Why MAID for mental illness has provinces and doctors worried

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Dr. Francois de Wet dreads March 2027, when Canada plans to allow adults suffering only from mental illness to qualify for medically assisted deaths. 

“I’m very, very worried about it,” he said. 

De Wet — a family doctor with 30 years of experience — worries about how this expansion could impact his patients who struggle with mental health. 

De Wet is the chief of staff at the Qikiqtani General Hospital in Iqaluit, Nvt., the territory’s only hospital. In June, Nunavut declared suicide a continuing crisis, repeating a declaration from 2015. 

“[Suicide] is a high burden of disease in [the] territory, and this is just going to add another complicated layer to it,” he said. 

De Wet does not oppose medical assistance in dying (MAID). He began doing MAID assessments and provisions shortly after it was legalized in 2016. In all cases, the individual’s death was reasonably foreseeable and reflected their desires, he says.

But he is one of many experts with concerns about the government’s plans to offer MAID solely for mental illness — when little is being done to ensure it can be practised safely.

“We trust that [MAID assessors] are going to be doing the right thing. …  And I think that for [mental illness cases] it has to be very clear that there’s very tight criteria where this would be appropriate, and whether it would not be,” de Wet said.

‘Path to death’

Ottawa has delayed MAID for the sole condition of mental illness twice. In 2021, it changed the Criminal Code to allow MAID for mental illness in 2023. Days before it was to take effect, Parliament passed a law delaying it for a year. 

In 2024, it passed another law, delaying it until 2027. The government said it was motivated by concerns from psychiatrists, provinces and territories that health-care systems were not ready.

But the political debate continues.

Tamara Jansen, a Conservative MP from B.C., recently introduced a private member’s bill that would prevent people from qualifying for MAID based solely on their mental illness.

Jansen’s bill is identical to one introduced by now-retired Conservative MP Ed Fast. His bill was narrowly defeated in October 2023, although the New Democrats, Greens and some Liberals supported it. 

“MAID for mental illness does not protect the vulnerable. It targets them,” Jansen said at a July 9 press conference in Langley, B.C.

“Canadians struggling with their mental health deserve care and support, not a state-sanctioned path to death.” 

Michael Cooper, a Conservative MP from Alberta, wants the bill to pass. “It is absolutely imperative that this radical and dangerous expansion of MAID for mental illness is permanently scrapped,” he said.

Cooper was part of the committee that recommended Ottawa delay MAID for mental illness until the federal government is satisfied it can be provided safely.

A Health Canada spokesperson told Canadian Affairs in an email that the government is “carefully considering” Jansen’s bill. “It will table its response to the bill through the Parliamentary process,” the spokesperson said.

Dying with Dignity Canada, a charity that advocates for access to MAID, denounced the bill. 

“We stand with the few but significant people across the country who are being excluded, stigmatized and discriminated against based on their diagnosis,” the charity wrote in a statement to Canadian Affairs. “Suffering caused by mental illness is no less ‘real’ than suffering caused by a physical illness, injury, or disability.”

Dying with Dignity is part of a lawsuit claiming that not allowing people to qualify for MAID because of their mental illness violates their Charter rights. 

‘Indefinite pause’

Most provinces have said they want MAID for mental illness stopped. In January 2024, health ministers in 10 provinces and territories wrote the federal government asking for an “indefinite pause” on the expansion. Manitoba, Quebec and Newfoundland and Labrador did not sign the letter.

In an email to Canadian Affairs, Saskatchewan’s Ministry of Health said it “will continue to advocate for an indefinite pause” on MAID for the sole reason of mental illness. 

Alberta also opposes MAID based solely on mental illness, Heather Johnson, press secretary for the province’s minister of justice wrote in an email. The province held a public consultation last year about how MAID impacts vulnerable people. Legislation may follow, Johnson said. 

B.C.’s ministry of health said it supports the delay until 2027 and said additional safeguards are needed when mental illness is the sole cause for MAID. The province did not say whether it thinks MAID for mental illness should be paused indefinitely.

P.E.I.’s health ministry said it had prepared guidelines for the 2024 expansion of MAID for mental illness, and will review those guidelines as needed. Nova Scotia said it continues its own preparations.

Numerous provincial health ministries told Canadian Affairs the federal government has not provided additional guidance on this topic. 

In an email to Canadian Affairs, Health Canada said it is not funding any research about MAID for the sole condition of mental illnesses. 

Psychiatrists disagree

In Nunavut, de Wet says the territory plans to introduce a requirement that, in cases where mental illness is the sole condition, one of the MAID assessors is a psychiatrist. 

That raises other concerns. “A lot of psychiatrists do not support this, so it’s difficult to find someone that has the adequate skills to be able to assess [for MAID],” he said.

Dr. Sonu Gaind, chief of psychiatry at Sunnybrook Health Sciences Centre in Toronto, says concerns are growing among psychiatrists about whether MAID requests can be distinguished from a desire for suicide.

Reports from Ontario’s chief coroner’s office have shown that people with a history of suicidal ideation have been approved for MAID.

Reports from Health Canada show many people who request MAID report suffering because of loneliness or feeling like a burden on others. Individuals who request Track 2 MAID — for people without reasonably foreseeable deaths — are more likely to live in socially disadvantaged neighbourhoods. 

These factors can put people at risk for suicide, Gaind says.

“When people are particularly at risk of suicidality, and it’s fueled by social isolation or marginalization, feeling [like] a burden is really concerning,” he said. 

Not every person who requests MAID is motivated by social isolation, he says. But some are. 

“It’s essential that people are aware that the social factors that do lead to suffering and are traditional suicide risk factors, are not able to be filtered out properly [in MAID requests]. They simply aren’t.” 

Some psychiatrists doubt that loneliness contributes to MAID requests. In a January blog post for Dying with Dignity, Alberta psychiatrist Dr. Alexandra McPherson listed loneliness and despair as motivations for suicide, but not MAID. Instead, people who request MAID are motivated by a desire to preserve their dignity and control their life, she wrote.

But de Wet says there are similarities between requests for MAID and suicide. 

“Inherently, every MAID procedure is technically a suicide,” he said. “The person decides that this is what they want.” 

Yet, he says it is important to respect patient autonomy. “I firmly believe in people’s autonomy to decide about aspects of their life.”  

He thinks legalizing MAID in 2016 was the right thing to do. But the planned expansion in 2027 gives him pause. 

“You have to wonder, ‘Where is the border? How far do we move the goalposts with MAID?’”

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