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A special parliamentary committee is recommending that the federal government “indefinitely exclude” people whose sole underlying condition is a mental illness from applying for medical assistance in dying (MAID).
In a report tabled in the House of Commons Wednesday, the Special Joint Committee on Medical Assistance in Dying (AMAD) recommended that the government “amend the Criminal Code” to add this exclusion.
The 88-page report — which comes on the 10-year anniversary of MAID being legalized in Canada — reviews whether the country is ready from a clinical, health systems and regulatory perspective based on expert testimony.
The report says that a common theme across testimony was the “pressing need for increased and more equitable access to adequate mental health services.”
In their conclusion, the committee points to a “divergence of perspectives” on whether Canada is ready to expand eligibility to MAID to those suffering with mental illness.
It also notes that these mixed views existed previously and were partly behind their 2024 decision to delay the expansion.
Asked about those suffering with mental illness hoping for medical assistance in dying (MAID) expansion, Conservative MP Andrew Lawton said ‘I am so grateful that we have come to a conclusion that will not tell these people that we should be killing them.’ A special parliamentary committee released a report on Wednesday recommending the federal government pause the expansion of MAID for the sole underlying condition of mental illness.
Unless Parliament intervenes, MAID eligibility is set to expand to include people with mental disorders as of March 17, 2027. AMAD’s report will now be reviewed by the Canadian government and inform their next steps on this issue.
The committee started to assess the country’s readiness to expand MAID last February. In recent months, it heard from multiple witnesses whose testimony informed the final report.
“Conservatives support the committee’s recommendation,” said Tamara Jansen, MP for Cloverdale-Langley City in B.C., in a news conference after the report was tabled.
“This will save thousands of lives and this is the position that Conservatives have taken from the beginning.”
She said the core issues that led to this decision are that doctors cannot “reliably determine” that someone won’t recover from a mental illness and they cannot accurately distinguish a request for MAID from suicidality.
‘We don’t matter’
Toronto resident Claire Elyse Brosseau, who struggles with several mental disorders including bipolar type 1 disorder, substance use disorder and post-traumatic stress disorder, has spent years advocating for MAID to be an option for herself and others.
“Message received: we don’t matter,” Brosseau told CBC News in response to the committee’s recommendation.
“It’s just not right. I’m not sure why we don’t have equal rights or body autonomy.”
While Brosseau is seeking an exemption from the current legislation to allow her to receive MAID, she knows that’s not an option for everyone. She says she’s worried about what this latest development means for a number of people who have reached out to her and want access to MAID.
For others, the recommendation is exactly what they were hoping for.
Georgia Vrakas, a professor at the University of Quebec and clinical psychologist, says she feels “relieved.”
Vrakas has spent decades struggling with her mental health and says during some of her lowest points, she might have considered MAID had it been available. In 2021, she says she found out that she’d been misdiagnosed with depression when really, she had bipolar type 2 disorder. Now on the correct medication, she says she’s doing a lot better.
“It’s a sign for me that people understand that MAID is not a solution for mental illness,” she said.
Psychiatrists divided over issue
Canadian psychiatrists also remain divided on the issue.
Dr. Sanjeev Sockalingam, chief medical officer at the Centre for Addiction and Mental Health (CAMH), told CBC News that CAMH supports the committee’s recommendation.
He noted that without the ability to accurately predict the trajectory of an illness or distinguish suicidality from a MAID request, there isn’t enough evidence to move forward.
“We’re not disputing that people with mental illness are suffering,” he said, but added that for MAID eligibility to expand, there needs to be additional mental health resources and scientific research into diagnoses and treatment options.
Joint chair of the Special Joint Committee on Medical Assistance in Dying, Liberal MP Dr. Marcus Powlowski, said ‘nothing has changed’ in the end-of-life program as it still does not extend to people whose sole underlying condition is mental illness.
Meanwhile, Montreal psychiatrist Mona Gupta says not being able to fully determine the trajectory of someone’s illness is not unique to mental disorders.
And when it comes to determining suicidality, Gupta says health-care workers are making that call every day.
“What this committee is saying very clearly is that people with mental disorders are not Canadians on the same footing as other Canadians, that their rights can be dispensed with,” she said.
MAID expansion delayed twice
The government has already delayed making a decision on expanding MAID twice. MAID for mental illness was expected to begin in 2023, but that was delayed to the following year. The next year, it was delayed again until 2027.
Justice Minister Sean Fraser, who is taking the lead on the government’s response, is not expected to release an immediate decision about the expansion of MAID.
Earlier Wednesday, before the report had been tabled, Fraser said the government will review it over the next few weeks. But he will likely respond by July 11 — the deadline for feedback.
Fraser’s response may not end the debate.
Asked about Canada’s MAID expansion timeline, Minister of Justice Sean Fraser said ‘this isn’t easy work’ and the government is taking its time to listen to expert and personal testimonies before making a decision.
There are a number of court challenges related to MAID solely for mental illness that could eventually make their way to the Supreme Court of Canada, which would have the final say on the matter.
The federal government will have to introduce new legislation if it wants to indefinitely pause the expansion of MAID or put it on hold for another two years.
If it wants to avoid court challenges, the government could invoke the notwithstanding clause for the first time since its introduction in 1982. The clause allows governments to temporarily override other sections of the Charter of Rights and Freedoms.
On Wednesay, before the report was tabled, Fraser was asked if the government would consider using the notwithstanding clause. “My mind certainly doesn’t go to that place as a first option,” he said.
“I want to have an opportunity to actually understand the recommendation, to review some of the testimony, to engage with stakeholders across Canada to some degree on my own before we come to a conclusion on the next path forward.”
Some committee members call process ‘flawed’
While the majority of AMAD members agreed with the recommendation, others on the committee did not.
In a dissenting opinion within the report, senators Dr. Rosemary Moodie, Pamela Wallin and Kristopher Wells said the committee undertook a “highly irregular and flawed process.”
The senators said that of the 44 witnesses called to testify, more than two-thirds have been “publicly opposed” to expanding MAID for mental illness and that those with lived experience weren’t a priority.
“Simply put, a flawed and biased process cannot be relied upon and has resulted in a report that lacks rigor and credibility,” wrote the senators. “We stress this is not the way parliamentary committees are designed to operate.”
The senators recommend that the government “make a direct reference to the Supreme Court of Canada to clarify the law regarding the extension.”
When asked about criticism related to the process, AMAD co-chair Marcus Powlowski said Wednesday that there’s no way they could accurately represent that perspective by just selecting a handful of people.
He defended the committee’s work and said they “studiously followed the rules on selecting witnesses.”
