MAiD and Mental Illness: Canada's Unfinished Debate
Why experts remain divided over MAiD for mental illness alone in Canada.
Posted May 11, 2026 | Reviewed by Michelle Quirk
In recent years, Canada’s Medical Assistance in Dying (MAiD) law has changed rapidly in its application. When Bill C-14 came into force in 2016, MAiD was limited to persons with grave and irremediable medical conditions whose natural death was “reasonably foreseeable.” In practice, the law often meant that persons whose suffering was only from psychiatric disease were excluded.
But the situation changed after the Quebec court case Truchon v. Procureur général du Canada , which found the “reasonably foreseeable death” condition unconstitutional. That led to Bill C-7 in 2021, which created two tracks for MAiD. The first track is for individuals whose death is anticipated. The second pathway is for people whose death is not predicted but who “experience a grievous and irremediable medical condition” and who have “voluntarily requested MAiD in the absence of external pressure or influence.” Similar legislation has already been passed in parts of Europe, though how such laws will be applied in Canada is difficult to predict.
While federal politicians continue to wrestle with the implications of these expanded guidelines, the controversy generated can be heard across the political spectrum and has even been fueled by erroneous information about MAiD coming from the Trump administration. Still, the heaviest burden in assessing MAiD candidates dealing with mental illness is with the mental health professionals charged with assessing how candidates qualify.
Making Life-and-Death Decisions
As Canadian psychologist Salman F. Mikail points out in a new piece in the journal Canadian Psychology, widening MAiD eligibility raises many hard questions that remain unanswered. Of these, the most critical is whether psychiatrists and psychologists are ready to make life-and-death decisions in circumstances where mental illness is the sole reason someone is seeking to die.
Under the current guidelines, two independent assessors must agree on whether the MAiD candidate meets all qualifications. This includes filing a written request, determining whether the candidate is fully aware of the implications of MAiD and of alternatives for relieving suffering, and confirming that they are free to withdraw at any time.
Predicting Risk of Suicide
In his paper, Mikhail focused primarily on suicide prediction and what the implications were for the new guidelines. Mental health specialists have long tried to identify who is most at risk of suicide, but research has repeatedly shown how unreliable these predictions can be. As a result, research indicates that clinicians are typically no better than random chance at predicting who will ultimately die by suicide. More disturbing, however, is that many who eventually kill themselves never tell anyone they are contemplating suicide before they do.
In turn, this raises another provocative question: How may doctors properly assess eligibility when they cannot reliably distinguish between a transient suicidal crisis and a considered MAiD request? While someone with extreme depression , chronic trauma , severe personality instability, or profound hopelessness may actually believe that their suffering is forever, it can still change due to treatment, social support, better relationships, or just the passage of time.
Along with this uncertainty, there is another problem: Many people at high risk for suicide appear calm and emotionally controlled during assessment. Some people are very good at masking sorrow from physicians, friends, and family members. It can be from perfectionism , shame , or fear of burdening others. Since MAiD requirements impose a 90-day assessment window, it is impossible to distinguish persistent distress from curable symptoms. In other words, what looks like a dead end today may not be a dead end months from now, and the misery they experience is far from “irremediable.”
Access to Treatment and Services
Also, current MAiD standards require clinicians to verify that patients have been informed of alternatives, including counseling, community services, disability resources, housing aid, and palliative care. But many Canadians still have difficulty accessing basic mental health services, especially in rural areas and neglected communities. If a person cannot access timely psychotherapy , trauma treatment, addiction services, stable housing, or culturally appropriate care, can we honestly say all reasonable options have been exhausted?
Supporters of expanding MAiD say excluding those with mental problems alone is discriminatory and patronizing. They argue that competent persons should have the right to make very personal judgments concerning severe suffering. Critics of MAiD fear that Canada may be moving too quickly, before the mental health system is able to safely manage such choices.
Ultimately, the dialogue about MAiD and mental health cannot be restricted to legal definitions or medical processes alone. Questions about quality of life, autonomy, and cultural factors also raise wider concerns about what sort of society Canada wants to be and how ready we are to protect vulnerable people before we conclude that death is the only remaining option.
And during important debates, medical expertise in diagnosing mental health issues alone may never be enough.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.
Mikail, S. F. (2026). Medical assistance in dying when a mental disorder is the sole underlying medical condition. Canadian Psychology / Psychologie Canadienne, 67 (2), 195–200.
Share this post Facebook Bluesky Linkedin Email
There was a problem adding your email address. Please try again.
By submitting your information you agree to the Psychology Today Terms & Conditions and Privacy Policy
Romeo Vitelli, Ph.D. is a psychologist in private practice in Toronto, Canada.
Get the help you need from a therapist near you–a FREE service from Psychology Today.
This article is part of the Bringwise Psychology Journal — daily insights on human behavior, mental health, and personal growth.