Canada says it will indefinitely suspend plans to expand its medically assisted dying law to people whose sole condition is mental illness, citing a lack of consensus on who would be eligible.
It comes after a parliamentary panel earlier this year recommended that medically assisted dying – known as Maid in Canada – should not be expanded.
On Wednesday, Canada’s justice minister, Sean Fraser, said that “while there is not a perfect consensus on this issue, we believe this is the correct approach at this particular time”.
Supporters of extending the programme to those with mental illness alone argue that not doing so violates their constitutional rights and access to medical care.
A federal case remains before the courts challenging the government’s earlier decision to delay access to Maid for people with mental illness.
Fraser acknowledged this is an issue that the Supreme Court could weigh on in the future.
Wednesday’s announcement means that Canadians with mental illness as their sole condition will not be able to access assisted dying by March 2027 as previously planned.
The government will instead introduce a new law in the coming weeks that suspends that expansion indefinitely, Fraser said.
That proposed legislation will also to allow patients who have a progressing incurable illness to consent to assisted dying before their health deteriorates to the point where they are unable to do so.
However, it will leave the final decision up to individual provinces.
Advanced requests are not currently legal under federal law, but are allowed in Quebec for those with serious and incurable illnesses.
“These are not easy decisions but we believe they will be the correct ones,” Fraser said.
Medically assisted dying became legal in Canada in 2016 for people with terminal illnesses, who still account for the vast majority of cases.
Following a court case in Quebec, it was expanded in 2021 to people with incurable conditions but whose death was not imminent.
Canada was first set to expand its assisted dying laws to people whose sole condition is mental illness in 2023, but it delayed doing so twice to allow for time to study its potential delivery.
Advocates for expanding assisted dying to people with mental illness alone say they should have the same rights as patients with other types of illness.
In a statement, advocacy group Dying with Dignity called the government’s decision “profoundly disappointing”.
“We anticipate that a very small number of individuals with severe and persistent mental illness would be eligible for Maid under this criterion, but their suffering is no less real than those who live with physical illnesses,” said Helen Long, the group’s CEO.
But concerns have been raised about whether mental illnesses are currently understood well enough by medicine to determine appropriate eligibility.
“When I hear that there is a lack of consensus in the medical community about the irremediable nature of certain mental illnesses, that gives me real cause for concern,” Fraser said.
Claire Brosseau, a woman with treatment resistant bipolar 1 disorder who is part of the federal case challenging Canada’s current laws, told the BBC earlier this year that assisted dying would offer her “a safe death”.
Brosseau’s lawyer, Michael Fenrick, told the BBC on Wednesday that he anticipates a lengthy legal battle on the issue.
“People will continue to suffer intolerably while the case goes through the courts,” he said.
More broadly, some experts have also raised concerns that Canada’s assisted dying programme has become a tool to alleviate the suffering of people who would be better served by improved access to affordable housing and healthcare, and not an option of last resort.
In a report earlier this year, a parliamentary committee noted competing opinions on the issue but recommended Canada “indefinitely exclude persons whose sole underlying medical condition is a mental illness” from assisted dying.
It added that there is a “pressing need for increased and more equitable access to adequate mental health services”.
The conclusions were made after committee members heard from doctors, advocates and experts from countries that do allow assisted dying for people solely with mental illness, like the Netherlands and Belgium.
Not all committee members agreed with its recommendation, and some released a dissenting report arguing the process was “fundamentally flawed” and “biased”.
Polls suggest the majority of Canadians support access to medically assisted death but that support falls when it comes to patients with mental illness alone.
