MAID and Mental Illness: Parliamentary Committee Recommends Indefinite Exclusion

The Special Joint Committee on Medical Assistance in Dying (Committee) has released its latest report, Medical Assistance in Dying and Mental Disorder as the Sole Underlying Medical Condition: A Complex and Challenging Conversation Among Canadians (the Report).

The Report makes one recommendation (Recommendation): Parliament should indefinitely exclude persons whose sole underlying medical condition is a mental illness from eligibility for medical assistance in dying (MAID).

Although the Federal government is not legally required to adopt the Recommendation, it is significant and encouraging. The growth of MAID in Canada has been unprecedented in contrast to other countries and it is arguably far from the “stringent limits that are scrupulously monitored and enforced” that were supposed to protect Canadians from the “casual termination of life.” This recommendation marks an important pause on MAID expansion.

How did we get here?

In 2015, the Supreme Court of Canada’s decision in Carter made an exception for assisted suicide within the homicide provisions of the Criminal Code. As a result, the Criminal Code was amended in 2016, and since then, eligibility has expanded. For example, in 2021, a Quebec court in Truchon declared it was unconstitutional to require that a person’s natural death be reasonably foreseeable. Again, legislation followed. Quebec allows MAID by advance directive, even though the Criminal Code does not allow for this method of MAID. 

When Parliament expanded MAID for those whose death is not reasonably foreseeable, it excluded MAID for mental illness, but only for 2 years. However, that delay was extended twice. It was also the subject of a previous Committee report, MAID and Mental Disorders: The Road Ahead.

The Committee’s latest report was required as part of the legislation that delayed expansion of MAID for mental illness. It was tasked with undertaking a “comprehensive review relating to the eligibility of persons whose sole underlying medical condition is a mental illness” to receive MAID.

What did the Committee find?

The Committee heard evidence reflecting widely differing views of extending MAID to mental illness. Several themes emerged from the testimony.

There is no professional consensus on determining “irremediability.”

• Unlike physical illnesses, psychiatrists disagreed about whether, and how, it is ever possible to determine that a mental illness is truly incurable. Current and former Chairs of Psychiatry from medical schools across Canada urged Parliament not to proceed with the expansion, highlighting many important issues, including that safeguards are inadequate for those affected by mental illness and that other countries (e.g. the Netherlands and Belgium) have used MAID for “common and treatable mental disorders.”

Recovery remains possible.

• Witnesses shared about individuals who, at one point, would have met proposed eligibility criteria for MAID but later experienced significant improvements in their mental health, including a renewed desire to live.

Suicide prevention and MAID would become increasingly difficult to distinguish.

• Witnesses expressed deep concern over how requests for MAID could be distinguished from suicidality, especially when mental illness itself may influence an individual’s desire to die. Introducing MAID into mental health care could also undermine therapeutic relationships and create internal inconsistency if psychiatry seeks to both prevent suicide and facilitate it through MAID.

Canada’s mental health system continues to face significant challenges.

• Approximately one-third of Canadians report unmet mental health care needs and demand for services continues to increase. For example, the national 9-8-8 Suicide Crisis Helpline has already received tens of thousands of calls or texts mentioning MAID, and witnesses noted that the real risk that people will choose MAID simply because it is faster and easier to access than it is to access mental health  treatment and support.

Some Canadians may be particularly vulnerable.

• The Committee heard evidence that women, Indigenous peoples, individuals living in poverty, those experiencing social isolation, and people who feel they are a burden on their families are disproportionately represented among MAID recipients. These factors of social vulnerability have not been adequately addressed.

Lack of Safeguards in Existing MAID Framework.

• Witnesses raised a long list of concerns with the existing MAID framework, including disproportionate MAID provision by a small number of “permissive clinicians,” doctor shopping, lack of consistency across jurisdictions, lack of opportunity for family involvement (even in crisis), the use of primarily retrospective oversight, and questions about the effectiveness of sanctions for misconduct.

Dissenting and Supplementary views

The Committee’s recommendation was not unanimous.

Three senators issued a dissenting report recommending that Parliament send a reference question about MAID for mental illness to the Supreme Court of Canada. Another group similarly supported a Supreme Court reference but also advocated for more oversight to allow MAID for mental illness rather than an indefinite exclusion.

A supplementary report signed by one senator and four Members of Parliament strongly supported the Committee’s recommendation. It also encouraged Parliament to adopt Bill C-218, which would amend the Criminal Code to permanently exclude mental illness from the definition of a “grievous and irremediable medical condition.” The supplementary report further called for stronger safeguards, improved monitoring, better oversight, and a renewed commitment to suicide prevention.

Another supplementary report from one MP concluded that based on “disturbing stories of questionable conduct by some MAID providers […] it is hard not to conclude that some providers take an exceedingly expansive interpretation” of what qualifies for MAID. In pausing MAID for mental illness indefinitely, this MP called for better, more accessible mental health services and to address socioeconomic factors that complicate and contribute to requests for MAID.

Why this matters

One observation in the Report deserves particular attention:

The Criminal Code does not create a right to MAID. It simply decriminalizes certain offences where specified legal requirements are met.

This reminder is important. MAID expansion is neither inevitable nor should it be. Parliament is tasked with drawing limits, and the Committee has recommended that those limits should continue to exclude eligibility where mental illness is the sole underlying condition. Public policy cannot answer all of life’s questions, but it should carefully protect those who are most vulnerable and promote access to compassionate care, meaningful support, and hope.

For Christians, the gospel does provide answers to those questions. And MAID touches on many essential questions about the dignity of every human being, along with our responsibility to care for the sick, encourage those who despair, visit the lonely and share the hope of the gospel in the midst of suffering.

How can we respond?

As Christians, we have an opportunity to engage thoughtfully and constructively.

First, we can pray for our elected representatives as they consider the Committee’s recommendations and determine the next steps. We can also pray for individuals living with mental illness, for their families, for health-care professionals, and for all those working to provide compassionate care.

Second, we can write to MPs to express support for the Committee recommendation, to strengthen mental health care and to protect vulnerable Canadians. This is an opportunity to encourage positive action and share our thanks for the Committee’s work and recommendation.

Finally, help inform your church and community about these important developments. Thoughtful, compassionate conversations rooted in truth and hope are an important starting point. This is one of the most significant public policy discussions facing Canada today and Christians need to be equipped to take part in the conversation, whether it is around the kitchen table, at the park, or with a local MP.

CCCC Advocacy  

The Recommendation is a welcome development from Parliament, but MAID expansion is also being dealt with by the courts. Earlier this year, CCCC appeared as an intervener before the British Columbia Supreme Court in a MAID-related case to preserve conscience rights for faith-based hospitals. The court reserved judgment, which means a decision wasn’t made at the end of the trial (nor was it expected), and will be released at a later date. For more information about the intervention, see our conscience intervention blog series.

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