Canada's federal government said on Wednesday that it will indefinitely bar people whose only medical condition is mental illness from receiving medical assistance in dying, known in Canada as Maid. Justice Minister Sean Fraser said new legislation would be introduced in the coming weeks. It will replace a plan under which the current exclusion would have expired in March 2027. "While there is not a perfect consensus on this issue, we believe this is the correct approach at this particular time," he told reporters.

The decision follows a report earlier this year by a parliamentary committee, which recommended that Canada "indefinitely exclude persons whose sole underlying medical condition is a mental illness". It also pointed to a "pressing need for increased and more equitable access to adequate mental health services". The committee heard from doctors, advocates and experts from countries such as the Netherlands and Belgium, which allow assisted dying for mental illness alone. Not all members agreed, and some issued a dissenting report calling the process "fundamentally flawed" and "biased". Fraser said he was concerned by the lack of agreement in the medical community on whether certain mental illnesses can be considered irremediable. The legislation is also seen as a way to head off a private member's bill that would write into the criminal code that a mental disorder is not a grievous and irremediable condition.

Canada legalised Maid in 2016 for people with terminal illnesses, who still make up the vast majority of cases. After a 2019 ruling by a Quebec judge, the law was widened in 2021 to cover people with incurable conditions whose deaths were not imminent. Lawmakers added a temporary exclusion for mental illness alone and extended it in 2023 and 2024. Government figures show 95.6% of Maid deaths involved people whose natural death was considered reasonably foreseeable.

Advocates for expansion say the exclusion violates their constitutional rights and access to healthcare. Dying With Dignity Canada called the decision "profoundly disappointing", saying only a very small number of people with severe and persistent mental illness would qualify, and that their suffering is "no less real" than that of people with physical illnesses. The group is involved in a federal court case challenging the earlier delays. Fraser acknowledged the courts, potentially including the Supreme Court, could weigh in and affect the bill. Lawyer Michael Fenrick, who represents a plaintiff with treatment-resistant bipolar disorder, expects a lengthy legal fight and said people "will continue to suffer intolerably" meanwhile. Some experts have separately raised concerns that Maid can become a response to problems such as inadequate housing and healthcare. Polls suggest most Canadians support assisted dying generally, but support drops for cases involving mental illness alone.

The bill will also seek to decriminalise advance requests, allowing people with progressive incurable illnesses such as Alzheimer's to consent to assisted dying before they lose the capacity to do so. Quebec is currently the only province that permits this. Provinces would decide whether to offer it, and Alberta has already said it will not. Fraser said the aim is to ensure doctors who provide the service are not treated as criminals.