MAiD for Mental Illness in Canada

"I and other colleagues are experiencing this: People are clearly getting MAID [Medical Assistance in Dying] for reasons that are frankly illegal."

"Suicide contagion is a well-proven reality. Don't pretend that it won't happen in Canada.:

"For the last 23 years, I've treated patients that other psychiatrists told me could not get better, and they get better."

"Suffering can always be reduced ... There is absolutely no such thing as 'everything has been tried'."

Dr. John Maher, psychiatrist specializing in treating severe mental illness 

Angus Reid Institute

 

"Under the guise of flimsy medical excuses", people suffering mental illnesses are already receiving assisted deaths in Canada, and others seeking MAID will "doctor-shop until dead" should euthanasia be extended under law to encompass psychiatric suffering alone, cautioned Dr. John Maher testifying before a Parliamentary committee of enquiry comprised of MPs and Senators. Should medical assistance in dying be seen as a legitimate option for mental suffering, he warned, the risk of a "suicide contagion" effect is high.

 

It's called the Werther Effect, referring to a notable increase in suicides following publicized reports of suicides among celebrities. In jurisdictions that have legalized doctor-assisted death, Dr. Maher pointed out, rates of suicide "have risen much faster after it was legalized, than before." 

 

Conflicting reports pro and con have been presented to the committee over the safety of MAID eligibility expansion to individuals having mental illness in isolation from any other medical conditions; a controversial topic that includes whether or how a mental disorder might be considered to be incurable and thus qualifying for MAID.  

"People are getting MAID for psychiatric reasons  under the guise of flimsy medical excuses."

"Prolific MAID providers are happy to assist with suicide while people are on wait-lists for effective treatment, [and] MAID is being offered to veterans, disabled people and people with very treatable illnesses." 

"People need lifeguards, not someone to push you under."

Dr. John Maher  

In 2023, urgent requests for same-day assessments and provision [less than 24 hours] were reported in Ontario, speaking to the possibility of impulsive decision-making on the part of people with mental disorders willing and determined to end their lives, under the influence of their mental delirium. This, in a background of long wait times for appointments with mental-health professionals in Canada's overworked health care system. 

 

"You're describing criminal misconduct, are you not, when you describe mental health as already qualifying people in the eyes of some assessors and providers for MAID?", asked one of the Members of Parliament on the committee. "I absolutely am", responded Dr. Maher. He informed the committee of his attempts to report his concerns with a doctor, to a provincial professional accreditation college and the response was "until the patient is dead, there is no malpractice".

 

And then, there were the counterarguments, as when University of Ottawa law professor Daphne Gilbert spoke of a small "very limited" number of people ultimately qualifying for MAID solely for mental illness. "This matters, because one justification for continued exclusion is the speculative claim that large numbers of people will become eligible if the ban is lifted. There is no evidence to support that claim." 

"[Denying MAID to those with mental illness is predicated on the belief that they lack decision-making capacity and] must be protected from themselves and that their suffering is somehow less real, or less serious."

"In 2026, we are reinforcing historic stigma and paternalistic assumptions. The law continues to infantilize those with mental illness."

Professor Daphne Gilbert, vice-chair, Dying with Dignity Canada  

 

Quebec, Assisted Suicide Capital of the World

"We're now no longer dealing with an exceptional treatment, but a treatment that is very frequent." "[Quebec is on track to complete the year with 7% of all deaths recorded as doctor-assisted] That's more than anywhere else in the world: 4.5 times more than Switzerland, three times more than Belgium, more than the Netherlands. It's two times more than Ontario."

"We see, more and more, that the cases receiving medical aid in dying are approaching the limits of the law. It's no longer just terminal cancer, there are all kinds of illnesses -- and that's very good, but it requires a lot of rigour from doctors to ensure they stay within the limits of the law."

"Medical aid in dying is not there to replace natural death."

"It's very easy to go from palliative care to medical aid in dying."

Dr. Michael Bureau, head, Commission sur les soins de fin de vie

Quebec is at the global forefront of medical aid in dying, with a higher proportion of people choosing the procedure in the province than anywhere else on earth. (Radio-Canada)

The enactment of a federal law permitting end-of-life medical assistance in committing suicide was an issue receiving mixed results in Canada. Some felt it was timely and needed, that when people deeply felt it was time for them to leave life due to extenuating medical conditions causing unendurable pain the humane thing for any caring society to do was to help these souls expedite themselves to freedom from pain, at their choice. 

 

Others raised concerns that once this setting aside of the prohibition against assisted suicide became law, there would be an inevitable loosening of guidelines, opening this new social service to an even greater number of people not facing end-of-life issues. Indeed, there have been 'updates' to the original legislation, loosening some of the strictures against assisted suicide being used indiscriminately by the medical profession and society in general.

 

Medical Assistance in Dying (MAID) as it is practised in Canada now, has resulted in Canada overtaking all other developed countries that permit assistance in accomplishing suicide, surpassing them in numbers and in the looseness of those whose medical conditions and even social status fails the original categories of permissible suicide assistance. Scheduled for the future is the acceptance of requests from people suffering mental illness. And later still, adolescents considered mature enough to make that decision for themselves.

Now, the head of the independent body monitoring assisted suicide in Quebec has publicly stated his concerns that doctor-assisted deaths -- that the original legislation made clear were to be viewed as a last resort -- when all else fails, has fallen by the wayside. MAID, it appears, is no longer viewed as an exceptional procedure to be undertaken on behalf of people suffering unbearably, and approaching the end of their lives.

 

A patient looks out a window at the palliative care unit at St Mary's Hospital Centre in Montreal   Photo by Phil Carpenter /Montreal Gazette

 

The commission that Dr. Bureau heads, earlier in the month forwarded a reminder memorandum to the province's medical practitioners, that it is only those patients with a serious, incurable disease, suffering and who have experienced an irreversible decline in their condition, who are deemed to be eligible to receive MAID. The procedure must be approved independently by two doctors; there should be no 'shopping' for a favourable second opinion.

He has noted, he stated, an increase in the occurrence of cases violating Quebec's end-of-life legislation. In the previous annual report, covering a period between spring of 2021 and spring 2022, 15 of 3,663 doctor-assisted deaths in Quebec failed to respect the letter of the law. Problematic cases included the administering of MAID to an individual with an expired provincial health insurance card; rather than continue to rely on provincial health coverage that had expired, the patient chose death.

Patients in another six cases were found not admissible for the procedure, while in another three cases, patients were in a condition of health that led to their inability to give consent. These are cases reported to the provincial college of physicians, College des medecins du Quebec. An emailed response had the college confirming that none of the 15 cases were referred to its internal disciplinary tribunal; additional negligence. Not was data available whether disciplinary measures may have been taken toward doctors violating MAID rules.

A concern was expressed by Dr. Bureau that doctors find themselves in awkward situations with elderly patients, ready to die, but whose health problems are not sufficiently serious to qualify them for MAID. Doctor-assisted deaths, according to Health Canada's most recent annual report on the subject, accounted for 3.3 percent in 2021 of deaths in Canada. Quebec had the highest rate of MAID deaths country-wide, their number was 4.7 percent that year, and numbers have steadily continued to rise.

Concerns about over-using MAID in Quebec

 

Canada's Assisted Suicide Regimen: "A Slippery-Slope Warning Sign"

"The [Canadian] law itself says this [assisted suicide] doesn't have to be [the] last resort ... and I think that's a very disturbing societal norm."

"[Canada is an example of the world's] most radically medicalized system of providing assisted dying."

"[The] most sobering [reality of Canadian euthanasia is that it pairs] very open eligibility [with a] very aggressive medical delivery system."

Dr. Scott Kim, senior bioethics investigator, U.S. National Institutes of Health 

"[It is a] misconception [that MAID was being employed as a] first resort [option for medical care]. I would simply state that what we know of the individuals who are receiving MAID, that 96 per cent received or had good access to disability support and 98 per cent received or had access to palliative care support."

James Downar, palliative care specialist, University of Ottawa

 

"[The system might create an] obligation to introduce [suicide] as a part of' mental health treatment." 

"Imagine that being applied in the context of mental health. You have a person suffering severe depression, seeks help from a therapist and is offered the solution of dying."

"[Vulnerable patients who aren't in the right state of mind could be convinced suicide is a reasonable option. The entire system is a] perverted concept of autonomy."

"I would say that Canada is a warning sign for countries that legalize medical assistance in dying."

Professor Trudo Lemmens, bioethicist, University of Toronto

The U.K. Health and Social Care Committee hears testimony on Tuesday about the Canadian assisted suicide regime. Photo by Parliament Live screenshot

The United Kingdom is pursuing data from other countries who have passed legislation to allow assisted suicide, under public pressure to legalize some form of doctor-assisted death in Great Britain itself. Currently, suicide and euthanasia, medically assisted, are illegal in Great Britain. Penalties of up to 14 years in prison for health practitioners who are found to be involved in aiding suicides make certain that no doctor at the present time would respond to such requests from their patients.

A panel of Members of Parliament has been struck, leading an official enquiry for information gathering "real-world evidence", pointing to how assisted suicide regimes have functioned in other countries that approve the the controversial regime. "The government has stated it is for parliament to decide on the issue so our purpose is to inform parliament in any debate", explained the committee chair. 

Medical experts from Canada and the United States have been advising the committee on Canada's experience to date on the issue. A 2015 Supreme Court of Canada decision, Carter v. Canada, broadly declared that assisted suicide is a constitutionally protected right. 18 years previously there was an entirely different Supreme Court decision, Rodrigues v British Columbia, where the opposite had been ruled, when justices were asked to consider the constitutionality of assisted suicide. Their reply: "The matter is essentially a policy decision that should be left to Parliament to resolve".

 

An initial, carefully prescribed suicide bill which passed with substantial support from Conservative MPs in the Canadian House of Commons leaned on safeguards to protect MAID (Medical Assistance in Dying) from ever being approved for children, the mentally ill and marginalized communities. A Quebec court in 2019 struck down Bill C-14, and the Trudeau government updated a bill in 2021 broadly lowering eligibility barriers for assisted death.

 

 

Professor Lemmens, bioethicist at University of Toronto, initially supported assisted suicide until it was adopted as a form of "harm reduction", the Canadian medical system accepting the idea of offering MAID "when people don't have adequate access to social support and care". Initial MAID advocates denied such cases were occurring, then championed them as "a solution to a worse-off situation". First legalized in Canada specifically to relieve terminally ill patient suffering where death was "reasonably foreseeable", successive changes to the law now mean it can be approved for any patient claiming a "grievous and irremediable condition".

 

MAID practitioners themselves have recently confirmed the qualifications could be as comparatively negligible as an inability to obtain care for a chronic illness, or even simply living in poverty. "The suffering and the irremediable disease don't have to be the same", observed Konia Trouton, a founder of the Canadian Association of MAID Assessors and Providers, aware that some people opted for assisted suicide as a result of socio-economic factors, and were still eligible.

"Canadian law, in all its majesty, has allowed both the rich as well as the poor to kill themselves if they are too poor to continue living with dignity."

"In fact, the ever-generous Canadian state will even pay for their deaths. What it will not do is spend money to allow them to live instead of killing themselves."

Yuan Yi Zhu, International Relations, University of Oxford

Escaping Life By Design

"The person will get into the capsule and lie down. It's very comfortable. They will be asked a number of questions and when they have answered, they may press the button inside the capsule activating the mechanism in their own time. The whole thing takes about 30 seconds Death takes place through hypoxia and hypocapnia, oxygen and carbon dioxide deprivation, respectively. There is no panic no choking feeling."

"[The person will] feel disoriented and slightly euphoric before losing consciousness."

"Gas may never be an acceptable method for assisted suicide in Europe due to the negative connotations of the Holocaust. Some have even said it's just a glorified gas chamber."

Dr.Philip Nitschke, assisted death proponent

 

"The goal of Sarco is to remove the need for any assistance. This ensures any use of the Sarco is legal."

"[Once the individual has triggered the mechanism, the pod] starts the process of flooding the inside with nitrogen, which will reduce the oxygen level from 21 percent to 1 percent."

Exit International 

"We will not and  cannot support any suggestion of using such equipment."

"Westerkerk will never support people offering equipment as promoted by Dr.Nitschke and we seriously wonder whether this contributes to a thorough and careful discussion about the issue."

Jeroen Kramer, president, Westekerk church board, Amsterdam

A 3D-printed "deathpod" named by its manufacturer Exit International, the "Sarco", short for sarcophagus, has been approved in Switzerland for legal use there as an assisted suicide machine. According to its manufacturer it promises a "painless death" one which can be activated among other means, simply by blinking, once ensconced within and its mechanics activated. The biodegradable pod is not wildly popular everywhere however, some claiming its use glamourizes death.

It is lightweight and highly portable. As such readily taken anywhere the individual proposing to end their life may decide a landscape is the last thing they would like to view while departing this mortal coil. There are no tubes, no monitoring equipment, and the pod has a futuristic look about it. Some, unimpressed with its purpose, compare it to a gas chamber. The selection of its sleek design chosen to "suggest a sense of occasion", of travel to a 'new destination', according to Exit International.

With this modern-day sarcophagus, no specialized skills are required and no medical involvement, much less difficult-to-obtain drugs. Australian physician, Dr.Philip Nitschke founded the non-profit organization that now produces the Sarco. He claims to have been the first in the world to introduce his patients to a legal, lethal, voluntary injection when he aided four terminally ill patients in 1996 to die under Australia's rights of the Terminally Ill Act. Now he is prepared to gift the world with his concept.

The design mechanism of the Sarco enables activation through eye movement or voice control. Its death-facilitation was inspired by a man who suffered from locked-in syndrome, a neurological condition where fhe individual suffers complete paralysis of all voluntary muscles save those controlling the eyes. 

 

Sarco has been displayed at several art and design events around Europe    Exit International

 

 

 

Only seven countries globally -- Canada, Belgium, Luxenbourg, New Zealand, Spain, the Netherlands and Colombia -- have legalized assisted suicide. Most of them require that only terminally ill or those suffering with an incurable illness can be eligible under their rules and regulations for end-of-life assistance. In the United States, though not legal federally, eight states have legalized assisted suicide.  

Argentina Chile and Uruguay have parliamentary bills moving along into law to decriminalize euthanasia. Sarco, according to its inventor and major exponent Dr.Nitschke, will soon be available to the entire world.

"[Everyone should have the right to] die with dignity [not just terminally ill people]."

"My vision has shifted from supporting the idea of a dignified death for the terminally ill [the medical model] to supporting the concept of a good death for any rational adult who has 'life experience' [the human rights model]. We interpret that to mean anyone over fifty years of age."

"The open-source plans will be freely available on the internet. I would like to think that it will find broad appeal and be able to help reframe conversations about, and people's experience, with death."

Dr.Philip Nitschke, Australian humanist, former medical doctor

Prototype versions of the Sarco have been exhibited at museums and art galleries in the Netherlands and Germany    Exit Internationa

"