Commentary
By Daniel Zekveld

On April 15, the Canadian Association for Suicide Prevention announced that it will close its doors at the end of June “after more than four decades of national leadership in suicide prevention and life promotion.”

That’s a sad development, particularly in a country that is set to expand Medical Assistance in Dying (MAiD) to Canadians with mental illness in less than a year.

The debate around MAiD for mental illness has been ongoing since 2021, when Parliament passed legislation including a “sunset clause” that would make those with mental illness eligible for MAiD as of March 17, 2023. That expansion was later delayed to 2024, then to 2027. Now, a committee of MPs and senators is once again studying whether Canada is “ready” to euthanize the mentally ill.

But if anything has changed since 2024, it’s that there is more evidence and more opposition against MAiD for mental illness.

MP James Maloney recently highlighted the need to “get it right” as the Special Joint Committee on Medical Assistance in Dying (MAiD) studies MAiD for mental illness alone: “It makes no difference to me whether it’s a small percentage or a large percentage. The issue we have to deal with is getting it right.” But evidence continues to pile up that getting it right means not doing it at all.

For a sense of the impact of MAiD for mental illness, consider the example of the Netherlands, which has had psychiatric euthanasia since 2002. The intent was to offer euthanasia in those situations as a last resort. And for years, the number of psychiatric euthanasia cases remained low. In 2011, there were two psychiatric euthanasia cases. In 2020, there were 88. By 2023, that number had increased to 138, and by 2024, to 219.

One recent study in Psychiatric Times suggests the Netherlands has seen a rapid increase in psychiatric euthanasia, particularly among young women, “without corresponding changes in prognostic certainty or treatment effectiveness.” This rise in cases is accompanied by shorter assessment periods, more permissive interpretations of “irremediable suffering,” and fewer physicians involved in more cases. These elements are already evident in Canada’s MAiD data.

Psychiatrist John Maher, in his testimony before the committee studying MAiD, argued that there is no such thing as “everything has been tried” when it comes to mental illness. In fact, he has had patients whom other psychiatrists say cannot get better, but he has been able to help them do so.

Professor of psychiatry Dr. Harvey Chochinov says that at least half the people who die by MAiD for mental illness would have gotten better. Psychiatrists are concerned that once MAiD for mental illness is permitted, patients will choose MAiD rather than continue to try to get better.

Sixteen current and former chairs of psychiatry departments across the country highlight that there is no broadly accepted definition of irremediability, no clear way to distinguish between suicidality and MAiD requests, and inadequate safeguards to protect the vulnerable. Additionally, mental health care remains lacking in Canada, and cases in other jurisdictions demonstrate some of the problems with MAiD for mental illness. Ultimately, they recommend an indefinite pause on MAiD for mental illness.

Getting it right on MAiD and mental illness means refusing to reframe mental illness as something to be solved through death. Offering MAiD to people suffering from mental illness encourages them to give up hope and flies in the face of suicide prevention efforts that Canada has long promoted.

As of 2025, Canada ranks 22nd out of 28 developed countries in terms of the availability of psychiatric beds and 16th in terms of the number of psychiatrists per person. Canadians in need of psychiatric care wait nearly 25 weeks after receiving a referral. And yet MAiD can be accessed in 90 days, and often much sooner.

The prospect of MAiD for mental illness alone has been looming since 2021. But none of the problems have been resolved. Mental health care remains lacking, irremediability cannot be accurately determined, and most psychiatrists reject MAiD for mental illness.

The reconvening of the Special Joint Committee on MAiD once again gives MPs and senators the opportunity to stop the upcoming expansion of MAiD to those with mental illness. After five years of discussing the recurring problems, this time let’s get it right and ensure Canadians with mental illness are given the hope and care they need rather than the prospect of MAiD.

Daniel Zekveld is a policy analyst with the Association for Reformed Political Action (ARPA) Canada.

MAiD in Canada

2015: Supreme Court opens the door
The Supreme Court of Canada’s Carter ruling struck down the blanket ban on assisted dying for competent adults suffering intolerably from a grievous and irremediable medical condition. The ruling forced Parliament to create a legal MAiD framework, but it did not settle how mental illness would be treated.

2016: Canada passes its first MAiD law
Parliament passed Bill C-14, limiting MAiD mainly to people whose natural death was “reasonably foreseeable.” That kept the system focused largely on end-of-life cases and left mental illness as a sole condition outside the practical scope of the law.

2019: Quebec court expands the debate
In Truchon v. Canada, the Quebec Superior Court struck down the federal “reasonably foreseeable death” requirement and Quebec’s “end of life” requirement. The decision pushed Ottawa to broaden access beyond people already near death.

2021: Bill C-7 changes the law
The federal government passed Bill C-7, removing the reasonably foreseeable death requirement. The bill created two tracks: one for people near death, and another with added safeguards for people whose death was not foreseeable. Mental illness as the sole underlying condition was temporarily excluded, but only for two years.

2023: Ottawa delays the change
Facing pressure from psychiatrists, disability advocates, provinces and health-care groups, the federal government passed Bill C-39. It delayed eligibility for MAiD where mental illness is the sole condition until March 17, 2024.

2024: Another delay
A parliamentary committee concluded Canada was still not ready. Ottawa then passed Bill C-62, delaying eligibility for three more years, until March 17, 2027. The law also requires another parliamentary review before that date.

Current status
Canadians whose sole underlying condition is mental illness are not currently eligible for MAiD. Unless Parliament changes the law again, that exclusion is set to expire in 2027.