What began as a narrowly framed end-of-life exception evolved into a system that places disability at the centre of eligibility debates
More than 90 disability and mental health organizations, including Autism Alliance of Canada, have called on Parliament to permanently halt the planned expansion of MAID for people whose sole underlying condition is a mental illness. In an open letter to the Prime Minister and federal Ministers of Justice and Health, the group urges the federal government to repeal the “sunset clause” that would allow the expansion of MAID to take effect on March 17, 2027.
Repeated delays are not enough. Parliament should make the current mental illness exclusion permanent.
Over the past decade, Canada’s MAID framework has undergone continual expansion beyond the narrow circumstances originally contemplated by the Supreme Court of Canada in Carter v. Canada. What was presented to Canadians in 2015 as a tightly safeguarded end-of-life exception has steadily broadened through legislative and judicial decisions into a framework where disability and mental illness have become increasingly central to eligibility debates.
In Carter, the Supreme Court struck down the blanket prohibition on assisted dying for competent adults experiencing grievous and irremediable suffering. Parliament’s response through Bill C-14 limited MAID to situations where natural death was “reasonably foreseeable,” reflecting an attempt to balance autonomy with safeguards for vulnerable persons.
That balance shifted following the 2019 Truchon decision, when the reasonably foreseeable death requirement was struck down and the federal government chose not to appeal. Bill C-7 followed in 2021, creating Track 2 MAID for people who are not nearing the end of life. A Senate amendment then added the future expansion of MAID to individuals whose sole underlying condition is a mental illness.
Bill C-7 marked a profound shift in Canada’s MAID framework. What began as a narrowly framed end-of-life exception evolved into a system that increasingly places disability at the centre of eligibility debates.
Critics, including these disability organizations, argue that Track 2 MAID created a separate
legal pathway tied to disability status by allowing eligibility based largely on suffering associated with disability, even where death is not reasonably foreseeable. In practice, the framework creates differential treatment on the basis of disability and singles out disability as a basis for eligibility in ways that continue to raise serious equality-rights concerns under the Charter.
These concerns are intensified by the reality that many disabled Canadians still face major barriers to housing, mental-health care, income security, employment and community supports. Canada should not continue expanding pathways to assisted death while core commitments to disability inclusion remain inadequately implemented.
This concern is particularly significant for many Autistic people and families.
Autism is not classified as a mental illness under the DSM. It is a neurodevelopmental condition. However, many Autistic people experience co-occurring mental-health conditions, often shaped by chronic exclusion, poverty, bullying, isolation and inadequate supports.
Autistic people experience disproportionately high rates of depression and suicidality, while continuing to face barriers to timely mental health care, disability supports, housing and employment. The concern is that broad psychiatric eligibility categories could indirectly place some Autistic people at increased risk within a system that still fails to provide adequate supports for living.
Importantly, Canada’s existing MAID framework already permits access for individuals who may experience mental illness alongside other qualifying medical conditions. The current debate is about something fundamentally different: whether mental illness alone should become sufficient grounds for eligibility.
A country that cannot consistently provide accessible and adequate support is not in a position to conclude that suffering is irremediable.
The government should demonstrate meaningful implementation of the commitments they have already made to disabled Canadians. That includes fully implementing Canada’s Autism Strategy, advancing the Disability Inclusion Action Plan, strengthening community mental-health services and addressing the broader social determinants of health and well-being.
Concerns about this expansion are no longer limited to advocacy organizations. Provincial and territorial health ministers have repeatedly stated that health systems are not prepared. The chairs of psychiatry departments at Canada’s medical schools have warned that it is difficult to reliably determine irremediability in psychiatric illness and difficult to distinguish suicidality from a request for MAID. The United Nations Committee on the Rights of Persons with Disabilities has also urged Canada directly to halt the expansion to mental illness.
Part of being human is experiencing suffering, uncertainty and vulnerability. The role of public policy should not be to abandon people in those moments, but to ensure they have the supports, care and community necessary to live through them with dignity.
Parliament should not continue treating implementation as inevitable. It should recognize that Canada has moved far beyond the narrow framework originally contemplated in Carter and permanently exclude mental illness as a sole underlying condition for MAID eligibility.
Canada should not respond to unmet needs, trauma, isolation and system failure by continuing the expansion of assisted death. It should respond by building the conditions that allow people to live with dignity, inclusion and support.
Photo courtesy of Hutima, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons
