Your Questions on MAiD and Mental Illness 

Right now, MAiD in Canada is legal only for people on the basis of a physical health condition. People whose only medical condition is mental illness are not eligible for MAiD, but this is expected to change in March 2027.

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

"Grievous and irremediable" is a legal term which means that a medical condition is serious and incurable. This definition involves two other criteria:                                                                                                                                                                                                             

• The condition has become permanent and cannot be reversed.
• The condition causes unbearable physical or psychological suffering for the person. This suffering cannot be relieved in ways that the person considers acceptable.

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

1. Be eligible for health insurance in Canada;
2. Be at least 18 years old;
3. Be capable of making health care decisions (In Ontario, this means the person understands the information related to the decision, and appreciates the consequences of that decision for themselves.);
4. Have a grievous and irremediable medical condition;
5. Make a voluntary request for MAiD, free from pressure from anyone else;
6. Give informed consent after being informed of all other treatment and care options.

A person's death does not need to be "reasonably foreseeable" for the person to be eligible for MAiD. This means that the person does not need to be at the end of their life to qualify for this procedure.

Requesting MAiD is a very serious and deeply personal decision. Because of this, the law includes safeguards to protect people. These safeguards make sure that the person understands their options, is able to communicate their decision and can change their mind at any time.

Here are the necessary steps before someone can have a medically assisted death:

• The person must undergo assessments to determine whether they are eligible for MAiD.
• The person must submit a written request for MAiD that is signed by an independent witness (someone who is not part of the person’s care team or who would not benefit from the person’s death).
• Health care practitioners must explain that the person has the right to withdraw the request for MAiD at any time.
• The person must provide final consent immediately before they receive MAiD. (This requirement may be waived if the person is at the end of their life and is losing or has lost the ability to give consent.)

Anyone who requests MAiD must be assessed by two health care practitioners (doctor or nurse practitioner) independent of one another. These assessors determine if the person meets all the criteria for MAiD, including if their illness is grievous and irremediable. In situations where a person is not at the end of life (their death is not “reasonably foreseeable”), one of the health care 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. There are no established clinical guidelines that health care practitioners can use to determine if a person’s mental illness is grievous and irremediable.

A federal government task group has published standards (Model Practice Standard for MAiD and Advice to the Profession) to help health care practitioners assess people who request MAiD. This includes general guidance for determining if a person has a grievous and irremediable  illness. The guidance recommends that MAiD assessors look at several criteria, including the severity and duration of the person’s illness and its impact on functioning, types of treatment attempts and interventions, and outcomes of these attempts and interventions. 

Right now, there are additional safeguards for MAiD requests where a person’s death is not reasonably foreseeable (they are not close to the end of life). It is expected that these safeguards will apply to MAiD requests where mental illness is the only medical condition, but it is not known at this time if there will be more safeguards when MAiD for mental illness becomes legal.

Currently, the following safeguards exist for people with physical conditions whose death is not expected soon:

1. At least 90 days must pass between the day the MAiD eligibility assessment begins and the day the person receives MAiD.
2. Two health care practitioners, independent of one another, must conduct assessments and confirm that the person is eligible for MAiD. One of those assessors must be a specialist in the condition that is causing the person unbearable suffering.
3. The assessors must inform the person of all reasonable and available options for relieving their suffering, including counselling, mental health and disability support, community services and palliative care. They must also offer the person consultations with people who provide those services.
4. The person and the assessors must have discussed all of the options for relieving the person’s suffering and agree that the person has seriously considered those options.
5. Immediately before the person is to receive MAiD, the MAiD provider must give them the opportunity to withdraw their request for the procedure. If the person wants to proceed, the MAiD provider must ensure that the person gives final consent. 

Currently, if a person whose death is not reasonably foreseeable requests MAiD, health care practitioners must inform them of all the options for relieving their suffering, including mental health services. The person and their health care practitioners must agree that the person has seriously considered all of these options. The person does not have to accept treatment or other services if they do not want them.

When MAiD for mental illness becomes legal, guidance from the federal government (Model Practice Standard and Advice to the Profession) recommends that health care practitioners look at the number and types of treatment attempts and the outcome of these attempts when determining if a person has a grievous and irremediable mental illness. This guidance does not indicate a specific number of treatments that a person must try before they may be eligible for MAiD. However, it does 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 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 having suicidal thoughts and a person who is rationally requesting MAiD due to their mental illness. Current MAiD practice requires that a health care practitioner conduct a capacity evaluation to determine if the person requesting MAiD is capable of making a decision to receive this procedure. In some cases, this evaluation may help a health care practitioner tell the difference between a person who is having suicidal thoughts and a person who is rationally requesting MAiD due to their mental illness, but in some cases it may not.

Guidance published by the federal government (Advice to the Profession) offers recommendations for health professionals to consider when they are assessing for suicidal thinking during the MAiD process. Suicide assessments and interventions are also a part of MAiD assessments when necessary.

This will be another key challenge when MAiD for people whose only medical condition is mental illness becomes legal. Not everyone in Canada has the same access to effective mental health care and treatment, but it is not clear if or how that will affect requests for MAiD for mental illness.

At this time, if a person whose death is not reasonably foreseeable requests MAiD, the health care practitioners conducting the MAiD assessments must inform the person of all the options for relieving their suffering, including mental health services. They must also offer consultations with people who provide those services. The person and their health care practitioners must agree that the person has seriously considered these options. Currently, it is not clear what will happen if a person who is requesting MAiD cannot access mental health services or other support due to factors such as location, affordability and availability.

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

At this time, when death is not reasonably foreseeable, health care practitioners conducting the MAiD assessments must inform the person of all the options for relieving their suffering, including community services. They must offer the person consultations with people who provide those services. The person and the assessors must also agree that the person has seriously considered all of the options for relieving their suffering.

Guidance from the federal government (Model Practice Standard) indicates that community services includes income and housing supports as a means to relieve suffering. It is not clear what will happen if the income or housing supports that are offered are inadequate, inappropriate or inaccessible.

There is no legal requirement for a person or their health care practitioners to inform family members if that person has requested or been accepted for MAiD. Like all personal health information, decisions about MAiD are protected by privacy laws 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 and friends do not have a legal right to be informed or to intervene.

The federal government has developed guidance (Model Practice Standard and Advice to the Profession) which recommends that health care practitioners conducting the MAiD assessment speak with the person’s family members or significant others if the person consents. The guidance also recommends that if the person refuses to give consent without good reason, the health care practitioner should consider refusing to conduct the MAiD assessment.

The guidance also acknowledges the potential harm to family members and significant others if the person wants to proceed with MAiD without telling them. It recommends that health care practitioners who assess and provide MAiD explain the potential harms of not telling family members. Ultimately, however, health care 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 right now to point us all in the same direction. For that reason, CAMH 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. The federal government has since introduced legislation to delay this change until March 2027.

CAMH called for a delay because we believe that the health care system is not yet ready for this change. 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 is also a lack of clinical guidelines, resources and processes to determine eligibility, provide support and deliver MAiD to people whose only 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.

No. 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. So, CAMH does not provide MAiD, and does not provide MAiD eligibility assessments.  

CAMH does provide MAiD capacity assessments in situations where a MAiD assessor is seeking additional psychiatric expertise in determining a patient’s capacity to consent to receiving MAiD. These capacity assessments would be for people with physical illnesses who have requested MAiD and have been referred by their eligibility assessors. 

Doctors or nurse practitioners can refer patients for a MAiD capacity assessment after a patient has had the first MAiD eligibility assessment completed outside of CAMH and the second assessor has been identified. Referrals can be sent through Access CAMH, the hospital’s central intake service (tel.: 416 535-8501, option 2).  

If you are looking for information about a MAiD assessment or referral, to determine whether a person is eligible for MAiD, please contact the provincial care coordination service.  

The provincial care coordination service provides individuals, caregivers, and providers with information about MAID and other end-of-life options, and referrals for MAID services. It accepts self-referrals and can connect you with a dedicated physician or nurse practitioner who can complete an assessment to determine eligibility for MAID. 

When you call the care coordination service you will speak to someone who can: 

• give you more information about MAID and other end-of-life options, including palliative care
• connect you with a physician or nurse practitioner who provides MAID, such as assessments or dispensing drugs 

The care coordination service: 

• can be reached toll free at 1-866-286-4023 or TTY: 1-844-953-3350 
• operates 24 hours a day, 7 days a week 
• offers referral services which are available Monday to Friday, 9 a.m. to 5 p.m. 
• is available in English and French 
• can arrange service in over 300 other languages if requested 

CAMH is in the process of determining the best role for our hospital when MAiD becomes legally available to people whose only medical condition is mental illness. We will ensure that our decision aligns with our vision, mission and values, and that it 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. We will also work with health care system partners to help eligible patients access MAiD. Patients who ask about or request this procedure will be treated with dignity and respect, and will continue to receive appropriate and compassionate care.

If you are a CAMH patient and want to know more about MAiD, please speak with your CAMH care provider or team. You can also look at the list of resources at the end of this FAQ.

To provide feedback, such as comments, suggestions, complaints and compliments related to MAiD or other matters, please contact CAMH’s Patient and Family Experience Office or pfe@camh.ca.  

• 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