no point have the courts said that people with psychiatric disabilities should be excluded. What the courts have said is that governments can establish parameters for eligibility.
Federal legislation and regulations on MAID contain many safeguards, including limiting it to people suffering from a “grievous and irremediable medical condition.” If a death is not “reasonably foreseeable” (also called Track 1) – a condition of the initial legislation that was struck down as unconstitutional – then a patient must undergo a more rigorous procedure to determine eligibility (Track 2).
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The system works remarkably well, and Canadians have embraced it. In 2024, there were 16,499 completed MAID procedures, only 732 of them Track 2.
People with a mental illness are not excluded from MAID, because many suffer from other irremediable medical conditions. But people whose sole underlying condition is a mental disorder are excluded.
Why? Because the government said back in 2021 that it wasn’t ready. Clinical guidelines needed to be drafted, and so did regulations.
A parliamentary committee was appointed but its first report concluded more time was needed. It nevertheless provided a good summary of the issues. The deadline was pushed back to March 17, 2027.
The latest iteration of the committee has done little but re-hash earlier debates, and in a one-sided manner.
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The committee co-chairs have both said publicly that they oppose MAID MD-SUMC, and the lack of impartiality showed. Of the 38 witnesses who testified at the hearings, 28 were clearly opposed to expansion of MAID. Only one patient was allowed to testify, and she was opposed; those favouring MAID expansion were told there was not enough time to hear them. And while several psychiatrists spoke, no representative from the Canadian Psychiatric Association was invited.
The CPA, unlike the parliamentary committee, has done its homework. They produced detailed guidance on how MAID for people whose sole underlying condition is mental illness could work in practice.
Similarly, the Canadian Association of MAID Providers and Assessors have created a thoughtful curriculum.
The CPA guidelines do a great job of underscoring the issues that make MAID MD-SUMC complex.
How can you determine if a mental illness is “grievous and irremediable”? How do you determine competency? How do you assess and manage the suicide risk of a patient requesting MAID?
Opponents of MAID argue that no psychiatric illness is irremediable, that everyone can be treated and cured eventually.
But how long should a person have to suffer? How many treatments should they have to attempt? There are cases where people have lived unbearable suffering for decades. One of those patients, Claire Brosseau, has asked the court to grant her emergency access to MAID MD-SUMC.
Yes, we have to protect the vulnerable. But not patronize them or deny them the rights other Canadians have.
Surely, there are limits to how much suffering an individual should have to endure.
Every legal challenge that has resulted in MAID expansion has been brought forward by a person with a disability. Time and time again, the courts have ruled in their favour, saying bodily autonomy and freedom of choice are paramount.
MAID providers and assessors, for their part, have shown themselves to be unfailingly compassionate and ethical in facilitating dignified deaths.
Implementation of a law allowing MAID for people whose sole condition is a mental disorder was delayed due to a lack of readiness.
Five years later, Canada is ready, clinically, legally, and societally. That it is not ready politically is not a justification for denying people who suffer from mental illness dignity in death.
It’s well past time for the government of Mark Carney to stop prevaricating and allow MAID to expand in 2027.
And, while they’re at it, get on with allowing advance requests for people with neurological conditions like dementia.
As always, the public is way ahead of the politicians on that one.