441-00760 (Justice)

Medical assistance in dying (MAID) is a complex and deeply personal matter. Last year, Parliament passed former Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), which responds to the September 2019 Superior Court of Quebec ruling in Truchon,which struck down the eligibility criterion of “reasonably foreseeable natural death” from the Criminal Code MAID regime.

The Government recognizes the difficult issues that arise when a mental illness is the sole underlying medical condition for a MAID request. Former Bill C-7, as adopted, excludes mental illness, on its own, as an eligible medical condition until March 2023. This temporary exclusion provides time for a panel of experts to examine the issue and recommend protocols, guidance and safeguards to apply to requests for MAID by persons who have a mental illness. The Expert Panel on MAID and Mental Illness was launched to undertake this review, and tabled its final report on May 13, 2022. Former Bill C-7 also required the establishment of a joint Parliamentary Committee to study this issue and other important issues concerning MAID. The Special Joint Committee on MAID (AMAD) tabled its interim report on the topic of MAID where a mental disorder is the sole underlying medical condition on June 22, 2022. AMAD began meeting again in late September and will hear from mental health stakeholders in the coming weeks/months. The Government is following these processes closely and continues to consider ways to ensure that our MAID laws reflect our evolving understanding of Canadians’ needs, support autonomy and freedom of choice, and protect those who may be vulnerable.

Medical assistance in dying (MAID) is intended for persons who freely choose to pursue a medically assisted death in situations where they have a grievous and irremediable medical condition (as defined in the legal framework for MAID) and whose illness, disease or disability or associated state of irreversible decline causes them enduring physical or psychological suffering that cannot be relieved under conditions they consider acceptable. 

Canada’s legislation on MAID includes mandatory safeguards that must be applied to any formal request for MAID. In the case of individuals not facing a reasonably foreseeable natural death, there are several mandatory enhanced safeguards that must be applied by the medical or nurse practitioner involved in that person’s MAID request. For example, the legislation includes a requirement for the practitioner to inform the patient of the means available to relieve their suffering, such as counselling, mental health, physical health and community support services, and to offer consultations with relevant professionals who provide those services. This and other enhanced safeguards aim to help practitioners identify and potentially address the sources of suffering and vulnerability that could lead the person to ask for MAID. 

The Government of Canada recognizes that there are complexities associated with extending access to MAID to individuals suffering solely from mental illness, such as whether the person’s condition can be considered “incurable” or “irremediable” and challenges in assessing capacity. That is why the new legislation on MAID included a 24-month sunset clause on the exclusion of MAID requests where mental illness is the sole condition. Importantly, the sunset clause in the legislation was accompanied by a legislative requirement to initiate an independent review by experts to consider protocols, guidance and safeguards that would be applied to MAID requests by persons who have a mental illness.

In order to implement this requirement, the Expert Panel on MAID and Mental Illness was launched in August 2021 to undertake this review. The Panel’s final report (tabled in May 2022) provides 19 recommendations which set out a thorough and rigorous approach to assessment of eligibility for MAID in complex cases (including but not limited to individuals with mental disorders).

In addition, a review of the MAID legislation is currently underway by a Special Joint Parliamentary Committee. Among other issues, the Committee is mandated to review the issue of MAID for those with mental illness. In June 2022, the Committee produced an interim report related to the issue of MAID for individuals whose only medical condition is a mental disorder. The Committee urged the Government to work with provinces and territories and others to ensure that the recommendations of the Expert Panel are implemented in a timely manner. It is anticipated that the Committee’s final review will be presented on February 17, 2023.

The Government of Canada is already advancing work in several areas identified by the Expert Panel, focusing on health system preparedness to address complex MAID cases more broadly, including but not limited to those involving a mental disorder diagnosis, in collaboration with provinces, territories and other partners. For example, we have convened a task group to develop MAID practice standards and we are funding the Canadian Association of MAID Assessors and Providers to develop accredited training modules for practitioners that will be launched early in 2023.

Addressing mental health remains an important priority for the Government of Canada. Mental illness affects many Canadian families and individuals, and has an impact on our economy and society as a whole. Since 2015, our government has made significant investments to support the mental health of Canadians, including:

• • $598 million for a distinctions-based mental health and wellness strategy for Indigenous peoples;
  • $140 million to support veterans’ dealing with post-traumatic stress disorder (PTSD), depressive, and anxiety disorders; and,
  • $45 million for national mental health care standards in collaboration with provinces and territories, health organizations, and key stakeholders.

To date, the Government of Canada has invested $270 million in Wellness Together Canada (WTC), the online mental health and substance use resource portal launched in 2020 to provide free access 24/7 to services and supports for mild to moderate mental health and substance use issues. The WTC portal offers resources with confidential counselling sessions with social workers, psychologists and other professionals. Since its launch, almost 3 million individuals across all provinces and territories have accessed the Wellness Together Canada portal in over 8.1 million web sessions.

Through Budget 2021, the Government of Canada also committed $500 million in support during the pandemic for Canadians experiencing mental health challenges, homelessness, or substance use. Budget 2021 also announced $100 million to support the mental health of those most affected by the COVID-19 pandemic, including youth, seniors, 2SLGBTQQIA+, First Nations, Inuit and Métis, and Black and other racialized populations. It also provided $50 million to address PTSD and trauma in front line and essential service providers and those most affected.

In 2022-23, to ensure that mental health care is treated as a full and equal part of our universal health care system, Health Canada will begin work to establish a new Canada Mental Health Transfer, to expand the delivery of high quality, accessible and free mental health services, including for prevention and treatment. In addition, the department will sustain efforts to improve access to virtual mental health supports, as well as establish a new fund to support the mental health of post-secondary students, including improving wait times for services and increasing access overall. This will include targeted supports to Black, Indigenous, and racialized students at post-secondary institutions across Canada.