This committee meeting studied the eligibility for medical assistance in dying (MAID) for those whose sole condition is a mental illness. Appearing were officials from the Department of Health and the Department of Justice, along with psychiatrists and a family physician.
Sarah Lawley, Assistant Deputy Minister at Health Canada, said that provinces and territories have varying levels of readiness to lift the exclusion for mental illness as a sole condition, with Quebec and Alberta having legislated against it while others prepare. She noted that mental health system capacity remains a central concern, that there are no metrics to define readiness, and that the federal government is facilitating inter-jurisdictional discussions but does not lead oversight.
Kimberly Gibner and Julia Nicol, from the Department of Justice, explained that the Criminal Code framework balances autonomy and protection of the vulnerable, and that Parliament has leeway under the charter to either permit or prohibit MAID for mental illness. They declined to say whether current safeguards are sufficient, stating that is a matter for Parliament, and noted that no court has ruled directly on the question of mental illness as a sole condition.
Claire Gamache, representing the Association des médecins psychiatres du Québec, argued that severe mental disorders can cause suffering equivalent to physical disorders and that psychiatrists are capable of assessing irremediability and distinguishing suicidality from a stable MAID request. She said only a tiny fraction of patients with severe mental illness would qualify, and that denying them access is discriminatory.
Ramona Coelho, a family physician speaking as an individual, said she has observed troubling patterns in MAID assessments, including premature eligibility and inadequate safeguards, particularly for socially vulnerable patients. She argued that it is not possible to reliably determine irremediability in mental illness, that MAID can allow structural coercion, and that the UN Committee on the Rights of Persons with Disabilities has advised against expanding MAID for mental illness.
Karin Neufeld, a psychiatrist and department chair at McMaster University, urged a delay in expansion, describing a patient who initially qualified for MAID under current criteria but later recovered. She said the Canadian Psychiatric Association’s guidance does not represent a consensus among psychiatry chairs, is not peer-reviewed, and offers no substantive criteria for determining irremediability or distinguishing MAID from suicidality.
Guillaume Barbès-Morin, a psychiatrist from the Association des médecins psychiatres du Québec, said that while resources are insufficient, severely ill patients often have access to adequate care, and that assessments for MAID would involve very few cases. He argued that psychiatrists are trained to assess decision-making capacity and that imposing a higher standard on psychiatry than on other medicine is discriminatory.
Harvey Max Chochinov, a distinguished professor of psychiatry at the University of Manitoba, said he cannot support expansion because it is impossible to predict who will recover from mental illness or to distinguish suicidality from a genuine MAID request. He warned that offering MAID changes the therapeutic relationship and that, extrapolating from Dutch data, Canada could see 2,500 to 5,000 annual requests, with many who would have recovered receiving MAID.
Pierre Gagnon, a psychiatrist specializing in psycho-oncology, said that suicidal ideation is intrinsic to many mental illnesses and that no guidelines can reliably separate it from a genuine desire for death. He argued that the irreversibility criterion is not met in psychiatry, that experimental treatments are underdeveloped, and that expansion would break with the physician’s code of ethics to offer all possible treatments.
The committee adopted its subcommittee report and work plan by unanimous consent at the start of the meeting.
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