Canada should stop the expansion of MAID for mental illness – once and for all

What began as a narrowly framed end-of-life exception evolved into a system that places disability at the centre of eligibility debates.

In an open letter to the Prime Minister and federal Ministers of Justice and Health, more than 90 disability and mental health organizations called on Parliament to permanently halt the planned expansion of medical assistance in dying (MAID) for people whose sole underlying condition is a mental illness.

Now, the Special Joint Committee on Medical Assistance in Dying has aligned with that position. The task before MPs and Senators is clear: follow through on the committee’s advice and end the planned expansion permanently.

Over the past decade, Canada’s MAID framework has undergone continual expansion beyond the narrow circumstances originally contemplated by the Supreme Court of Canada in Carter v. Canada. What was presented to Canadians in 2015 as a tightly safeguarded end-of-life exception has steadily broadened through legislative and judicial decisions into a framework where disability and mental illness have become increasingly central to eligibility debates.

In Carter, the Supreme Court struck down the blanket prohibition on assisted dying for competent adults experiencing grievous and irremediable suffering. Parliament’s response through Bill C-14 limited MAID to situations where natural death was “reasonably foreseeable,” reflecting an attempt to balance autonomy with safeguards for vulnerable persons.

That balance shifted following the 2019 Truchon decision, when the reasonably foreseeable death requirement was struck down and the federal government chose not to appeal. Bill C-7 followed in 2021, creating Track 2 MAID for people who are not nearing the end of life. A Senate amendment then added the future expansion of MAID to individuals whose sole underlying condition is a mental illness.

Bill C-7 marked a profound shift in Canada’s MAID framework. What began as a narrowly framed end-of-life exception evolved into a system that increasingly places disability at the centre of eligibility debates.

Critics, including these disability organizations, argue that Track 2 MAID created a separate 

legal pathway tied to disability status by allowing eligibility based largely on suffering associated with disability, even where death is not reasonably foreseeable. In practice, the framework creates differential treatment on the basis of disability and singles out disability as a basis for eligibility in ways that continue to raise serious equality-rights concerns under the Charter.

These concerns are intensified by the reality that many disabled Canadians still face major barriers to housing, mental-health care, income security, employment and community supports. Canada should not continue expanding pathways to assisted death while core commitments to disability inclusion remain inadequately implemented.

This concern is particularly significant for many Autistic people and families.

Autism is not classified as a mental illness under the DSM. It is a neurodevelopmental condition. However, many Autistic people experience co-occurring mental-health conditions, often shaped by chronic exclusion, poverty, bullying, isolation and inadequate supports. 

Autistic people experience disproportionately high rates of depression and suicidality, while continuing to face barriers to timely mental health care, disability supports, housing and employment. The concern is that broad psychiatric eligibility categories could indirectly place some Autistic people at increased risk within a system that still fails to provide adequate supports for living.

Importantly, Canada’s existing MAID framework already permits access for individuals who may experience mental illness alongside other qualifying medical conditions. The current debate is about something fundamentally different: whether mental illness alone should become sufficient grounds for eligibility.

A country that cannot consistently provide accessible and adequate support cannot conclude that suffering is irremediable. 

The government should demonstrate meaningful implementation of the commitments they have already made to disabled Canadians. That includes fully implementing Canada’s Autism Strategy, advancing the Disability Inclusion Action Plan, strengthening community mental-health services and addressing the broader social determinants of health and well-being.

The Special Joint Committee has now done its work. Its recommendation reflects years of testimony from disability organizations, mental health advocates, clinicians, researchers and people with lived experience. MAID for mental illness is not a temporary implementation problem waiting to be solved. It raises fundamental questions about equality, disability rights and how Canada responds to suffering.

The immediate task for Parliamentarians is clear: stop this expansion from becoming law.

The answer to unmet needs, isolation and system failure cannot be assisted death. It must be the supports, care and inclusion that allow people to live with dignity. nH

Jonathan Lai, PhD, is the Executive Director of Autism Alliance of Canada.

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