Canada’s federal government is moving to make permanent what has so far been a temporary fix — and the stakes could not be higher.
On Wednesday, Justice Minister Sean Fraser announced that the Liberal government would introduce legislation to indefinitely bar people whose sole underlying medical condition is a mental illness from accessing Medical Assistance in Dying, the program commonly known as MAID. The announcement comes as an existing exclusion was set to expire in March, forcing Parliament to act before the deadline arrived and the question resolved itself by default.
Understanding why this matters requires a brief look at how Canada’s assisted dying framework came to exist in its current form. The program traces its legal origins to a landmark 2015 Supreme Court decision that struck down the criminal prohibition on physician-assisted death. Initial legislation restricted access to those whose natural death was reasonably foreseeable — a threshold that a Quebec Superior Court judge ruled unconstitutional in 2019, compelling Parliament to broaden eligibility. The 2021 amendments that followed allowed adults with grievous and irremediable physical conditions, even without a terminal prognosis, to apply for MAID. Lawmakers at that point recognized the particular complexity surrounding mental illness and inserted a temporary exclusion, which has since been renewed twice, in 2023 and again in 2024.
The question of what makes mental illness different from physical illness in this context is not merely philosophical. The core concern is clinical uncertainty: whether a psychiatric condition can ever be reliably judged irremediable, given that mental illnesses often fluctuate, that effective treatments continue to evolve, and that a patient’s capacity to consent may itself be affected by the very condition under consideration. A parliamentary committee examined these questions earlier this year and concluded that the government should expand MAID access broadly while simultaneously recommending that people whose sole condition is a mental illness remain excluded — indefinitely. That same report called for substantially improved access to mental health services, framing the exclusion not as a denial of rights but as a recognition that the healthcare system has not yet built the infrastructure to handle such requests safely and equitably.
Fraser told reporters Wednesday that while there was no “perfect consensus” on the issue, the legislation his government would advance reflected what he called the “correct” approach. He acknowledged that the government faces a legal challenge from Dying With Dignity Canada, an advocacy organization that argues the repeated delays violate the constitutional rights of people living with mental illness. That case, Fraser conceded, could affect the legislation as it moves through Parliament.
The government’s decision is also a tactical one within Parliament itself. The Liberals are acting partly to head off a private member’s bill that would amend the Criminal Code to explicitly exclude mental disorders from the definition of a grievous and irremediable medical condition — a move that would entrench the exclusion in a different and potentially more rigid way.
Alongside the mental illness announcement, Fraser indicated that lawmakers would also move to decriminalize what are known as advance requests. These would allow individuals diagnosed with conditions such as Alzheimer’s disease to formally consent to MAID before their illness strips them of the capacity to do so. Currently, Quebec is the only jurisdiction in Canada that permits such requests. Fraser said the federal bill would leave it to provinces to decide whether to offer advance requests within their healthcare systems — though he was careful to note that the legislation would protect physicians who provide the service from criminal liability, even in provinces that choose not to formally authorize the practice. Alberta has already signalled it will not permit advance requests, illustrating the kind of provincial variation the federal framework must accommodate.
According to the most recent federal figures, 95.6 percent of all MAID deaths in Canada involve patients whose natural death was considered reasonably foreseeable. The remaining 4.4 percent — covering conditions such as multiple sclerosis and severe neurological disease — represent the expanded access introduced in 2021. The program continues to operate within a framework built on judicial interpretation, legislative compromise, and ongoing constitutional negotiation, and Wednesday’s announcement makes clear that negotiation is far from over.
If you or someone you know is in crisis, Crisis Services Canada is available at any time at 1-833-456-4566, or by text at 45645 between 4 p.m. and midnight ET.
