Final Report of the Expert Panel on MAID and Mental Illness

On March 17, 2021, Bill C-7, An Act to amend the Criminal Code (medical assistance in dying) received Royal Assent and came into force. This Bill amended Canada’s original 2016 MAiD legislation, Bill C-14, An Act to amend the Criminal Code and to make related amendments to other Acts (medical assistance in dying). The effect of Bill C-7 was to extend eligibility for medical assistance in dying (MAiD) to individuals with a grievous and irremediable medical condition whose natural death is not reasonably foreseeable and to add certain legislative safeguards for this group of requesters.

Bill C-7 temporarily excludes, until March 17, 2023, eligibility for individuals with a mental illness as their sole underlying medical condition. To support an objective and informed approach to the issue, Bill C-7 required the Minister of Health and the Minister of Justice to initiate an independent expert review “respecting recommended protocols, guidance and safeguards to apply to requests for medical assistance in dying by persons who have a mental illness.”

The Expert Panel on MAiD and Mental Illness (the Panel) was formed in August 2021 to undertake this review. The Panel’s Terms of Reference (Appendix A), indicated that its role was not to debate whether or not persons with a mental illness as their sole underlying medical condition should be eligible for MAiD. Nonetheless, the Panel considered very carefully the concerns of researchers, clinicians and stakeholders who question the advisability of allowing access to MAiD by individuals with mental illness.

Early in its deliberations, the Panel was confronted with two challenges related to the scope of its work.

First, the Panel’s mandate uses the term ’mental illness.’ However, the term ’mental illness’ does not have a standard definition. The Panel was concerned that referring to ’mental illness’ would create confusion, as it would be unclear to whom the Panel’s advice applies. A comprehensive review of the knowledge available on the topic of MAiD for mental illness required by the 2016 MAiD legislation (Council of Canadian Academies, 2018) recommended the use of the standard clinical term, ’mental disorder’. Therefore, throughout this report, the Panel uses ’mental disorder’ as that is the term used in both major diagnostic classification schemes relied upon in Canadian psychiatric practice: the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) and the World Health Organization’s International Classification of Diseases (ICD).

Second, the Panel believes that the concerns raised in the debate on MAiD MD-SUMC (and discussed in greater detail below) do not apply only to people with ’mental illness’ nor to all people with ’mental illness.’ While we acknowledge that our mandate refers only to mental illness, the Panel believes that its recommendations for safeguards, protocols, and guidance should apply to all clinical situations in which any, several or all of these major concerns arise—incurability, irreversibility, capacity, suicidality, and/or the impact of structural vulnerabilities—regardless of the requester’s diagnoses.