Medical Assistance in Dying (MAiD) and Mental Illness – FAQs

Right now, people whose sole medical condition is mental illness are not eligible for MAiD in Canada. This is set to change in March 2024.

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

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 is considered to have a grievous and irremediable medical condition if they meet all of the following criteria:

1. They have a serious and incurable illness, disease or disability (excluding mental illness at this time);
2. They are in an advanced state of irreversible decline; and
3. 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

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 procedural safeguards that must be met before a person can access MAiD. These safeguards include undergoing medical 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. 

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, one of the healthcare practitioners must be a specialist in the condition that is causing intolerable suffering. 

Currently, there are no agreed upon standards for psychiatrists or other healthcare practitioners to use to determine if a person’s mental illness is ‘grievous and irremediable’ for the purposes of MAiD.  A government-appointed expert panel recently made recommendations for determining if a person has a grievous and irremediable mental illness. They recommended that healthcare practitioners look at the number and types of treatment attempts, outcomes of these treatment attempts and the severity and duration of the person’s illness. It is important to note that these are just recommendations at this point. It is not clear whether the government will use these recommendations and/or if further instructions or standards for determining grievous and irremediable mental illnesses will be developed before MaiD for mental illness as a sole medical condition becomes legal.

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. a 90-day mandatory assessment period;
2. a second assessment by a healthcare practitioner who is specialist in the condition that is causing the person unbearable suffering;
3. that the person be informed of all available 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 agree that reasonable means to alleviate the person’s suffering have been discussed and seriously considered; and
5. the healthcare practitioner gives the person the opportunity to withdraw their request for MAiD and ensures that they provide express consent immediately before MAID is provided.

It is expected that these safeguards will apply to MAiD requests where mental illness is the sole medical condition. It is not known at this time if there will be further safeguards specifically for MAiD requests where mental illness is the sole 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 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 discussed and ‘seriously considered’. However, the law states that that the person does not have to accept the treatments or services if they do not want them.

Recently, a government-appointed expert panel made recommendations on determining if a person has a grievous and irremediable mental illness and this included looking at the number and types of treatment attempts and the outcomes of these treatment attempts. It is important to note that these are just recommendations at this point.

This will be one of the key challenges when MAiD for people whose sole underlying medical condition is mental illness becomes legal. There is still a lot of disagreement amongst 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 that decision. Suicide assessments and interventions are also a part of MAiD assessment practices, when deemed necessary. It is not certain if there will be new safeguards added that address suicidality for MAiD requests where mental illness is the sole underlying medical condition.

This will be another key challenge when MAiD for people whose sole 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 sole 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 discussed and 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, etc.

There is no obligation for a person or their healthcare practitioners to inform family members if that person has requested or received MAiD.  Like all personal health information, decisions about MAiD are protected by privacy law and can only be shared if the person agrees. 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. 

Recently, a government-appointed expert panel recommended that for MAiD requests where death is not reasonably foreseeable, that the healthcare practitioner completing the MAiD assessment speak with the person’s family members or significant others, if the person consents. They 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 assessment. It is important to note that these are just recommendations at this point.

This will be another the key challenge for people whose sole 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 sole 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 discussed and seriously considered.

Recently, a government-appointed expert panel recommended that ‘community services’ be interpreted to include income and housing supports as a means available to relieve suffering.  It is important to note that this is just a recommendation at this point. It is also unclear what would happen if the income or housing supports that are offered are inadequate, inappropriate, or inaccessible.

• Medical Assistance in Dying (General Information), 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 has publicly expressed concern with the federal government’s intention to extend MAiD eligibility to people whose sole medical condition is mental illness, at this time. There is a lack of consensus on the issue, and we have requested that the government extend the temporary prohibition on MAiD for people whose sole medical condition is mental illness until further discussion and consultation takes place, particularly with people with lived experience of mental illness and their families.

Our key concern is the lack of agreement amongst experts on whether mental illness can be considered ‘grievous and irremediable’ for the purposes of MAiD, and what criteria should be used to determine if a person is suffering from an irremediable mental illness. There is also disagreement amongst experts on whether a request for MAiD can be distinguished from suicidal intent. Additional concerns centre on access to mental health care and the social determinants of health.

CAMH is in the process of updating our position on MAiD for mental illness.

Right now, people whose sole 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 general psychiatric assessments, MAiD capacity evaluations and MAiD eligibility assessments for people with mental illness who also have a grievous and irremediable physical health condition and are requesting MAiD.  If you have inquiries about MAiD assessments at CAMH, please call Access CAMH, 416-535-8501 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.

CAMH is in the process of determining the best role for our hospital when MAiD becomes legal for people whose sole 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. 

CAMH offers general psychiatric assessments, MAiD capacity assessments and MAiD eligibility assessments 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 Client/Patient Relations, 416-535-8501 ext. 32028 or client.relations@camh.ca

• 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