Canada indefinitely bars assisted dying for mental illness and plans advance requests

Indefinite exclusion of mental illness

Canada will introduce legislation to indefinitely bar individuals whose sole underlying health condition is a mental illness from accessing medical assistance in dying (MAID). Justice Minister Sean Fraser announced the decision on Parliament Hill on Wednesday, confirming that the federal government will amend the Criminal Code during the autumn parliamentary sitting. The expansion had previously been scheduled to take effect on 17 March 2027, following earlier legislative pauses in March 2023 and March 2024. Fraser stated that the administration of Prime Minister Mark Carney formalized its stance following a report from a special parliamentary committee of members of Parliament and senators released in June.

Canada has taken the decision not to move forward with the expansion of medical assistance in dying where mental illness is the sole basis.

Disparities in healthcare and lack of consensus

The federal government cited two primary factors for maintaining the exclusion of psychiatric conditions from assisted dying. First, Fraser pointed to disparities in mental healthcare, noting inadequate access to psychiatric services in multiple Canadian communities. Second, the justice ministry pointed to a lack of consensus within the psychiatric and medical communities over when a mental illness can be classified as irremediable. The upcoming autumn bill will also amend the Criminal Code to ensure physicians who comply with statutory criteria for permitted assisted deaths remain protected from criminal prosecution.

While there is not a perfect consensus on this issue, we believe this is the correct approach.

Evolution of Canada's assisted dying framework

Canada first established its MAID framework in 2016 following a 2015 Supreme Court decision, initially restricting eligibility strictly to adults in a terminal condition. A 2019 ruling by a Quebec court determined that limiting access solely to patients with a reasonably foreseeable death was unconstitutional, prompting parliament to amend the statute. Under a 2021 revision introduced under former Prime Minister Justin Trudeau, adults with irremediable physical conditions became eligible if two physicians confirmed severe, unrelievable suffering. Lawmakers placed a temporary moratorium on psychiatric cases in that 2021 legislation, which was subsequently renewed in 2023 and 2024 before the current decision to halt the rollout indefinitely.

Federal data indicates that 95.6% of assisted deaths under the program have involved individuals whose natural death was considered reasonably foreseeable. The remaining 4.4% of cases comprised patients whose deaths were not reasonably foreseeable, such as individuals suffering from multiple sclerosis and incurable neurological diseases.

Advance requests and ongoing legal challenges

In addition to excluding psychiatric conditions, the federal government announced plans to introduce provisions allowing advance requests for assisted dying. This measure will allow patients diagnosed with serious and incurable conditions to register their consent before anticipated cognitive decline impairs their decision-making capacity. The province of Quebec already permits advance requests under specific provincial guidelines. The federal decision follows division among lawmakers and ongoing litigation, including a federal court challenge brought by a Canadian patient who has lived with bipolar disorder for over 30 years and argues that the exclusion discriminates on the basis of diagnosis.