OTTAWA — Prime Minister Mark Carney’s government should “indefinitely exclude” people with mental illness alone from accessing an assisted death, a parliamentary committee report urged Wednesday, citing “grave concerns and deep divisions” hanging over the issue.
Federal Justice Minister Sean Fraser said he would be taking time to review the report. With only days to go until the House of Commons rises for the summer, the government would not be prepared to introduce legislation until the fall.
The call for the government to abandon for an indefinite period of time expanding MAID to those whose sole underlying condition is a mental disorder, marked 10 years to the day physician-assisted death became legal in Canada.
The report tabled Wednesday by the special joint committee of senators and MPs contains a single recommendation: “That the Government of Canada amend the Criminal Code to indefinitely exclude persons whose sole underlying medical condition is a mental illness from eligibility for medical assistance in dying.”
The mental illness expansion, set to take effect next March, has already been deferred twice.
The joint committee concluded the “divergence of perspectives” on readiness persists. Some witnesses said Canada is or would be ready for the scheduled expansion on March 17, 2027, others said there are unresolved concerns over proceeding, while others still said the expansion should never proceed, full stop, “under any circumstances.”
“Having heard of the significant complexities and risks, grave concerns and deep divisions that continue to accompany this issue,” the committee said it had four options: recommend the government repeal the provision of the Criminal Code excluding MAID for those with mental disorders alone, extend the exclusion for a definite or indefinite period, introduce legislation to permanently prohibit MAID for mental illness or refer the matter to the Supreme Court of Canada for a ruling on the constitutionality of the exclusion.
It ultimately decided to recommend an indefinite pause.
The decision was not unanimous. Three senators as well as Bloc Québécois MP Luc Thériault wrote dissenting opinions.
Critics such as Dying with Dignity Canada said the committee didn’t hear from a sufficient number of people who’ve experienced severe psychiatric illnesses and that witnesses were biased against expansion, charges committee co-chair, Liberal MP Marcus Powlowski, a former emergency doctor in Thunder Bay, rejected, telling reporters that members “studiously followed the rules on selecting witnesses.”
Each committee member put forward names of people they wanted to appear as witnesses, and witnesses were apportioned in equal numbers to members, Powlowski said.
“The number of people with lived experience with mental illness and suicidal ideation is enormous,” Powlowski added. “If you look across Canada, there’s probably literally millions of people who had psychiatric illnesses and had thoughts of suicide.
“How could you do justice to that large number of people and bring in a couple of people that would not be represented in any manner?”
The ministers of health for Saskatchewan and Quebec wrote to the committee, strongly opposing the expansion of MAID to those with mental illness alone.
The joint committee heard from 44 witnesses. Members heard opposing views from psychiatrists, raising concerns for some members that if the experts couldn’t reach consensus, how could legislators recommend the expansion proceed.
Some experts warned that expanding MAID eligibility to those with mental disorders alone would be the “height of irresponsibility.” Several psychiatrists said it is impossible to predict when depression, anxiety or other mental disorders have truly become “irremediable,” a core requirement under Canada’s MAID law, and whether doctors can separate suicidality from a rational, reasoned MAID request.
“Some psychiatrists highlighted what they saw as an inherent incoherence if ‘psychiatry claims it can both prevent suicide in one patient and help finalize suicide in another with the same suffering,’” according to the committee’s final report.
A recurring theme was the pressing need for more access to mental health services and concerns that long waits could exacerbate suffering that might drive MAID requests.
“Some opined that ‘we have an obligation to provide access to mental health treatment before providing access to MAID,’” the committee reported.
Some witnesses warned expanding MAID could lead to so-called “suicide contagion” and that doctor-assisted suicide would be reframed as a rational response to suffering.
Others testified that doctors have reached a consensus that mental disorders can be irreversible and that the relevant training, practice standards and guidelines have been developed.
The committee’s decision “is a wise recommendation that reflects the evidence,” Trudo Lemmens, a University of Toronto professor in health law and policy, said in an email to National Post.
“The explicit legal suspension reflects in a way that key MAID eligibility criteria — irremediability and advanced state of irreversible decline — cannot be individually established in the context of mental illness,” Lemmens said.
“We cannot predict who will not recover, and most will, particularly with quality mental health care.”
Canada’s MAID law does not require that reasonable treatments have been tried, only that they be considered.
The committee also heard testimony that people with mental illness alone have already been offered MAID, in violation of the law.
In a supplemental opinion, Powlowski said that although “some, perhaps a majority of MAID providers, assured us of their readiness” and that existing safeguards are adequate, “we also heard disturbing stories of questionable conduct by some MAID providers” as well as stories of doctors “with a seemingly cavalier attitude towards ending a life.
“Several witnesses suggested the criminal system, the medical colleges and at times (the) government ministry responsible for MAID provision (BC) all allegedly treat enforcement as someone else’s responsibility,” Powlowski wrote.
“Given the lack of evidence to the contrary it is frankly difficult to believe that the system is ready to expand.”
As of the end of 2024, 76,475 MAID deaths had been reported in Canada. The country is expected to mark its 100,000 death this summer.
Euthanasia was legalized in Canada on June 17, 2016. In 2021, the law was amended to allow MAID for people whose deaths are not reasonably foreseeable. However, Bill C-7 also added a provision that mental illness not be considered an eligibility for MAID, a provision that was set to be repealed in March 2023, but was later pushed back to March 2024, and then a third time, to March 2027.
A dissenting report by three senators on the committee called on the government to ignore the recommendation, requesting instead it bring the question of expansion to the Supreme Court of Canada.
They believed the committee followed a “flawed and biased process” in terms of which experts were invited to testify, saying that most who did were those who had publicly stated views against expanding the regime’s eligibility into mental illness.
“We stress this is not the way parliamentary committees are designed to operate,“ read the dissenting report from Sen. Rosemary Moodie, Sen. Pamela Wallin and Sen. Kristopher Wells.
“Concerns were repeatedly raised by senators about witness selection and how the committee sessions were managed but these concerns were ignored.”
The report argues the committee heard “little evidence” from those who assess patients for assisted-dying or have studied the system that can discuss the existing safeguards.
The senators also raised concerns about how the committee failed to hear from “a comparable number of patients and advocates” who wanted to present on why they believed limiting eligibility around mental illness was “discriminatory.”
“Much of the testimony heard at committee relied on clinical and non-clinical opinions, anecdotal experience, and theoretical risk projections rather than on findings drawn from rigorous peer-reviewed scientific evidence,” the report read.
The Bloc Quebecois also issued a dissenting report calling on the Liberals to ask the Supreme Court to weigh in on the matter.
Luc Thériault, Bloc MP who served as a vice-chair on the committee, wrote that members pulled a “180-degree turn” on the planned expansion, saying that evidence was ignored about the discriminatory nature of excluding people with mental illness and how assessors say they are ready.
The Quebec party took particular aim at the Conservatives.
“I find it troubling that we are faced with legislators who are prolonging the exclusion … despite the fact that it is discriminatory and unconstitutional, yet who lack the courage to refer the matter to the Supreme Court to prevent this burden from being imposed on suffering patients,” the report read.
“This stems from ideological rigidity, sad partisanship and a glaring lack of compassion.”
Christine Normandin, the Bloc’s house leader, suggested to reporters on Wednesday that the shift away from expanding eligibility for assisted-dying was another example of Carney’s shifting of the Liberals to the political right.
“What we see is that the prime minister being a proud Catholic, that’s public knowledge, is also going towards the Conservatives on social issues,” she said.
NDP Leader Avi Lewis said the party’s caucus would be discussing the committee report.
National Post
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