Canada will not move ahead with plans to let people whose sole medical condition is a mental illness access medically assisted dying, Justice Minister Sean Fraser announced Wednesday, saying the country lacks a firm consensus on how such eligibility should work.
Fraser said the government will bring forward legislation in the coming weeks that suspends the expansion indefinitely. The change means Canadians with a mental illness as their only underlying condition will not be able to seek the procedure by March 2027, the deadline that had previously been set, according to the BBC.
"While there is not a perfect consensus on this issue, we believe this is the correct approach at this particular time," Fraser said. "These are not easy decisions but we believe they will be the correct ones."
The move follows a recommendation earlier this year from a parliamentary committee that Canada should permanently keep people with mental illness alone out of the program.
Why it matters
Medically assisted dying, known in Canada as MAID, has been one of the country's most closely watched policy files for nearly a decade. It became legal in 2016 for people with terminal illnesses, who still make up the overwhelming majority of cases. A Quebec court case led to an expansion in 2021 covering people with incurable conditions whose deaths were not imminent.
Extending access to those with mental illness alone was first scheduled for 2023. The government pushed that date back twice to allow more study of how the change would work in practice. Wednesday's decision closes off that path for the foreseeable future, at least through legislation.
The question carries weight well beyond Canada. Other countries that permit assisted dying for people with mental illness alone, including the Netherlands and Belgium, were studied by the parliamentary committee as it weighed its recommendation. How Canada handles the issue is likely to be cited by lawmakers and advocates elsewhere.
A split among doctors and advocates
Supporters of expansion argue that denying the option to people with mental illness alone treats them differently from patients with physical conditions and infringes on their constitutional rights and access to medical care.
The advocacy group Dying with Dignity called the government's position "profoundly disappointing." Its chief executive, Helen Long, said the number of people who would qualify under the criterion is likely to be very small, but that their suffering is just as real as that of people living with physical illness.
Fraser pointed to uncertainty within medicine as a central reason for caution. He said hearing that doctors do not agree on whether certain mental illnesses can be considered irremediable gave him serious concern.
Some experts have raised a broader worry: that Canada's assisted dying framework has come to serve as a way of easing the distress of people who would be better helped by improved access to affordable housing and health care, rather than functioning as a genuine last resort.
The parliamentary committee captured the competing views in its report, noting that opinions differed but concluding that Canada should indefinitely exclude people whose only underlying medical condition is a mental illness. It also said there is an urgent need for broader and fairer access to mental health services. Not every member signed on. Some issued a dissenting report describing the process as deeply flawed and biased.
Public opinion appears to follow a similar split. Polling indicates that most Canadians back access to medically assisted death in general, but that support drops when the question is limited to patients with mental illness alone.
Court fight ahead
A federal case challenging the government's earlier delays remains before the courts, and Fraser acknowledged that the Supreme Court could eventually take up the issue.
Claire Brosseau, who has treatment-resistant bipolar 1 disorder and is part of that case, told the BBC earlier this year that assisted dying would give her what she described as a safe death. Her lawyer, Michael Fenrick, said Wednesday that he expects a long legal battle and that people will keep suffering while the matter works its way through the courts.
The legislation Fraser described will do more than freeze the mental illness expansion. It will also permit patients with a progressive, incurable illness to give consent to assisted dying in advance, before their condition declines to the point where they can no longer make that decision. Such advance requests are not currently permitted under federal law, though Quebec allows them for people with serious and incurable illnesses.
Watch for the government's bill in the coming weeks, and for how the courts respond to a challenge that now targets both the delay and the planned permanent exclusion.
