Extending euthanasia to include mental health conditions: will Canada have a change of heart?
Ten years after assisted dying was legalised in Canada, the Special Joint Committee on Medical Assistance in Dying (MAID), established in 2021, was tasked with reviewing eligibility for MAID for people whose sole health condition is a mental illness, following motions in the Senate and the House of Commons.
Originally scheduled for 17 March 2024, the extension of the MAID to cover mental health conditions had already been postponed to 17 March 2027 by the Canadian government, after it concluded, following consultations with the provinces, healthcare professionals and various experts, that the system was not yet ready to implement this reform.
Between March and May 2026, the Committee – comprising Canadian senators and members of parliament – heard from 44 witnesses and received 32 written submissions (from experts, clinicians, psychologists, etc.). The concerns raised remain the same as in the previous reports from 2022 and 2024: the difficulty, or even impossibility, of establishing the irreversible nature of a mental disorder and the lack of consensus within the medical community on this issue; the sometimes blurred line between a request for medical assistance in dying and suicidal thoughts; and the risks to the protection of vulnerable individuals.
Believing that these obstacles are far from being resolved, the Committee recommends that ‘the Canadian government amend the Criminal Code to indefinitely exclude from eligibility for medical assistance in dying those whose sole underlying medical condition is a mental illness’.
This recommendation, however, has divided the political class. Le Bloc Québécois condemns it as a step backwards for established rights and believes that an indefinite exclusion would force those affected to turn to the courts to assert their rights. Conservative MP Tamara Jansen, on the other hand, welcomes this recommendation, which she believes “could save millions of lives” if implemented.
It remains to be seen whether this recommendation will actually be acted upon. MP Markus Polwowski, co-chair of the Joint Committee, stated in his supplementary opinion on the report: “The recommendation not to grant access to medical assistance in dying to people with mental illness does not amount to suggesting that we are moving towards banning suicide or restricting people’s autonomy. Rather, it suggests that the state should refuse to help people suffering from mental illness to end their lives, or to allow healthcare professionals to do so on their behalf”, without first providing them with every opportunity to be listened to and heard fully.
Ultimately, the debate raises a fundamental question: it is not merely a matter of whether a person has the right to wish to die, but also of determining whether the state should play an active role in facilitating that choice. In the field of mental health, the difficulties in assessing the prognosis for recovery and the persistent shortcomings in access to care make this issue particularly complex.
The Belgian experience also illustrates these concerns: many psychiatrists point out that despair and the wish to die are the very symptoms of depression. Consequently, a request for euthanasia raises the question of the nature of the support provided to a person with a mental illness. The case of a 24-year-old woman, who had been granted authorisation for euthanasia but subsequently withdrew her request after regaining a sense of purpose in her life, shows just how changeable the desire to die can be.
The issue of extending authorisation for medical euthanasia to people with mental health conditions raises questions about the actual priority given to their care, and the guarantee of ongoing and appropriate support.
