OTTAWA – Canadian Justice Minister Sean Fraser and Health Minister Marjorie Michel are set to address the future of medically assisted dying (MAID) on Wednesday, focusing specifically on the contentious issue of whether individuals with mental illness as their sole underlying condition should be allowed to access MAID. This discussion is part of an ongoing examination of the evolving legal framework surrounding assisted dying in Canada.
The history of MAID legislation in Canada has undergone significant transformations over the years. In 1892, Canada’s first Criminal Code prohibited aiding and abetting suicide, imposing a life sentence for such acts and criminalizing suicide itself. This foundational law paved the way for later debates on assisted dying.
In 1972, under Prime Minister Pierre Elliott Trudeau’s government, Canada repealed the Criminal Code section that criminalized suicide but maintained laws against assisting someone in ending their life. Over the following decades, various private member's bills seeking to decriminalize assisted suicide were introduced but none were successfully passed between 1991 and 2010.
A pivotal moment occurred in 1993, when Sue Rodriguez, who was diagnosed with amyotrophic lateral sclerosis (ALS), challenged the Criminal Code in Canada’s Supreme Court. The court ruled against her in a narrow 5-4 decision. Despite the ruling, Rodriguez ended her life with the assistance of an anonymous physician in 1994, underlining the urgency and public concern surrounding the issue.
In 1995, a Senate committee released a report addressing euthanasia and assisted suicide, revealing a consensus on the need for safeguards if assisted suicide were to be permitted. This included stipulations on competency, irreversible illness, and free consent. Fast forward to 2009, when the Collège des médecins du Québec acknowledged euthanasia as a potential option in end-of-life care under exceptional circumstances.
By 2015, a landmark ruling by the Supreme Court of Canada struck down prohibitions against assisted dying. The court declared that the existing laws were unconstitutional, violating the rights of competent adults enduring unbearable suffering. The court's ruling commanded the federal government to establish a legal framework for assisted dying within a year, leading to the passage of Bill C-14 in June 2016, which legalized MAID under specified conditions.
In 2019, the Superior Court of Quebec found the restriction of MAID eligibility to individuals whose deaths were “reasonably foreseeable” as unconstitutional. The Canadian government did not appeal this decision, which encouraged further legislative changes. Consequently, in 2021, Parliament passed a law that expanded eligibility for MAID, concluding the requirement for a reasonably foreseeable death, marking significant progress in MAID legislation.
However, Parliament also excluded individuals whose sole underlying condition was mental illness, citing the complexities associated with mental health cases. An independent expert panel was mandated to review these conditions, leading to recommendations aimed at developing standards for practice and oversight in the administration of MAID.
The government extended this exclusion for one additional year in 2023, allowing for further preparation and consideration of reports on the matter. Meanwhile, Quebec’s National Assembly took steps to amend its laws to permit individuals to draft advance requests for MAID in the event they lose the capacity to consent.
Most recently, in 2024, the federal government decided to delay the eligibility of persons with mental illnesses until March 2027, further extending the timeline for careful evaluation and establishment of appropriate assessment processes. This decision reflects the ongoing complexities and challenges associated with integrating mental health conditions into the broader MAID conversation in Canada.
