Canada’s decision to permanently exclude people whose sole underlying condition is mental illness from assisted dying shows that lawmakers can continue to scrutinise, review and set boundaries around assisted dying legislation after it has been introduced.
The Canadian government has announced that it will legislate to prevent a planned extension of Medical Assistance in Dying, known as MAID, to people whose sole underlying medical condition is mental illness.
The change was due to take effect in March 2027. Instead, the government will keep this group excluded from eligibility after a parliamentary review of the issue.
For My Death, My Decision, the decision further demonstrates that legalising assisted dying does not mean lawmakers lose control over how the law develops.
In countries where assisted dying has been introduced, legislation continues to be monitored, reviewed and regulated. Canada’s decision shows that legislators can examine difficult questions, decide where they believe the boundaries should sit and change course where they are not satisfied a proposed change is safe or workable.
Luke Costello, an Intensive Care Nurse and Board member of My Death, My Decision, was born and raised in Canada by his British mother. He now lives and works in the UK. His mother, who had metastatic cancer, chose an assisted death at home in Canada, surrounded by her family.
“I actually find this reassuring. I was born and raised in Canada, and my mum was able to have an assisted death there when she was dying from cancer. I now live and work as a nurse in the UK, so I’ve watched this debate from both sides.
Canada’s decision is incredibly reassuring to me. They haven’t treated assisted dying as something that, once introduced, is simply allowed to develop without question. Lawmakers have looked at the proposed extension to people whose sole underlying condition is mental illness and decided they are not satisfied it should go ahead.
My mum having the choice of an assisted death meant an enormous amount to her and to our family. I would never want fear about difficult cases to take that choice away from people like her. Supporting assisted dying does not mean saying every possible circumstance has to be treated in exactly the same way.
You can give people meaningful choice at the end of life without giving up the ability to be cautious, to draw boundaries and to change course when something does not feel ready.”
How does Canada’s assisted dying law work?
Canada first legalised MAID in 2016 following the Supreme Court of Canada’s Carter ruling. Its legal framework has since been reviewed and amended.
Eligibility is not based simply on having an illness or disability.
To qualify, an adult must have decision-making capacity, make a voluntary request without external pressure and provide informed consent. They must also have what Canadian law calls a “grievous and irremediable medical condition”.
That means all of the following must apply:
- the person has a serious and incurable illness, disease or disability
- they are in an advanced state of irreversible decline in capability
- they are experiencing enduring physical or psychological suffering that they find intolerable and that cannot be relieved in a way they consider acceptable
Since changes introduced in 2021, a person’s natural death does not have to be reasonably foreseeable to qualify, although additional safeguards apply in those cases.
People whose sole underlying medical condition is mental illness have never been eligible under the current framework. The proposed introduction of eligibility for this group has been delayed several times as questions about assessment, safeguards, and readiness have been considered.
A different approach from the England and Wales Bill
The Canadian system differs significantly from the Terminally Ill Adults Bill recently debated in England and Wales.
That Bill would have limited eligibility to terminally ill adults expected to die within six months.
My Death, My Decision supported the Bill but has long argued that assisted dying should also be available to mentally competent adults who face intolerable suffering from incurable physical conditions.
Canada should not simply be treated as a model for the UK to copy, but its latest decision does demonstrate what we have long known: that assisted dying laws can have boundaries. Scrutiny is not simply abandoned, safeguards continue to be reviewed, and legislators can decide not to proceed with a proposed change where they are not satisfied it should go ahead.
That experience should inform any serious discussion about what safe, compassionate assisted dying reform could look like in England and Wales.
Notes to editors
My Death, My Decision campaigns for a change in the law to allow mentally competent adults facing constant and unbearable suffering from an incurable physical condition the legal right to a safe and compassionate assisted death, subject to robust safeguards.
Media enquiries:
kerry.hogan@mydeath-mydecision.org.uk
07922 363248
