Canada indefinitely pauses assisted dying expansion for mental illness

Canada’s federal government said on 7 October that it will indefinitely suspend the planned expansion of medical assistance in dying, or MAID, to people whose only underlying condition is mental illness. Justice Minister Sean Fraser said the government would introduce legislation before the previously planned March 2027 change took effect.¹²³

Eligibility remains restricted

People whose sole medical condition is mental illness will not qualify for MAID under the proposed approach. The government’s decision follows a parliamentary committee recommendation that MAID be expanded in some respects while the exclusion for mental illness as the sole underlying condition is maintained indefinitely.¹²³

Fraser cited the absence of agreement over eligibility, including uncertainty in the medical community about whether some mental illnesses can be considered irremediable. He said the government regarded an indefinite suspension as the appropriate course for now.¹²

The committee also said that more accessible and equitable mental-health services were urgently needed. Some committee members, according to the BBC, argued that the committee process had been flawed and biased.¹²

A delayed expansion

Canada legalised medically assisted dying for people with terminal illnesses in 2016, according to the BBC. In 2021, eligibility was extended to people with incurable conditions even where death was not imminent. The mental-illness expansion was first envisaged for 2023 but was delayed twice while its delivery was studied.¹

The current exclusion for people whose only condition is mental illness had been due to end in March, with the BBC identifying the planned date as March 2027. The Guardian reported that the temporary exclusion had previously been renewed in 2023 and 2024.¹²

Advance requests

Alongside the mental-illness decision, the government intends to advance measures on advance requests for MAID. These would allow some patients with a progressing incurable illness to give consent before they become unable to do so, while provinces would decide whether to offer the service, Fraser said.¹²

The New York Times reported that the measure concerns patients with other qualifying conditions who expect cognitive decline. Quebec permits advance requests, while Alberta has said it will not permit them, according to the Guardian.²³

Legal challenge continues

The decision comes as a federal legal case challenges the exclusion. Claire Brosseau, who has treatment-resistant bipolar 1 disorder, is involved in that case, and her lawyer, Michael Fenrick, called the government’s decision “deeply disappointing”. Supporters of expanding access for mental illness alone argue that the existing rules infringe constitutional rights and access to healthcare, according to the BBC and the Guardian.¹²

Fraser said the Supreme Court of Canada could consider the issue in the future, according to the BBC. The Netherlands and Belgium permit assisted dying where mental illness is the sole condition, the BBC reported.¹