Submission to the Special Joint Committee on Medical Assistance in Dying

The Evangelical Fellowship of Canada (EFC) welcomes the opportunity to participate in this study.

The EFC is opposed to MAID, believing that it fundamentally devalues human life and normalizes suicide. We are gravely concerned that expanding eligibility on the basis of mental illness would disproportionately impact marginalized Canadians and undermine suicide prevention in Canada.

International commitments

In its strongly worded April 15, 2025 report, the UN Committee on the Rights of Persons with Disabilities recommended Canada repeal Track 2 MAiD, including expansion of eligibility to persons whose sole underlying medical condition is a mental illness.

MD-SUMC originally excluded

• In the Carter decision, the Supreme Court stated that MAiD for persons with psychiatric disorders did not fall within the parameters of its decision.

  
  

• Former Bill C-7 originally excluded mental illness as a disease, disability or condition that would make someone eligible for MAiD.

  
  

The Charter Statement on Bill C-7 explained this exclusion was “based on the inherent risks and complexity that the availability of MAID would present for individuals who suffer solely from mental illness.”

Limitations of the current law

 This expansion would come to a system already riddled with serious problems.

• The law does not require that a patient has tried all available treatments – or any treatment. It only requires that eligible patients be informed of treatment options and seriously consider them.

  
  

• We cannot assume the percentage of Canadians with mental illness who access MAID will be as low as in Benelux countries when those countries have different safeguards. For example, in the Netherlands, the doctor and the patient together must come to the conclusion there is no reasonable alternative in the patient’s situation. This will not be the case in Canada.

  
  

• The existing MAiD framework includes subjectively interpreted language which allows for a wide variability of assessment. What is a grievous or serious illness? An advanced state of irreversible decline? Who decides? Assessing patients primarily on a case-by-case basis means there are no universal protections.

  
  

• The law doesn’t require evaluation by a psychiatrist for patients with mental illness, including when mental illness is the sole underlying medical condition.

  
  

• There is a lack of oversight for the regime.

  
  

The Canadian reality

• Statistics Canada reports a sharp increase in mental disorders over the last decade, particularly among many marginalized groups.

  
  

• There are numerous reports of individuals in vulnerable situations choosing Track 2 MAID because of socioeconomic concerns. Canadians with mental illness already face stigma and discrimination. They may face similar pressures and challenges accessing care and support that may push them toward MAID.

  
  

• MAID for mental illness must not become an option – and particularly not the most accessible option – when mental health care may not be accessible or affordable, when treatment and support are not available. According to CAMH:

  • Only half of Canadians experiencing a major depressive episode receive ‘potentially adequate care.’

  • One-third of Canadians aged 15 or older who report having a need for mental health care say those needs were not fully met.

    
    

It is unconscionable that it may become easier for a person with mental illness to access MAID than the care and supports they need to live.

The complexity of mental illness

The law limits eligibility to those with a serious and irremediable medical condition. However, the Expert Panel says “it is difficult, if not impossible, for clinicians to make accurate predictions about the future for an individual patient.”

• Mental illness is complex and doesn’t necessarily follow a predictable trajectory.

• Suicidality and a closed view of the future are symptoms of some mental illnesses.

• Treatment can be expensive and waiting lists can be long. Many Canadians struggle to access treatment in a timely way.

• There is no clear distinction between suicidality and a request for MAID. This will be a subjective assessment, carried out unevenly in a fractured and overburdened health care system.

  
  

Additional safeguards

We urge the committee to consider the safeguards that are currently legally required, not the best-case scenario of how this might be carried out or what non-binding recommendations suggest.

 Canada is already one of the most permissive jurisdictions in the world and currently has no additional legislated safeguards for MD-SUMC.

• International jurisdictions that allow euthanasia for sole mental illness have more rigorous and additional requirements for psychiatric MAiD.

• Data from the Benelux countries shows women with mental disorders are twice as likely to die by MAID than men. The reasons for this must be researched and addressed before MAID for mental illness is put in place.

  
  

 While we do not believe this practice can be adequately safeguarded, if MAID for mental illness is to be allowed, the legislation must first require: 

• It be a last resort when all reasonable treatment options have been exhausted.

• An extensive review of treatment history.

• Conversations about MAID be patient-initiated in order to protect patients from feeling pressured to request MAID in moments of vulnerability.

• Direct assessment of the patient by a psychiatrist.

• A minimum age of eligibility of 25 years for MD-SUMC, the age at which the prefrontal cortex, responsible for judgment and decision-making, fully matures. There is no decision more grave than to end one’s life.

  
  

These safeguards should be enshrined in the law.

Conclusion

We urge this committee to recommend a repeal of MD-SUMC, in compliance with the recommendations of the UN CRPD.

At minimum, the committee should again recommend an indefinite delay to allow careful study of the practice and outcomes in other jurisdictions, proper assessment of the adequacy of the existing safeguards under the current eligibility structure, and work with provinces and territories to ensure all Canadians have timely and equitable access to proper mental health care.   

It is essential the strongest possible safeguards are in place to protect Canadians in moments of vulnerability before this expansion takes place.