Your Questions on MAiD and Mental Illness 

Right now, people whose only medical condition is mental illness are not eligible for MAiD in Canada. This is currently due to change in March 2027. 

Currently, some people with mental illness may be eligible for MAiD if they also have a ‘grievous and irremediable’ medical condition that is physical in nature.

At this time, to receive MAiD a person must meet all of the following criteria:

1. Be eligible for health insurance in Canada;
2. Be at least 18 years old and capable* of making health care decisions;
3. Have a grievous and irremediable medical condition;
4. Make a voluntary request free from external pressure; and
5. Give informed consent after being informed of all other available treatments and care.

A person’s death does not need to be reasonably foreseeable for MAiD eligibility (i.e., a person does not need to be at the end of life).

There are also safeguards that must be met before a person can access MAiD. These safeguards include undergoing eligibility assessments; submitting a written request that is observed by an independent witness; being informed of the right to withdraw the request for MAiD at any time; and providing final consent immediately before receiving MAiD. (Please note that in some situations a person may be eligible to have their final consent waived if their death is ‘reasonably foreseeable’ and they are at imminent risk of losing their capacity to consent to MAiD). 

*In Ontario, a person is capable of making health care decisions if they understand the information related the health care decision and appreciate the consequences of making that decision. 

In order for a person’s medical condition to be considered 'grievous and irremediable' for the purpose of receiving MAiD, the condition must be 'serious and incurable'.  The following additional criteria must also be met:  

1. They are in an advanced state of irreversible decline; and
2. Their illness, disease or disability or state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable.

Any person who requests MAiD must be assessed by two healthcare practitioners (medical doctor or nurse practitioner) to determine if they meet all the criteria, including if their illness is grievous and irremediable.  In situations where a person is not at the end of life (their death is not considered ‘reasonably foreseeable’), one of the healthcare practitioners must be a specialist in the condition that is causing intolerable suffering. 

Right now, people whose only medical condition is mental illness are not eligible for MAiD in Canada. Currently there are no agreed upon clinical guidelines for healthcare practitioners to use to determine if a person’s mental illness is ‘grievous and irremediable’ for the purposes of MAiD.  

A federal government task group published a Model Practice Standard for MAiD with accompanying Advice to the Profession to provide healthcare practitioners with a high level standard for assessing people requesting MAiD. The Standard includes general guidance for determining if a person has a grievous and irremediable mental illness for the purposes of MAiD when it becomes legal. It recommends that MAiD assessors look at a variety of criteria including the severity and duration of the person’s illness and functioning, types of treatment attempts and interventions, and outcomes of these attempts and interventions.

Right now, there are additional safeguards which must be met for MAiD requests where a person’s death is not reasonably foreseeable (i.e. when they are not at the end of life) which include:

1. At least 90 days between the day the MAiD eligibility assessment begins and the day when MAiD is provided; a second assessment by a healthcare practitioner who is specialist in the condition that is causing the person unbearable suffering;
2. Two independent healthcare practitioners (one of whom is a specialist in the condition that is causing the person unbearable suffering) must provide an assessment and confirm all eligibility requirements are met;
3. That the person be informed of all available and appropriate means to relieve their suffering, including counselling services, mental health and disability support services, community services and palliative care, and be offered consultations with those who provide those services;
4. That the person and the healthcare practitioners must have discussed reasonable and available means to alleviate the person’s suffering, and agree that the person has seriously considered those means; and
5. Immediately before MAiD is provided, the healthcare practitioner gives the person the opportunity to withdraw their request for MAiD, and ensures that they provide express consent.

It is expected that these safeguards will apply to MAiD requests where mental illness is the only medical condition when it becomes legal. It is not known at this time if there will be further safeguards specifically for MAiD requests where mental illness is the only medical condition.

Currently, there is a requirement that for MAiD requests where a person’s death is not reasonably foreseeable that the person be informed of all available and appropriate means to relieve their suffering, including ‘mental health support services’. There is also a requirement that the person and their healthcare practitioners agree that reasonable means to alleviate the person’s suffering have been ‘seriously considered’. However, the law states that the person does not have to accept the treatments or services if they do not want them.

When MAiD for mental illness becomes legal, the federal government’s Model Practice Standard and Advice to the Profession recommend that healthcare practitioners look at the number and types of treatment attempts and the outcome of these treatment attempts when determining if a person has a grievous and irremediable mental illness for the purposes of MAiD. The Standard and Advice does not provide a specific number of treatments that a person must try before they may be eligible for MAiD. These documents do say that a person cannot just refuse all or most treatments to make themselves eligible for MAiD.  

This will be one of the key challenges when MAiD for people whose only underlying medical condition is mental illness becomes legal. There is still a lot of disagreement among experts on whether it is possible to distinguish between a person who is suicidal and one who is rationally requesting MAiD due to their mental illness.  Current MAiD practice requires that a healthcare practitioner conduct a capacity evaluation to determine if the person requesting MAiD is capable of making a decision to receive MAiD. Suicide assessments and interventions are also a part of MAiD assessment practices, when deemed necessary.

The government’s Advice to the Profession recognizes the disagreement among experts on whether or not it is possible to distinguish between suicidal thinking and a rational request for MAiD.  It offers some recommendations for health professionals to consider when assessing for suicidal thinking during the MAiD process. 

This will be another key challenge when MAiD for people whose only underlying medical condition is mental illness becomes legal.  We know there is inequitable access to evidence-informed mental health care and treatment across the country and it is unclear if or how that will impact requests for MAiD where mental illness is the only underlying medical condition.

At this time, there is a requirement that for MAiD requests where a person’s death is not reasonably foreseeable that the person be informed of all available means to relieve their suffering, including ‘mental health service supports’, and be offered consultations with those who provide those services. There is also a requirement that the person and their healthcare practitioners agree that reasonable means to alleviate the person’s suffering have been seriously considered. There is no mention of what happens when a person who is requesting MAiD cannot access ‘mental health service supports’ or other means due to location, affordability, availability etc.

This will be another key challenge for people whose only underlying medical condition is mental illness when MAiD becomes legal.  We know that people with mental illness are overrepresented among those who live in poverty or those who experience homelessness, and it is unclear if or how that will impact requests for MAiD where mental illness is the only underlying medical condition.   

At this time, there is a requirement that for MAiD requests where a person’s death is not reasonably foreseeable that the person be informed of all available means to relieve their suffering, including ‘community services’, and be offered consultations with those who provide those services. There is also a requirement that the person and their healthcare practitioners agree that reasonable means to alleviate the person’s suffering have been seriously considered.

The government’s Model Practice Standard states that ‘community services’ must be interpreted to include income and housing supports as a means available to relieve suffering.  It is not clear what happens if the income or housing supports that are offered are inadequate, inappropriate, or inaccessible.

There is no legal requirement for a person or their healthcare practitioners to inform family members if that person has requested or received MAiD.  Like all personal health information, the confidentiality of a person’s decisions about MAiD are protected by privacy law and can only be shared with others if the person consents. People who want to pursue MAiD are strongly encouraged to talk with their family members and those they care about, but family members/friends do not have a legal right to be informed or to intervene. 

The government’s Model Practice Standard and Advice to the Profession recommend that the healthcare practitioner completing the MAiD assessment speak with the person’s family members or significant others, if the person consents. These documents also recommend that if the person refuses to give consent to speak to family members or significant others without good reason, the healthcare practitioner can decline to proceed with the MAiD assessment. 

The Advice to the Profession document also acknowledges the potential harm to family members and significant others if their loved one wants to proceed with MAiD without telling them. It recommends that healthcare practitioners assessing and providing MAiD explain the potential harms of not telling family members, but that ultimately healthcare practitioners must protect the privacy of the person seeking MAiD. 

• Medical Assistance in Dying (General Information), Government of Canada
• Medical Assistance in Dying: Support and Resources, Government of Canada 
• Canada’s new Medical Assistance in Dying Law, Government of Canada
• Model Practice Standard for Medical Assistance in Dying (MAiD), Government of Canada
• Advice to the Profession: Medical Assistance in Dying (MAiD), Government of Canada
  
• Final Report of the Expert Panel on MAiD and Mental Illness, Government of Canada
• Provincial and Territorial MAiD Legislation, Regulations, Policies, and Programs, Health Law Institute, Dalhousie University

CAMH recognizes that MAiD and mental illness is a complex and emotional issue that many people have strong feelings about.  We have spent the last several years discussing and debating this issue with a range of experts, including people with lived experience of mental illness.  What has always stood out is that there are no clear answers, and that is because there is not enough evidence to point us all in the same direction.  For that reason, CAMH has expressed concern on several occasions with the government’s intention to extend MAiD eligibility to people whose only medical condition is mental illness, at this time. 

In CAMH's submission to the Special Joint Committee on MAiD in November 2023, we urged the government to delay extending MAiD eligibility to people whose only medical condition is mental illness, at this time. The federal government has since introduced legislation to delay the implementation of MAiD for people whose only medical condition is mental illness until March 2027. 

CAMH called for delay because we believe that the health care system is not ready at this time. We are particularly concerned about the lack of consensus among health care practitioners on when a mental illness can be considered ‘irremediable’ for the purposes of MAiD. There are also a lack of clinical guidelines, resources and processes to determine eligibility, support or deliver MAiD to people whose only underlying medical condition is mental illness. Health practitioners have told us that they need these supports and resources to provide high quality, standardized and equitable MAiD services. 

CAMH wants to be very clear that our position is not based on the belief that suffering caused by mental illness is not comparable to suffering caused by physical illness. There is no doubt that for some people mental illness can be grievous and cause physical and psychological suffering. 

Right now, people whose only medical condition is mental illness are not eligible for MAiD in Canada, and therefore there are no facilities in Canada that can offer MAiD in these situations.

CAMH does offer a series of assessments for people with mental illness who also have a grievous and irremediable physical health condition and are requesting MAiD.  These assessments are:

1. General psychiatric assessment: An assessment used to determine if a person has a mental illness and if so, to diagnose the type of mental illness(es) they have. 
2. MAiD capacity evaluation: An evaluation that determines whether or not a comorbid mental illness is affecting the capacity of a person to decide about MAiD for a physical condition. 

If you have inquiries about MAiD assessments at CAMH, please call Access CAMH, 416-535-8501 press 2. 

CAMH is in the process of determining the best role for our hospital when MAiD becomes legally available to people whose only underlying medical condition is mental illness. We will ensure that our decision aligns with our vision, mission and values and adheres to all legal obligations and government policy. Regardless of whether or not CAMH will offer MAiD, we will ensure that our patients have access to accurate information and resources on MAiD, and will work with health care system partners to facilitate access to any MAiD services for which patients are eligible. Patients who make inquiries or requests for MAiD will be treated with dignity and respect, and will continue to receive appropriate and compassionate care. 

CAMH offers general psychiatric assessments and MAiD capacity evaluations for people with mental illness who also have a grievous and irremediable physical health condition and are requesting MAiD.  For more information on MAiD assessments, please call Access CAMH, press 2. 

*Please note that CAMH personnel do not provide or administer MAiD.  Any patient who is deemed eligible will be transferred to another facility where MAiD can be administered.

To provide feedback, such as comments, suggestions, complaints and compliments related to MAiD or other matters, please contact CAMH’s Client Relations Office, 416-535-8501 ext. 32028 or [email protected]

• Submission to the Special Joint Committee on Medical Assistance in Dying, November 2023
• CAMH Submission to the Special Joint Committee on MAiD, May 2022
• CAMH Presentation to the Standing Committee on Justice and Human Rights On Bill C-7, An Act to amend the Criminal Code (medical assistance in dying), November 2020
• CAMH Submission to the Department of Justice on the Consultations on Medical Assistance in Dying (MAiD): Eligibility Criteria and Request Process, January 2020
• CAMH Policy Advice on Medical Assistance in Dying and Mental Illness, October 2017