Canada indefinitely bars mental illness as sole grounds for euthanasia access

Canada's government moved this week to lock in place a permanent ban on physician-assisted death for people whose only medical condition is mental illness, settling—at least for now—one of the country's most contentious questions about who should have access to euthanasia.

Justice Minister Sean Fraser announced Wednesday that his Liberal government would introduce legislation to indefinitely exclude people with mental illness as their sole underlying condition from the Medical Assistance in Dying program, known as Maid. The decision comes as a temporary moratorium on such access was set to expire in March, a deadline that had triggered fierce debate among lawmakers and prompted constitutional challenges from advocacy groups.

Canada's approach to assisted dying has shifted dramatically over the past decade. A 2015 Supreme Court ruling opened the door to physician-assisted death, initially limited to the terminally ill. A Quebec judge's 2019 decision struck down the requirement that death be "reasonably foreseeable," forcing lawmakers to broaden eligibility. By 2021, the law permitted adults to access Maid if two doctors confirmed an irremediable physical condition causing unbearable suffering. At that same moment, lawmakers inserted a temporary pause on mental illness cases, citing uncertainty about how to assess such conditions. They renewed that pause twice—in 2023 and again in 2024.

A government committee that examined the question earlier this year recommended making the mental illness exclusion permanent while simultaneously calling for expanded and more equitable access to mental health services. Fraser told reporters there was no "perfect consensus" on the issue but that the government's approach reflected the "correct" path forward. He acknowledged that a federal lawsuit brought by the advocacy group Dying With Dignity Canada—challenging the government's previous decision to delay access—could still affect the upcoming bill.

The stakes of this decision rest on competing claims about rights and safety. Advocates for expanding Maid to include mental illness argue the current rules violate constitutional protections and deny equal access to healthcare. They contend that some people with severe, treatment-resistant mental illness experience suffering as profound and permanent as any physical condition. The government, by contrast, has expressed concern about the difficulty of determining whether a mental illness is truly irremediable and whether someone with such a condition can give informed consent to end their life.

Current data offers a window into how Maid is actually being used. According to the latest government figures, 95.6 percent of Maid deaths involved people whose natural death was considered reasonably foreseeable. Only 4.4 percent were cases in which death was not expected soon—people with conditions like multiple sclerosis or incurable neurological diseases that cause profound disability and suffering. The mental illness exclusion has meant that no one whose sole condition is psychiatric has accessed Maid under current law.

The Liberal legislation also serves a tactical purpose: it aims to head off a private member's bill that would amend the criminal code to explicitly state that mental disorder cannot be classified as a grievous and irremediable medical condition. By advancing their own bill first, the government shapes the terms of the debate.

Fraser also signaled the government's intention to decriminalize what are called advanced requests—a mechanism that would allow people with conditions like Alzheimer's to request Maid before their illness erodes their capacity to consent. Quebec is currently the only jurisdiction permitting such requests. Alberta has already said it will not allow them. The justice minister offered no timeline for the legislation but said the bill would protect doctors from criminal liability for honoring advance requests, leaving the decision about whether to permit them to individual provinces.