Introduction

In February 2026, the Special Joint Committee on Medical Assistance in Dying (the committee) was re‑established by motions in the House of Commons^[1] and Senate.^[2] Both motions provided that,

pursuant to subsection 2(1) of An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2, a special joint committee of the Senate and the House of Commons be appointed to undertake a comprehensive review relating to the eligibility of persons whose sole underlying medical condition is a mental illness to receive medical assistance in dying[.]

For this study, the committee held six meetings between 24 March and 5 May 2026, heard from 44 witnesses and received 32 written briefs, in addition to other correspondence. Among the witnesses were clinicians, researchers, academics, representatives of associations and professional bodies, government officials, people with lived experience, and legal and international experts. The committee members would like to sincerely thank all those who took the time to contribute to this important study. The subject matter is inherently complex and emotionally challenging, and it raises weighty questions for Canadians. The committee members appreciate the dedication of those working to address these issues and the courage of those who have shared their testimony.

The terminology in this report – medical assistance in dying (MAID or MAiD) where the sole underlying medical condition is a “mental illness” (MI‑SUMC) or a “mental disorder” (MD‑SUMC) – relies on the following approach described in the committee’s first report of the 44^th Parliament:

While the Criminal Code provisions refer to “mental illness,” which is the term used in the Expert Panel’s mandate and the motion creating this committee, the Expert Panel uses “mental disorder,” noting that there is no standard definition of “mental illness” and that using it could cause confusion. In addition, the Expert Panel explains that:

A comprehensive review of the knowledge available on the topic of MAiD for mental illness required by the 2016 MAiD legislation (Council of Canadian Academies, 2018) recommended the use of the standard clinical term, ‘mental disorder.’ Therefore, throughout this report, the Panel uses ‘mental disorder’ as that is the term used in both major diagnostic classification schemes relied upon in Canadian psychiatric practice: the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization’s International Classification of Diseases (ICD).

The Committee agrees that using the standard clinical term “mental disorder” is preferable to “mental illness,” and has used that term throughout this interim report, except where directly quoting a witness or referring to the Criminal Code provisions.^[3]

This terminological ambiguity remained unresolved throughout the present study. Some witnesses may have chosen either of the two terms deliberately, while others may have used them interchangeably. This report attempts to be faithful to the context in which a term arises, such as a witness’s statement or legislation, while prioritizing, to the extent possible, the approach endorsed in the committee’s previous report.^[4]

Background

In the 2015 case of Carter v. Canada (Attorney General) (Carter),^[5] the Supreme Court of Canada (Supreme Court) held that the Criminal Code^[6] provisions that prohibit a person from assisting another to die by suicide unjustifiably infringed section 7 of the Canadian Charter of Rights and Freedoms (Charter),^[7] which guarantees the right to life, liberty and security of the person. It further held that those Criminal Code provisions were of no force or effect to the extent that they prohibited physician‑assisted dying for competent adults who consent to such assistance as a result of a grievous and irremediable medical condition that causes enduring and intolerable suffering. The Supreme Court suspended its declaration of invalidity for 12 months. It later granted a four‑month extension of the suspension of the declaration of invalidity, while permitting persons wishing to seek physician assistance in accordance with the Carter criteria to apply for judicial authorization during the suspension period.^[8]

In May 2016, in the context of such an application for judicial authorization in the case of Canada (Attorney General) v. E.F (E.F.),^[9] the Court of Appeal of Alberta held that the Carter criteria could apply to persons with psychiatric conditions.

In June 2016, Parliament passed Bill C‑14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying),^[10] to remove criminal liability for medical and nurse practitioners who provide MAID to eligible persons whose natural death is reasonably foreseeable (now known as “Track 1”), when done in accordance with the provisions added to the Criminal Code. Quebec had previously passed, in 2014, its own assisted‑dying law, the Act respecting end‑of‑life care,^[11] which also restricted access to MAID to persons at the “end of life.”

In 2021, following the Superior Court of Quebec’s decision in Truchon c. Procureur général du Canada (Truchon),^[12] the passage of Bill C-7, An Act to amend the Criminal Code (medical assistance in dying),^[13] provided a pathway to MAID with different safeguards for those whose natural death is not reasonably foreseeable (known as “Track 2”). Bill C‑7 also added a provision to the Criminal Code establishing that “a mental illness is not considered to be an illness, disease or disability” for the purpose of determining eligibility for MAID. This exclusionary provision was set to be repealed on 17 March 2023. On 9 March 2023, the date of the repeal was pushed to 17 March 2024, through the enactment of Bill C‑39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying).^[14]

In June 2023, Quebec amended its assisted‑dying law to prohibit MAID for a mental disorder other than a neurocognitive disorder,^[15] among other changes.

In March 2026, Alberta introduced Bill 18, Safeguards for Last Resort Termination of Life Act.^[16] The bill seeks notably to limit MAID eligibility to persons whose natural death is reasonably foreseeable within 12 months and to prohibit MAID MI‑SUMC.^[17] Bill 18 received Royal Assent on 14 May 2026 and is to come into force on proclamation.

Third Report of the Special Joint Committee on Medical Assistance in Dying and Bill C-62, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2

In October 2023, the committee was re-established to study the extent to which Canada was prepared for a safe and adequate application of MAID MD­‑SUMC. On 29 January 2024, the committee tabled its third report,^[18] concluding that the health system in Canada was not prepared for MAID MD‑SUMC and recommending

• a.     [t]hat MAID MD-SUMC should not be made available in Canada until the Minister of Health and the Minister of Justice are satisfied, based on recommendations from their respective departments and in consultation with their provincial and territorial counterparts and with Indigenous Peoples, that it can be safely and adequately provided; and
• b.     [t]hat one year prior to the date on which it is anticipated that the law will permit MAID MD-SUMC, pursuant to subparagraph (a), the House of Commons and the Senate re‑establish the Special Joint Committee on Medical Assistance In Dying in order to verify the degree of preparedness attained for a safe and adequate application of MAID MD‑SUMC.^[19]

The report was not unanimous; four out of five senators on the committee issued dissenting opinions, while members from the Conservative Party of Canada and the Bloc Québécois issued supplementary opinions.

On 29 February 2024, Bill C-62, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2,^[20] was enacted. This legislation further extended the timeline of the exclusion by three years, to 17 March 2027. It also required that

[a] comprehensive review relating to the eligibility of persons whose sole underlying medical condition is a mental illness to receive medical assistance in dying … be undertaken by a Joint Committee of both Houses of Parliament designated for that purpose.^[21]

Review Relating to the Eligibility to Receive Medical Assistance in Dying of Persons Whose Sole Underlying Medical Condition is a Mental Illness

To be eligible for MAID, a person must – among other requirements – be capable of making health‑related decisions, have a “grievous and irremediable medical condition” and make a voluntary request for MAID.^[22]

A “grievous and irremediable medical condition” means that the person has a “serious and incurable illness, disease or disability” and is in an advanced state of irreversible decline in capability. The illness, disease or disability, or that state of decline, must cause the person enduring physical or psychological suffering that is intolerable to the person and cannot be relieved under conditions that the person considers acceptable. Two independent medical or nurse practitioners must be of the opinion that all of the eligibility criteria have been met. For persons whose natural death is not reasonably foreseeable, if neither of the two practitioners has expertise in the medical condition that is causing the person’s suffering, a practitioner who has such expertise must be consulted. In all cases, a person may withdraw the request for MAID at any time and must give express consent to receive MAID.^[23]

For the present review relating to the eligibility to receive MAID of persons whose sole underlying medical condition is a mental illness, the committee received evidence on general preparations that have been undertaken since January 2024 and on the state of readiness as it applies to clinicians, health systems and regulations. It also heard from witnesses who spoke of lessons that may be drawn from international experiences or of their positions on MAID more broadly. The following sections summarize that evidence.

General Developments Since January 2024

Sarah Lawley, from the Department of Health, highlighted the creation of a federal–‍provincial/territorial committee on MAID in 2024. This committee supports inter‑jurisdictional senior‑level discussions and the sharing of best practices, including on preparations for the expansion.^[24]

Ms. Lawley noted that levels of readiness and approaches varied across jurisdictions, as illustrated by the legislative initiatives in Quebec and Alberta, for example. She explained that

[e]ach jurisdiction is able to design a health system to deliver MAID that aligns with what its jurisdiction is asking for. It can be more strict [than the Criminal Code] in its requirements for MAID, but it can’t be more permissive, so every jurisdiction has a slightly different approach to the way it is delivering MAID and the way its assessment process works.^[25]

As a Department of Justice official explained, “The Criminal Code doesn’t provide a right for MAID. It simply decriminalizes certain offences if certain rules are followed.”^[26] Researcher Eliana Close noted that provincial “variability is [not] necessarily a problem, because ultimately it’s up to the provinces to decide how to deliver MAID. Depending on the local context, different mechanisms of regulation can be more appropriate.”^[27]

In correspondence dated 30 April 2026 and shared with the committee, the Quebec Minister of Health and Minister Responsible for Seniors and Caregivers wrote to her federal counterpart, describing that province’s current position on MAID MD‑SUMC. This position is reflected in its amended assisted‑dying law and was informed by the 2021 report of the Select Committee on the Evolution of the Act respecting end-of-life care, which recommended that access to MAID not be extended to persons whose only medical condition is a mental disorder.^[28] Nevertheless, the Quebec minister urged continued consideration of this issue, in the federal and Quebec legislatures, as well as among the general public.^[29]

According to Ms. Lawley, save for Quebec and Alberta, “[t]here are others that are preparing and are quite actively ready. … [T]he vast majority of them are in the process of preparing to be ready for March [2027].”^[30] She added that they “are building governance to bring together their MAID and mental health systems and increasing training and clinical supports for assessors.”^[31]

Helen Long, representing Dying with Dignity Canada, noted that 80% of Canadians who were polled support access to MAID MI-SUMC.^[32] The Association for Reformed Political Action Canada, in a written brief, cited 2023 polling from Angus Reid indicating that only 28% of Canadians supported MAID for mental illness, while 50% opposed it, and that 82% said MAID should not be expanded without first improving access to mental health care.[33]

Clinical Readiness

Dr. Mona Gupta explained that clinical readiness requires clinical guidance, training and a community of practice that can support mentorship, supervision and case consultation.^[34] According to some witnesses, the relevant training, practice standards and guidelines have been developed for MAID MD‑SUMC, and some providers and assessors are ready for the expansion.^[35]

For others, and as summarized by Melissa Prokopy of the Ontario Hospital Association, there is still no clear agreement among clinicians on the approach to assessing eligibility – including determining irremediability and distinguishing between a reasoned MAID request and suicidal intent – or on the adequacy of guidelines, the existence of a professional consensus or the capacity of Canada’s health systems.^[36] These points are discussed below.

Practice Standards and Clinical Guidelines

Canadian Psychiatric Association Guidance

In March 2026, the Canadian Psychiatric Association (CPA) published a document entitled Canadian Guidance on Medical Assistance in Dying (MAID): Evaluating the “Grievous and Irremediable” Eligibility Criterion in Persons with Mental Disorders who Request MAID and Managing Suicide Risk during the Process for All MAID Eligibility Requests.^[37] In correspondence sent to the committee, the CPA indicated that the year‑long study conducted for this guidance document involved 25 external experts. The recommendations were formulated relying on international academic literature and using the Delphi technique, “a common research method used to reach consensus about a specific issue or complex problem when there is limited evidence or contentiousness.”^[38] The CPA further notes that the recommendations are consistent with existing approaches in analogous scenarios, such as when persons with mental disorders refuse life‑sustaining or life-saving treatments.^[39]

The CPA’s guidance on assessing the grievous and irremediable nature of a medical condition includes recommendations such as the following:

• “[T]he Assessor should explore the reasons a Requester has not accessed standard treatments or supports for their illness, disease, or disability where this is the case.”
• “The Assessor should consider using criterion‑referenced and evidence‑informed tools as appropriate for the Requester’s diagnosis or clinical presentation.”
• “The Assessor should review any relevant medical records.”
• “[T]he Assessor should explore treatment attempts made up to that point, including their duration and intensity, outcomes of those treatments, and the severity and duration of illness, disease, or disability.”
• “The Assessor should adopt a life course and biopsychosocial approach when exploring the various dimensions of the Requester’s experience of suffering.”
• “If social factors are the sole or primary cause of the Requester’s suffering, the Requester would not be considered to have a grievous and irremediable medical condition.”^[40]

Guidance on managing a requester’s suicide risk includes recommendations such as the following:

4. The Assessor should be aware of the Requester’s previous suicide behaviour and current suicidal ideation. The Assessor should seek this information from the Requester, clinicians involved in the Requester’s care, important others (e.g., family members, caregivers), and (or) from a review of medical records.

5. The Assessor must determine whether a person’s request for MAID arises from an acutely distressing circumstance, reflects suicidal ideation as a symptom of a psychiatric condition, or is a reasoned wish to die arising from the suffering related to the Requester’s medical condition(s).

• Requesters in an acute suicidal crisis cannot be assessed for MAID.^[41]

In Dr. Gupta’s assessment, the CPA guidelines are based on sound methodology and supported by a review of the scientific literature. She stated that such guidelines from the CPA, together with others from the Canadian Association of MAiD Assessors and Providers (CAMAP), demonstrate that “clinicians from various disciplines agree on how to assess the relevant aspects of a request for MAID, and they are prepared to do so.”^[42] Certain other witnesses concurred that the CPA document reflected good practice.^[43]

Some witnesses took the position that the CPA document does not constitute adequate guidance.^[44] Dr. K. Sonu Gaind was critical of the CPA’s document, stating that “it lacks evidence” and is based on “a constructed consensus that most psychiatrists do not share.”^[45] According to Dr. Sanjeev Sockalingam, representing the Centre for Addiction and Mental Health, the document does not lay out evidence‑based criteria but, rather, merely an assessment process.^[46] Others pointed out that it had not been peer‑reviewed.^[47] Dr. Karin Neufeld stated that it did not reflect a consensus among the chairs of psychiatry.^[48]

Assessing Irremediability

Witnesses were divided on the question of whether it is possible to assess the irremediability of mental disorders. Dr. Gupta indicated that CAMAP has, since 2024, published a number of guidance documents, particularly on assessing incurability. She added that the CPA guidelines offer a strategy for determining whether a mental disorder constitutes a serious and irreversible medical condition.^[49] Some witnesses, while acknowledging the complexity of the matter, asserted that clinicians are equipped to assess irremediability.^[50]

Nevertheless, other witnesses testified that it would not be possible – either at this moment or at any future time – to reliably determine irremediability in mental illness^[51] or “reliably distinguish in practice those rare cases where suffering is truly irremediable from those where despair may yet be treatable.”^[52]

For example, Dr. Sockalingam stated that “[t]here are currently no established criteria or consensus among psychiatrists about whether or when a mental illness should be considered irremediable.” He added that Canada needs to “invest significantly in research” and that “[i]t will take a significant amount of time” to obtain solid evidence on diagnostic and clinical assessment tools in mental health.^[53]

Dr. Neufeld recounted her work with a MAID requester who would have met the eligibility criteria, in her view, and the subsequent improvements to his health and life, which now includes a will to live.^[54] The committee heard from other witnesses who shared stories of individuals with longstanding mental health issues that had improved.[55] Dr. John Maher asserted that suicidal thinking and “[s]uffering can always be reduced.”^[56]

Furthermore, according to Dr. Harvey Max Chochinov, the availability of MAID may undermine the therapeutic relationship. The strength of that relationship is, in his opinion, the most helpful factor for predicting successful outcomes.^[57] Some witnesses warned that, in the absence of established criteria or consensus, assessments may be “inherently subjective and arbitrary,”^[58] biased or discriminatory.^[59]

Dr. Lilian Thorpe stated that MAID MD‑SUMC “should be occasionally available in rare circumstances,” although she highlighted the unpredictable nature of mental disorders.^[60]

Another point of divergence among witnesses was their understanding of the number of treatments that patients must have undergone before they can be determined to have an irremediable condition.^[61] Dr. Gupta reminded the committee that, even though capable persons may refuse a recommended treatment, such a refusal does not render them automatically eligible – in other words, the “process is an eligibility assessment. It is not intended to provide unconditional access to MAID.”^[62]

Distinguishing Requests for Medical Assistance in Dying from Suicidality

Witnesses diverged on the question of whether reasoned MAID requests can be differentiated from suicidality. For some witnesses, making this distinction may be complex but is not impossible.^[63] Dr. Sisco van Veen referred to the use by Dutch psychiatrists of the “well known and internationally recognized” Appelbaum and Grisso criteria for assessing patients’ capacities to consent to or refuse treatment.^[64]

Dr. Gupta noted that the CPA guidance addresses suicide risk in the context of MAID requests and that MAID assessments must not occur during periods of crisis. She added that suicide‑risk evaluation is relevant to all MAID assessments, that suicidality can attach to physical as well as mental disorders, and that the mere existence of a mental disorder does not necessarily make a person at risk for suicide. She questioned “why it is acceptable to allow MAID if a person with both a mental disorder and a physical disorder has experienced suicidality, yet this is a justification to exclude those with mental disorders as their sole condition.”^[65]

Dr. Gordon Gubitz, from CAMAP, and Dr. Claire Gamache, from the Association des médecins psychiatres du Québec, also told the committee that suicide‑risk evaluations are routinely part of their clinical work.^[66] Dr. Douglas Grant explained that “[i]t’s a regular feature of medicine … to identify whether a patient has decisional capacity and can provide informed consent,” including in complex cases.^[67]

However, others testified that the delineation between MAID requests and suicidality was not framed by clear guidance, was inherently difficult or was altogether impossible.^[68] Dr. Sandip Singh Gandham expressed the “worry that in some cases, we may not be responding to an autonomous, enduring request for assisted dying, but rather to the voice of the illness itself.”^[69]

According to Dr. Gaind, MAID reporting data “ignores many known suicide risk factors, so we can’t know the full scope of how much suicidality fuels MAID requests.” However, he indicated that the evidence shows “strong suicide risk factors” associated with Track 2 requests (that is, involving people whose natural death was not reasonably foreseeable). In his opinion, people with mental illness have higher rates of psychosocial suffering, and “these factors related to life suffering are actually the same as suicide risk factors,” such that distinguishing between the two becomes impossible.^[70] Professor Brian Mishara pointed to research showing that, in Canada, over 90% of people who die by suicide have been or could have been diagnosed with mental illness.^[71]

Dr. Pierre Gagnon warned that compassion fatigue among caregivers, patients and families can also complicate decision‑making.^[72] He nevertheless indicated that he has previously assessed patients with mental disorders as being capable of deciding to refuse or discontinue life‑sustaining or life‑saving treatments.^[73]

Some psychiatrists highlighted what they saw as an inherent incoherence if “[p]sychiatry claims it can both prevent suicide in one patient and help finalize suicide in another with the same suffering.”^[74] As Dr. Jitender Sareen explained, “[t]his goes to the core psychiatric practice, which is grounded in assessing and treating hopelessness and preventing suicide.”^[75]

Differentiating Mental and Physical Conditions

Several witnesses emphasized that the suffering associated with mental disorders is real and can be unbearable.^[76] Some told the committee that complex cases exist for both physical and mental conditions alike, that there was no justification for distinguishing between the two, and that no new complexities would arise if the expansion were to proceed.^[77] Although Dr. van Veen saw differences between chronic physical and psychiatric suffering, he did not think that these differences were sufficient to justify a complete ban of psychiatric MAID. He further noted that suffering is always subjective.^[78]

For other witnesses like Dr. Gagnon, a distinction was justified on the grounds that “[s]uicidal thoughts are inherently part of mental illness, and that is not the case with physical illness.”^[79]

Gabrielle Peters, representing Disability Filibuster, stated that “[t]he division between physical and mental illness is asserted and maintained by the medical model and the Canadian state.” She added that “[c]o-occurrence of chronic illness and mental illness is common.”^[80]

Dr. Guillaume Barbès‑Morin testified that most psychiatrists in Canada are equipped to assess all the criteria, and he expressed concern at the possibility that patients with mental illness may experience discrimination “just because … we can’t see the illness on a scanner.” He indicated that mental illness is no different from disorders involving the brain, such as multiple sclerosis, and that clinicians are able to recognize when a patient is doing well or suffering terribly.^[81] In Dr. Gamache’s words: “The psychiatrists in Quebec consider the suffering [severe mental disorders] cause to be the equivalent of the suffering caused by physical disorders. The only real difference is the way in which they are manifested.”^[82]

Dr. Sockalingam explained that, for some physical conditions, clinicians can confirm a diagnosis and prognosis by relying on diagnostic markers and laboratory tests, whereas these options do not yet exist for mental illness, which “is defined more by differences in equities, in terms of access to treatments.”^[83] He stressed the need for more funding and resources to advance research on mental health assessments and treatment.^[84]

Training and Professional Development

Dr. Stefanie Green stated that CAMAP’s MAID curriculum is a national program, fully accredited by the Royal College of Physicians and Surgeons of Canada, College of Family Physicians of Canada and Canadian Nurses Association. She also indicated that CAMAP has provided guidance on capacity, incurability and complex chronic conditions.^[85] She attested to the clinical readiness of practitioners and noted that, for the past 10 years, they have been assessing patients with comorbid mental illness.^[86]

Dr. Green and Dr. Gubitz described various aspects of the 27‑hour curriculum, which includes material on ableism and vulnerability, and indicated that over 95% of program attendees had felt it was beneficial.^[87]

Ms. Lawley reported the following levels of participation in the curriculum:

Participation has tripled over the past two years. We have seen a definite increase in those who identify as having a specialty in psychiatry and as general practitioners, with a tripling in the number of clinicians accessing that training, both those who identify with a speciality in psychiatry and those who have completed the MAID module on mental health and MAID.^[88]

However, Professor Catherine Frazee criticized the curriculum as being “designed to make practitioners look away”^[89] and avoid meaningful scrutiny. She made the following statement:

They are unable or unwilling to disentangle those structural forces—I believe you’re referring to them as social determinants of health. They’re unable to disentangle that kind of suffering in cases involving stable physical disability.

I therefore conclude that there is no basis on which to be confident that they will do so when mental illness is the sole underlying condition.^[90]

Position of the Profession

According to Dr. Gaind, “Most psychiatrists in the country are against expanding MAID solely for mental illness.”^[91] Some witnesses also underscored the 2025 position paper of the American Psychiatric Association, opposing legislation that permits MAID MI‑SUMC.^[92]

Dr. Gamache stated that the Association des médecins psychiatres du Québec, which represents 25% of the psychiatrists in Canada, “believes that patients with mental disorders cannot be considered as different” and that “[p]sychiatrists are ready to support patients through that [MAID] process.”^[93]

Dr. Sareen testified that Manitoba’s psychiatry leadership council had “reached a clear consensus … that expansion to mental disorders should not proceed.” He referred to a letter submitted to the committee by current and former chairs of psychiatry departments across several Canadian provinces, recommending an indefinite pause to the expansion.^[94]

Dr. Gubitz pointed out that clinical medicine always involves differing opinions and that the requirement of two assessments for each MAID requester is to ensure “consensus of opinion around the individual case itself.”^[95]

Professor Jocelyn Downie differentiated clinicians’ positions on clinical readiness from the question of whether the expansion should proceed – the latter, in her view, being a decision for Parliament: “That’s a public policy decision, not a clinical decision. Clinical readiness is clinical, and the clinical community for MAID has demonstrated its readiness.”^[96]

Health Systems Readiness

Evidence on the readiness of Canada’s health systems focused on the capacity to ensure necessary mental health services and to support suicide prevention measures.

Mental Health System Capacity

A recurring theme across the testimony was the pressing need for increased and more equitable access to adequate mental health services.^[97] Certain witnesses doubted that a person’s illness could be determined to be irremediable in the absence of sufficient access to mental health and social services.^[98] Some opined that “[w]e have an obligation to provide access to mental health treatment before providing access to MAID.”^[99]

Ms. Lawley underscored that mental health system capacity encompasses “access to psychiatrists for consultation and broader access to mental health services and treatments.”^[100] She added:

A number of things have to be met before mental illness as a sole underlying condition can be a reason for medical assistance in dying. The concern around the country is whether we have the system in place that would allow supports for an individual for the duration of their illness, and I would say we do not.^[101]

The following are among the statements that certain witnesses made highlighting the inadequacy of mental health care in Canada:

[Statistics from the Canadian Institute for Health Information] show us that we aren’t increasing the number of psychiatrists in our country… and it’s still below the number of family health practitioners we are providing.^[102]

Demand for care continues to grow, while service capacity does not. One in three Canadians reports that their needs for mental health care are unmet or only partially met. In Ontario alone, over the last four years, mental health service volumes have increased by 66%.^[103]

Several Canadian provinces face worse problems with access to timely and quality mental health care, as 10% of people wait for six months or more for mental health care and 50% wait for a month.^[104]

In 2025, the Canadian Institute for Health Information found that 41% of adults with a mental illness said that their needs were met not at all or only partially, while 52% of young adults reported being able to obtain not any or only limited help for their mental illness. One out of three Canadians said they did not have access to mental health services because they were unable to pay the cost.^[105]

Ms. Lawley noted that the level of demand for psychiatrists, should the exclusion be lifted, is not yet known.^[106] Some witnesses asserted that the expansion would result in few additional MAID approvals in practice.^[107] For example, Dr. Gamache testified that, in her opinion, “a tiny percentage” of the 3% of the population who have severe mental disorders may become eligible.^[108] Professor Daphne Gilbert told the committee: “[O]ne justification for continued exclusion is a speculative claim that large numbers of people will become eligible if the ban is lifted. There’s no evidence to support that claim.”^[109]

Krista Carr, representing Inclusion Canada, considered that the expansion would be “hugely wide,” given that “now we’re looking at expanding [Track 2 MAID] to 297 more labels under the definition of mental disorder in the DSM-5”^[110] (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition).

According to Ms. Lawley, in 2024, 4.4% of MAID provisions were for people whose natural death was not reasonably foreseeable – or 732 people. Of those 732 people, 13 were reported as having a mental illness in addition to their underlying medical condition. However, she noted that, “as practitioners are not required to provide detailed information on all of an individual’s conditions and comorbidities, this finding should be interpreted cautiously.”^[111]

Witnesses such as Dr. Coelho and Dr. Allison Crawford further pointed out that long wait times and inequitable access to care “can produce or exacerbate the suffering that may drive MAID requests and suicidal thoughts and behaviours.”^[112]

Dr. Kevin Young, representing the Ontario Hospital Association, indicated that existing barriers to care can also complicate MAID assessments and provision. For example, in the application process, practitioners may need to facilitate consultations or seek expedited treatment for applicants, and this accelerated pathway to mental health care can further exacerbate inequities in access.^[113] Dr. Sockalingam noted the ethical and financial considerations that arise in decisions to prioritize MAID resources or access to effective treatments.^[114]

Dr. Gagnon also highlighted the discrepancy between mental and physical medicine as regards available resources: “If we work in both physical palliative care and in psychiatry, we can see that psychiatry is the poor cousin in terms of the variety of approaches.”^[115]

Professor Margaret McKinnon, speaking as a person with lived experience, asserted that Canada is not prepared for the expansion, mainly because of “inequities in the allocation of mental health resources and mental health treatments.”^[116]

Suicide Risk and Prevention

Some witnesses warned that expanding MAID may lead to the “so-called suicide contagion effect,”^[117] or “Werther effect,”^[118] and undermine suicide prevention efforts.^[119] Dr. Maher noted that, in jurisdictions that have MAID, suicide rates rose faster after legalization.^[120] Reference was also made to the 2025 statement of the International Association for Suicide Prevention, which takes a stance against euthanasia and assisted suicide.^[121]

Dr. Crawford, as Chief Medical Officer of 9-8-8: Suicide Crisis Helpline, spoke of an “overlap”^[122] between persons experiencing suicidality and those considering MAID. She reported that 7% of interactions with the helpline – representing almost 70,000 calls and texts – mention MAID. She also testified that, among contacts who referenced MAID, 74% had endorsed thoughts of suicide in the previous two days, compared with 48% among other contacts.^[123]

Some witnesses suggested that the availability of MAID may help to prevent suicides.^[124] Dr. Barbès‑Morin expressed a concern that, in the absence of MAID as an option, “[p]atients will take their own lives because they are not being heard,” whereas “[i]f they had ongoing support, they could regain hope and they could be supported further through treatment.”^[125] Dr. Thorpe similarly described a paradoxical effect, where Track‑2 MAID requests lead patients “to be hooked up with resources” and to “become engaged with appropriate treatments,” such that they see an improvement in their quality of life.^[126]

Dr. Maher countered: “The argument that somehow a messy death justifies supporting [medically assisted] suicide misses the point completely. What it justifies is treatment to prevent getting to a messy death or MAID in the first place.”^[127] Dr. van Veen explained that the relationship between suicidality and psychiatric MAID is very complex. He added that patients, especially ones with persistent suicidality, mostly “want to have a connection to talk about their death wish,” rather than wanting physicians to act on a MAID request immediately.^[128]

Regulatory Readiness

Finally, the committee heard about readiness from a regulatory standpoint. Some witnesses pointed to the many layers of existing oversight,^[129] with Eliana Close explaining that MAID regulation involves not only the Criminal Code but also guidelines, training, institutional practices and communities of practice.^[130] Certain witnesses expressed concerns, notably around possible non‑compliance and the perceived lack of safeguards needed to achieve the right balance between ensuring access or autonomy and protecting potentially vulnerable populations. Constitutional considerations were also raised. These discussions are summarized below.

Monitoring and Oversight

General Framework

Ms. Close stated that the federal monitoring system, which collects aggregate data on MAID provision, is “rigorous” and that “MAID is one of the most comprehensively reported medical practices in the country.” She added that “Health Canada’s annual reports on MAID are among the most detailed in the world.”^[131]

“Oversight” in the provincial context refers to the review of individual cases for compliance with the law and applicable standards. Ms. Close and Dr. Green indicated that over 90% of MAID cases have some form of retrospective oversight through provincial mechanisms of accountability and scrutiny.^[132] Dr. Gubitz explained that certain provincial oversight systems employ retrospective chart reviews, while others use both prospective and retrospective reviews.^[133]

Ms. Close also spoke of the importance of “coal face regulation” in medicine, explaining that “[c]oal face regulation extends formal regulation into day-to-day practice and includes clinical practice recommendations, peer consultation and best practices.” As an example, she pointed to Nova Scotia’s province‑wide team that is informed of all MAID cases and provides prospective support and retrospective review.^[134]

Regulators

The committee heard diverging views on the effectiveness of oversight provided by professional regulators.

According to Professor Downie, professional regulatory colleges are ready for the expansion of MAID.^[135] Dr. Douglas Grant testified that the College of Physicians and Surgeons of Nova Scotia “will be ready because it’s our legal duty to be ready.” He also pointed to a letter from the Federation of Medical Regulatory Authorities of Canada attesting to readiness.^[136]

Several witnesses further noted that physicians have a professional and regulatory obligation to be competent when undertaking any clinical activity and to practise within their scope of practice.^[137]

Dr. Grant referred to multiple layers of regulation and professional standards, including the duty to report unprofessional conduct. He explained that regulatory colleges rapidly investigate allegations of misconduct and that, if there is merit to the concern, the college imposes available interim sanctions and refers the case to law enforcement.^[138]

Ms. Close expressed confidence that regulators’ “tiered response” mechanisms were effective and indicated that, according to data from Ontario’s MAiD Death Review Committee (MDRC), “no MAID cases have been escalated to the police.” She affirmed that “Canada’s MAID system has real regulatory strengths, strong oversight, comprehensive monitoring and a layered ecosystem,” and that clinical guidance and coal face regulation are best placed to address MAID MD‑SUMC. However, she recommended greater transparency in provincial oversight and continuous quality improvement.^[139]

Other witnesses raised concerns around professional oversight and discipline, notably regarding the effectiveness of the legal framework in sanctioning misconduct, ensuring proper interpretations of criteria or safeguards, and balancing access against protection.^[140] These issues are discussed below.

Eligibility Criteria and Safeguards: Balancing Access and Protection

Some witnesses asserted that no additional legislative safeguards are required.^[141] Dr. van Veen spoke approvingly of Canada’s two‑track framework.^[142] Others stated that the safeguards were insufficient or that no safeguards could possibly mitigate the concerns raised.^[143]

Certain witnesses expressed misgivings stemming from what they perceive to be a lack of adequate safeguards for MAID MD‑SUMC,^[144] or from potential “inter-assessor variability”^[145] in the interpretation of eligibility criteria and safeguards.^[146] Related issues that were raised include assessors who may be “interpreting the law liberally,”^[147] the potentially disproportionate provision of MAID by “a small number of permissive clinicians”^[148] and “doctor shopping.”^[149] Ms. Lawley, representing Health Canada, also confirmed that MAID assessments are not shared across jurisdictions and that practitioners are not required to reach across jurisdictions; when asked if prior denials must be considered by a later assessor, she answered that she was unaware of whether that was part of the MAID assessor checklist.[150] Dr. Wilbert van Rooij encouraged the committee to listen to clinicians “who have seen safeguards stretch, criteria soften and procedure replace presence.”^[151]

Christopher Lyon expressed serious concerns around the adequacy of laws surrounding MAID and their interpretation by assessors.^[152] He described what he viewed as his father’s wrongful death by MAID and called British Columbia’s system “a pinball machine of deflection among colleges, police and coroners.”^[153]

Alicia Duncan told the committee that the circumstances surrounding her mother’s death by MAID show that Canada is not ready for the expansion. In her experience, the framework does not allow families to intervene in a crisis, to subsequently determine legal compliance or to verify oversight and accountability.^[154]

Michelle Hewitt, of Disability Without Poverty, recounted her husband Victor’s death from MAID, an experience she found painful and undignified. In her view, the assessors had been lax in complying with the criteria. She added that “[t]he current MAID program is severely broken.”^[155]

Dr. Maher described what he considered to be a case of illegal MAID provision.^[156] He testified that, given the clinical reality, safeguards are “fanciful” and “going to fail.”^[157]

Alexander Schadenberg, of the Euthanasia Prevention Coalition, asserted that, rather than expanding MAID,

Parliament needs to examine how Canada’s euthanasia law is actually functioning. How has the law been implemented? Is it achieving its intended outcomes? Are there abuses of the law based on its original intention? Does the law require amendments?^[158]

Socio-economic Vulnerabilities

The committee heard that issues identified within the current MAID framework may foreshadow problems flowing from a future expansion, especially regarding particular vulnerabilities.

Dr. Coelho cautioned that cases examined by the MDRC “demonstrate premature eligibility, inadequate safeguards and a failure to address suffering before ending lives.” She reported that MDRC statistics “reveal that track 2 cases reflect high social vulnerability and untreated mental illness.” In her view, these factors mean that, “[a]lthough framed as a choice, MAID can allow structural coercive influences to push people towards death.”^[159]

Professor Downie noted that the MDRC does not assess for legal compliance and that its reports do not reflect consensus or make findings but, instead, present various members’ views.^[160]

Dr. Gandham was among those witnesses who raised concerns about structural vulnerabilities and their potential role in obscuring the cause of suffering in eligibility assessments:

Requests for death don’t arise in a vacuum. They may emerge in the context of trauma, poverty, isolation, inadequate housing, long ways [sic] for treatment, and lack of access to care and supports. … In such cases, the suffering may be real, but its drivers may be remediable through social response rather than death as a medical intervention.^[161]

Some witnesses feared that systemic vulnerabilities, inequities and inadequate access to health and social supports would have the effect of complicating the irremediability assessment or denying a person meaningful alternatives to MAID.^[162] The committee also heard that “systemic inequalities such as racism, poverty, homelessness and others can worsen mental health.”^[163]

Some witnesses highlighted specific populations. Professor Trudo Lemmens pointed to the potential risks faced by “people with intersecting disabilities.”^[164] Krista Carr asserted that “Track 2 MAID applies only to persons with disabilities who are not dying” and that it is incompatible with Canada’s domestic and international human rights obligations. Alongside certain other witnesses, she noted the recommendation, put forth by the United Nations (UN) Committee on the Rights of Persons with Disabilities,^[165] that Canada repeal Track 2 MAID, including for MI‑SUMC.^[166] Professor Gilbert questioned the extent to which that UN report was balanced and urged the committee to prioritize objective research.^[167]

Dr. Gaind indicated that, among those who have received MAID under Track 2, the evidence shows “signals of marginalization” and a higher proportion of women than men. In his opinion, “[a]ll these things would get even worse if MAID was provided for mental illness and addictions.”^[168]

Professors Elizabeth Sheehy and Isabel Grant testified that “[i]f MAID is extended to those whose sole disabling condition is mental illness, it will disproportionately end the lives of mentally ill women, just as track 2 already disproportionately ends the lives of disabled women.”^[169] According to Professor Sheehy, Health Canada data shows that approximately 59% of all Track 2 deaths in 2022 and 2023 were women, as were 57% in 2024. She also highlighted a link between male violence and mental illness and suicidality in women, criticizing the lack of Canadian data on the role of trauma in MAID requests. She concluded that “Canada’s resources should be focused on providing better supports for women with mental illness to escape male violence and to live dignified lives.”^[170]

Ms. Carr stated that “the data we have on track 2 MAID tells us that the people accessing track 2 MAID are disproportionately women, indigenous, living in poverty, low income and isolated, and they feel they’re a burden on their families.”^[171]

Other witnesses highlighted different elements or interpretations of the data. According to Dr. Gupta, Health Canada’s data demonstrates “that MAID is accessed to a greater extent by people who are better off, who are white and who are in better social situations.”^[172] In echoing these conclusions, Professor Gilbert and Dr. Green pointed to recent research.^[173] Professor Gilbert added that the proportion of women receiving MAID “tracks with the epidemiology of populations with chronic conditions. Women are more likely to develop these conditions and less likely to die from them.”^[174]

Professor Downie stated that Health Canada data on all MAID provisions since 2016 “show that socio‑economic vulnerabilities and marginalization are not drivers of requests for MAID.” She added that, according to this data, “well over 90% of people who access MAID and have a disability do have access to disability supports and services.”^[175]

Indigenous Peoples

An official from the federal health department highlighted Health Canada’s consultation and resulting report on Indigenous perspectives regarding end‑of‑life care and MAID. She also noted the government’s continued engagement with Indigenous partners.^[176]

The committee heard from Neil Belanger, representing Indigenous Disability Canada (IDC). He described IDC’s work with people whose medical and social needs had not been met and who had been approved for Track 2 MAID. In his view, a decision to contemplate or receive MAID that is spurred by a lack of supports is not a voluntary, uncoerced act. He indicated that funding in First Nations communities is often insufficient to address mental health issues and that the Health Canada consultation had garnered little uptake among Indigenous participants. His sole recommendation was “that we provide quality, adequate and timely services to persons with mental illness as the sole underlying condition and to persons, indigenous people, with disabilities.”^[177]

Professor Roderick McCormick saw the expansion of MAID as an “abdication of responsibility by the Government of Canada”:

Instead of making every effort to provide the range of mental health services needed by indigenous people to overcome their pain, Canada is instead imposing upon them the burden of deciding whether or not they should choose a government-sanctioned and medically sanctioned permanent solution to what could easily be a temporary problem.^[178]

Professor McCormick described the numerous factors contributing to make “indigenous people … one of the most vulnerable sectors of Canadian society,” such as a history of colonization and ongoing oppression, minimal access to opportunities and services, and disproportionately high rates of unresolved trauma, illness and suicide.^[179] He also viewed MAID as being “culturally biased … , in that it emphasizes the individual’s right to autonomy and choice without taking others into consideration.”^[180]

Persons with Disabilities and Lived Experience

Professor McKinnon urged the committee to consider Canadians who, like her, “will feel at risk and unsafe should this legislation be enacted.”^[181]

Gabrielle Peters pointed to a study finding “that support for euthanasia on the basis of mental illness was positively correlated with holding attitudes of stigma towards people with mental illness.” She asserted that a faulty understanding of disability rights was being invoked in the name of expanding MAID and that the expansion must be halted.^[182] Krista Carr reported that the people with whom Inclusion Canada works “feel … that the availability of track 2 MAID and the further expansion of it embeds stereotypes and is discriminatory about their lives and their lives not being worth living or being worth saving.”^[183]

Helen Long, representing Dying with Dignity Canada, read out to the committee statements from people with mental illness who support MAID MI‑SUMC, including the following:

• From John Scully –

I suffer from severe mental illness including incurable depression, incurable post‑traumatic stress disorder, and incurable anxiety disorder. I was first diagnosed 30 years ago and since then I have been admitted to seven psychiatric hospitals, I have undergone every possible treatment and taken every medication known to science, including all the drugs developed since 1950. To this day, none have had any positive effects on me, and some have had dangerous effects.^[184]

• From Savannah Meadows –

I’m sure you can understand that some mental health issues are so severe and the pain they cause so great that they cannot be effectively treated or cured. When a person is in immense mental pain and no treatment can help them, under the current system people are left to suffer grievously, which is cruel and unusual punishment.^[185]

• From Claire Elyse Brosseau –

I’ve been treated for 35 years. Some people don’t respond to treatment. That’s a medical reality, not a philosophical debate. Broad assumptions...and guess work isn’t protecting us, but rather people’s feelings. It excludes us. Equality doesn’t mean special restrictions. Speculation isn’t lived experience.^[186]

Constitutional Considerations

Various witnesses raised constitutional considerations when discussing the advisability of expanding or restricting MAID. It was also noted that constitutional legal challenges are underway,^[187] with some witnesses emphasizing the heavy burden borne by litigants in such cases.^[188]

For certain witnesses, the risk of discrimination lies in the anticipated expansion of MAID or even in the availability of Track 2,^[189] whereas for others such discrimination would result from maintenance of the exclusion.^[190]

An official from the federal Department of Justice told the committee that “both permitting and prohibiting MAID can be in conformity with the charter, be it section 7 or section 15.”^[191] Section 15 guarantees equality rights, including the right of individuals to the equal protection and equal benefit of the law without discrimination. Referring the committee to the government’s Charter statements,^[192] the official added:

The Supreme Court of Canada noted in Carter that Parliament has leeway under the charter in deciding how to balance the competing interests engaged by MAID. The difficult question of whether or when to permit the provision of MAID on the basis of mental health alone is one that can be answered in different ways in conformity with the charter.^[193]

Another Department of Justice representative also indicated that MAID MD‑SUMC has not been examined by a court through the lens of current legislation and that the Supreme Court had noted, in Carter, that its position reflected the facts of that case, which did not involve a mental disorder.^[194]

Professor Downie affirmed that the current legal framework is sufficient and that regulatory readiness has been met, such that “the answer from a legal perspective about whether to allow MAID MI-SUMC was and remains robustly ‘yes’.” In her view, maintaining the exclusion would violate the section 7 and 15 Charter rights of persons with mental illness. She reasoned that the Supreme Court had held in Carter “that a ban on MAID is unconstitutional if it prohibits access for those with a grievous and irremediable medical condition, including an illness, disease or disability, and mental illness falls within this category.”^[195] She pointed to the rulings in E.F. and Truchon as further confirming this interpretation.^[196] Professors Downie and Gilbert also referred to the Supreme Court’s decision in Ontario (Attorney General) v. G^[197] in support of the position that “a blanket ban on access to MAID MI‑SUMC unjustifiably violates section 15 of the charter by failing to allow for individualized assessments.”^[198]

Professor Lemmens asserted that MAID MI‑SUMC is not constitutionally required. He stated that the Carter case did not involve persons whose sole underlying medical condition was a mental disorder and that the judgment referred to end‑of‑life decision‑making. He also questioned the weight to be attributed to the E.F. decision and the relevance of the Truchon ruling in the context of mental illness.^[199]

According to Professor Kerri Froc, “the charter does not require extension of MAID to mental illness as a sole underlying condition. Carter does not establish that requirement and section 15 does not compel it.” She stated that the MAID provisions create “a limited exemption from the criminal law” and that “[c]haracterizing that exemption as a benefit would be a significant and novel extension of section 15.” In her view, if the committee and Parliament “decide that mental illness as the sole underlying condition presents special problems of prognosis, irremediability and suicidality, then drawing a distinction on that basis is not necessarily going to be found to be discriminatory by a court.”^[200]

By contrast, under Professor Gilbert’s analysis, “[t]he exclusion of individuals who would otherwise qualify for MAID but for the fact that their grievous and irremediable condition is a mental illness is discriminatory and violates section 15 of the charter.” She affirmed that “[t]o suggest that an entire category of competent adults should be denied a legal medical service is profoundly discriminatory.”^[201]

Dr. Gandham explained that

[r]ecognizing this suffering is one of the reasons that many support MAID where mental disorder is a sole underlying condition. The potential benefit, ethically speaking, is the respect for autonomy and also equal treatment. If grievous and irremediable suffering is the foundation of MAID eligibility, some argue it would be discriminatory to categorically exclude those whose suffering is solely from mental illness.^[202]

Nevertheless, Dr. Gandham considered that “the risks of proceeding [with the expansion of MAID] currently outweigh the potential benefits.”^[203]

Professor Downie predicted the following consequences of not proceeding with the expansion:

What will happen if there is an extension or an exclusion is that people will die by suicide. They will go to Switzerland because they can access it there, or they will not get MAID in either way and will continue to experience enduring and intolerable suffering caused by a serious and incurable disease. They just have to have that suffering.

The consequences for the government are to end up in court.^[204]

International Context

Some witnesses drew on international experiences to comment on Canada’s approach or on outcomes that may flow from the decision to lift the exclusion or not.

According to Dr. Gupta, other jurisdictions have concluded that “[t]here is no justification on clinical, ethical or legal grounds to exclude all people with mental disorders from the possibility of accessing assisted dying.”^[205]

Dr. van Veen summarized the decades‑long history of psychiatric MAID in the Netherlands. He noted that psychiatric MAID remains relatively rare, at around 2% of all cases. He was supportive of a limited access to psychiatric MAID for a small number of patients, in compliance with specific “due diligence criteria,” as he found it “hard to justify excluding patients with psychiatric disorders whose suffering can be immense or, in other words, unbearable.”^[206]

Dr. Jim van Os told the committee that the Dutch experience “offers a warning for Canada” not to expand. He stated that, “[u]nder Dutch law, physicians must agree that there are no reasonable options,” such that “[e]uthanasia is, in principle, the very last resort.” He contrasted this requirement with his characterization of Canadian law: “In Canada, patient choice trumps the physician’s professional judgment, so a doctor cannot insist that other options be tried first.” In his view, “[t]hat single difference will … drive Canadian numbers beyond ours.”^[207] Some witnesses pointed to research by Dr. Scott Kim estimating that 2,500 to 5,000 MAID MD‑SUMC requests would be made in Canada each year, with approximately half being approved.^[208]

Dr. van Os responded to questions about a recently published article^[209] he had co‑authored with Dr. Wilbert van Rooij, another witness who shared similar concerns. Both highlighted increases in euthanasia requests and euthanasia delivered to young persons under 30 years of age, relying on statistics from the Regional Euthanasia Review Committees in the Netherlands.^[210]

Dr. van Os explained that, whereas 3% of applications by young people result in MAID, “there’s been a growth of about 500% over five years in the number of young people getting MAID.” ^[211] This data, also cited in his co-authored paper, is taken from the Regional Euthanasia Review Committees’ Annual Report 2024, which notes that the number of psychiatric euthanasia cases increased from 2 in 2011 to 138 in 2023, followed by a further rise to 219 cases in 2024, representing an increase of roughly 60% in a single year.^[212] Of the 219 cases, 30 concerned people aged between 18 and 30.^[213]

According to Dr. van Os, most of those who request psychiatric euthanasia are traumatized, marginalized and living in poverty, and women are more likely than men to request psychiatric euthanasia.^[214] Professor Sheehy also highlighted research finding that between 69% and 77% of those receiving psychiatric euthanasia in countries where it is allowed are women.^[215]

Furthermore, Dr. van Os pointed to an increase in suicide rates in the Netherlands, particularly among young women.^[216] He testified that, according to his research, there is no inverse correlation between euthanasia and suicide rates and that “it’s not possible to say that euthanasia is necessary to prevent suicide”:

You have a number needed to treat of 10, and a number needed to harm of nine, meaning that 10 young people must undergo euthanasia to prevent one suicide, and nine die without any preventive purpose being served.^[217]

Dr. van Rooij described a reduction in the availability of psychiatric care in the Netherlands, alongside the normalization and acceleration of psychiatric euthanasia.^[218]

Ultimately, Dr. van Os recommended that Canada implement “a transparent public body for oversight with representatives of disability, palliative care, psychiatry” and Indigenous and lived‑experience communities.^[219]

Conclusions and Recommendation

The committee’s 2024 report underlined conflicting views on Canada’s state of readiness at that time:

While some witnesses said Canada is clearly ready, others stated that preparations are still in progress, or that the state of the country’s readiness for 17 March 2024 is difficult to ascertain. Still others felt that readiness for MAID MD‑SUMC will never be attained.^[220]

At the conclusion of the present review relating to the eligibility to receive MAID of persons whose sole underlying medical condition is a mental illness, the committee finds that this divergence of perspectives persists. Some witnesses asserted that Canada is or will be ready for the expected expansion on 17 March 2027. Others stated that the conditions for proceeding have yet to be met, including the establishment of evidence‑informed, consensus-based criteria for determining irremediability and delineating between a reasoned MAID request and suicidal intent; the existence of adequately resourced mental health systems; or the presence of sufficiently stringent regulatory safeguards. Finally, for some, the expansion should never proceed, under any circumstances. Many recognized that these issues are difficult, challenging and consequential for Canadians.

Having heard of the significant complexities and risks, grave concerns and deep divisions that continue to accompany this issue, the committee identified four possible avenues forward for the Government of Canada:

• 1)      Firstly, it could allow the expected repeal of the provision excluding MAID MI‑SUMC to proceed, in accordance with existing legislation, thereby permitting persons whose sole underlying medical condition is a mental illness to become eligible to receive MAID.
• 2)      Secondly, it could introduce legislation to further extend the exclusion of MAID MI‑SUMC, for a definite or indefinite period.
• 3)      Thirdly, it could introduce legislation to permanently prohibit MAID MI‑SUMC.
• 4)      Fourthly, if maintenance of the exclusion is contemplated, it could refer the matter to the Supreme Court for a ruling on the constitutionality of such an exclusion.

The committee also notes that the continuing ambiguity surrounding questions of terminology – “mental illness” or “mental disorder” – would benefit from greater clarity and consensus.^[221]

Ultimately, the committee makes the following recommendation:

Recommendation 1

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.