Canada Moves to Permanently Bar People With Mental Illness Alone From Assisted Dying

Canada's federal government announced on Feb. 12 that it will introduce legislation to prevent people whose only health condition is a mental illness from accessing assisted dying. The move is an effort by the governing Liberal Party to resolve a growing domestic dispute over who should be allowed to receive medical assistance in dying.

Under current rules, people whose sole underlying condition is a mental illness are already barred from the program, known as Maid. That ban, however, was scheduled to be lifted in March, leaving lawmakers divided over whether the program should be expanded.

Speaking to reporters on Feb. 12, Justice Minister Sean Fraser said the government will keep the exclusion for people with a mental illness alone in place indefinitely. He acknowledged there is no "perfect consensus" on the issue but said the coming bill reflects the "right" approach.

Earlier this year, a government committee concluded that access to Maid should be expanded while "indefinitely excluding persons whose sole underlying condition is a mental illness" from eligibility. The report also pointed to the need to "strengthen and make more equitable" access to mental health services.

Canada's assisted dying law was drafted after a 2015 Supreme Court ruling and initially allowed only people with terminal illnesses to qualify for the procedure. In 2019, a Quebec judge ruled that limiting access to those whose deaths were "reasonably foreseeable" was unconstitutional, forcing federal lawmakers to amend and expand the existing law.

In 2021, the law was updated to allow adults to receive assisted dying if two doctors confirm they have an incurable physical condition causing unbearable suffering that cannot be relieved. Amid uncertainty surrounding mental illness, lawmakers in 2021 initially imposed a temporary exclusion for people whose sole condition was a mental illness. They extended that pause in 2023 and 2024.

According to the latest government figures, the vast majority of assisted dying cases — 95.6 percent — involved people whose natural death was deemed "reasonably foreseeable." Only 4.4 percent involved deaths not considered reasonably foreseeable, including people with conditions such as multiple sclerosis and terminal neurological diseases that can cause severe disability and unbearable suffering.

The Liberal bill also aims to head off a private member's bill that would amend the section of the Criminal Code on Maid to state that "a mental disorder is not a serious and incurable illness."

Supporters of expanding Maid to people whose sole condition is a mental illness argue the current rules violate their constitutional rights and their right to access health care. Fraser acknowledged to reporters that a federal lawsuit led by advocacy group Dying With Dignity Canada, challenging the government's earlier delay of Maid access for people with a mental illness, could influence the coming bill.

The justice minister said lawmakers will also work to decriminalize so-called advance requests, which essentially give people with certain conditions such as Alzheimer's the option to choose Maid before the disease robs them of the capacity to consent.

Quebec is currently the only jurisdiction that allows advance requests. Fraser did not give details on the timing of the legislation but said provinces will decide whether to offer advance requests. While Alberta has said it will not allow advance requests, the justice minister said the bill aims to ensure "practitioners will not be criminalized for providing that."

In Canada, Crisis Services Canada can be reached at any time at 1.833.456.4566, or by texting 45645 from 4 p.m. to midnight ET. In the United States, call or text the 988 Suicide & Crisis Lifeline at 988 or chat at 988lifeline.org. In the UK and Ireland, Samaritans can be contacted free of charge at 116 123. In Australia, the Lifeline crisis support service is 13 11 14. Other international helplines are available at befrienders.org.