Canadian Committee Cites “Grave Concerns” Over Mental Illness Euthanasia; Recommends Indefinite Exclusion

A Special Joint Committee on Medical Assistance in Dying (MAID) in Canada has recommended an indefinite exclusion of MAID care for patients whose deaths are not “reasonably foreseeable” and whose sole underlying medical condition is a mental health disorder. The Canadian parliament still needs to act in accordance with the recommendation, or the expansion will take effect on March 17, 2027. MAID has been available in Canada for a decade, and they enabled Track 2 in 2021, which allows patients whose death is not “reasonably foreseeable” to be approved if they have a grievous and irremediable condition. The mental health disorder category has been pushed back several times since then.

The committee revealed “significant complexities and risks, grave concerns and deep divisions.”  related to the potential of allowing individuals without a terminal illness and whose death is not “reasonably foreseeable.” The committee listened to 44 witnesses and received dozens of briefs. Many experts, including psychiatric department chairs from across Canada, warned that determining “irremediability” in mental illness is unreliable. In order to greenlight the MAID expansion safely, psychiatrists would have to distinguish between “reasonable” MAID requests and suicidal ideation.

Some of the witnesses said Canada would be prepared for the MAID expansion in March 2027, while others said the necessary conditions for proceeding haven’t yet been met. Specifically, they say there is no establishment of evidence-informed, consensus-based criteria for evaluating reasonable MAID requests against suicidal ideation. There also needs to be adequately resourced mental health systems and sufficiently stringent regulatory safeguards.

Suicidal ideation itself is a symptom of a mental illness, which is why some of the witnesses expressed concern that the evaluation procedure for a mental health MAID request cannot be conducted in an ethically sound manner. Dr. Sandip Singh Gandham said, “We may not be responding to an autonomous, enduring request for assisted dying, but rather to the voice of the illness itself.”

MAID is a program designed to end the suffering of patients, and the difficulty comes when psychiatrists must evaluate the suffering a patient is enduring alongside the suicidality that could be a symptom of a potentially curable mental health disorder. In Canada, 90% of suicides occur in people who could have been diagnosed with a mental health disorder.

Some of the psychiatric expert witnesses described an inherent contradiction within the field of psychiatry if this is approved. The core of the psychiatric practice is “grounded in assessing and treating hopelessness and preventing suicide.” Psychiatrists would be tasked with approving suicide for some patients while working to prevent suicidality in other patients who have the same symptoms.

Dr. van Veen acknowledged differences between chronic physical and psychiatric suffering, but didn’t feel it was enough to warrant a ban on psychiatric MAID. He said that suffering is always subjective. Dr. Gagnon disagreed on the basis that suicidal thoughts “are inherently a part of mental illness,” but “that is not the case with physical illness.”

Dr. Guillaume Barbès-Morin said he believes psychiatrists can adequately assess the criteria and said he is concerned that people with mental illness will face discrimination “just because…we can’t see the illness on a scanner.” He added that physical illnesses like multiple sclerosis also involve the brain, and psychiatrists in Quebec believe patients suffering from mental disorders can have the same degree of suffering as those with physical disabilities.

There were mixed opinions from the committee, but the final recommendation was to indefinitely exclude people whose sole underlying medical condition is mental illness from MAID eligibility. The risk of proceeding currently outweighs the benefits, with a primary ethical dilemma of whether the state can sanction euthanasia and assisted suicide while still offering psychiatric care to individuals experiencing suicidality, with a potential for curing the disorder.

Since the recommendation was revealed last month, there has been a report from the Canadian Press that includes testimonies from patients who have mental illness and have been waiting to become eligible. The patients interviewed in the story say they feel betrayed, dehumanized, and devastated by the latest recommendation. The Canadian government is expected to follow through before the scheduled launch in March, which means the individuals suffering from mental health disorders would not be able to qualify for MAID procedures in Canada.

There is a note at the bottom of the article stating, “Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.” The CMA has received criticism from dissenting physicians and ethicists for not holding a neutral stance on the role of MAID in Canada and for allegedly creating a hostile environment with regulations that compel medical professionals to participate in the MAID program despite moral and/or religious objections.

A 2017 study published in the CMA journal concluded that MAID could reduce health care spending by at least $34.7 million and up to $138.8 million annually, while the costs of the program would only be $1.5 million to $14.8 million.

Canada is currently facing two MAID-related lawsuits, one from each side of the debate. One lawsuit brought by disability groups alleges that approving patients into the program under Track 2 who are not dying is discriminatory. A separate lawsuit brought by Dying with Dignity, a pro-MAID advocacy group, alleges the program is violating the rights of patients with mental health disorders by preventing them from accessing state euthanasia services.

Canadian Prime Minister Mark Carney said the direction from the special committee is clear and the government is expected to take action to halt the March 2027 directive from taking effect.