Excluding Those With Mental Illnesses from MAiD is Discrimination

Dr. Patricia Celan
5 min readApr 14, 2024

Those who suffer from mental disorders can seek medical assistance in dying (MAiD) in Europe. To die in Switzerland, one must pay 11000 Swiss Francs, or close to $17,000 CAD (not including flights and other expenses). This creates a significant inequity: the wealthy have access to end their suffering abroad. The poor must continue to suffer because they are not allowed the right to self-determination in Canada. In fact, the majority of the people receiving MAiD so far in Canada are people of higher socioeconomic status. Why should the rich be the only ones allowed to buy dignity and relief from suffering?

Canada currently allows MAiD for individuals diagnosed with a grievous and irremediable condition. Statistics from 2023 polls show that the vast majority of Canadians support Medical Assistance in Dying for a variety of causes, including whether or not death is reasonably foreseeable and even if no grievous or irremediable condition exists.

Yet when Canada was due to expand MAiD to include those with mental illness on March 17, 2023, the government introduced legislation (Bill C-39) to extend exclusion of those with mental illness for 1 more year. Then in 2024, the government introduced further legislation (Bill C-62) to again extend exclusion of those with mental illness for 3 more years until March 17, 2027. Conservative advocates suggest abolishing the expansion entirely. But there is no way around this fact: excluding those with mental illnesses from having access to medical assistance in dying is discrimination.

Canada has chosen to commit to the ideology of bodily autonomy in allowing MAiD thus far. If we are a country that supports bodily autonomy, we must support it absolutely, otherwise it is frank discrimination to those excluded from this right to self-determination.

Anyone who supports MAiD yet opposes the expansion of MAiD for mental illness is essentially supporting the following message: “Your life is yours to end if you are experiencing a grievous condition that causes you significant suffering. You have a right to bodily autonomy — unless, of course, you have a mental disorder. If your illness is of the mind and not the body, then your life doesn’t belong to you. Your body doesn’t belong to you. Your life and your body belong to the government. If your behaviour raises concerns about your risk of harm to yourself, government-paid psychiatrists have the legal power to take your freedom away and require you to receive various treatments that you may or may not agree to, and you are not allowed to opt out and request medical assistance in dying. Even if those treatments don’t fully cure your illness, even if your life has become unrecognizable, even if you are suffering tremendously and would like it to stop — too bad. Your body is not your own.”

What is it about mental illness that leads our society to become so controlling, paternalistic, and compassionless? Why enable psychiatrists to overrule patients’ pleas repeatedly? Why dismiss someone’s suffering as insufficient if the cause is a mental disorder? This approach continues to stigmatize mental illness. Until we can talk about mental illness like any other illness, and give those with mental illnesses the same rights as those suffering from any other illness, we are discriminating against those who suffer from psychiatric diagnoses.

Much of the criticism I’ve seen against MAiD suggests that Canada is trying to use MAiD to kill off unhoused or impoverished people. This is false. During the current assessment process for MAiD, the applicant’s reasons for requesting assisted death are evaluated. If those reasons are social — like homelessness or poverty — then that applicant is not eligible for MAiD. The system has a duty to provide resources and rectify those problems. Only once social problems are resolved can someone be reassessed for MAiD if their suffering continues for purely medical reasons. In other words, nobody can receive medical assistance in dying for social problems; only medical problems qualify.

Some critics suggest that allowing MAiD for mental illness — with a wait-time of 3 months contrasted with a 6-month wait-time to see a psychiatrist — would allow people to die because of insufficient mental health resources in Canada. That is also false. The evaluation process for MAiD contains safeguards, requiring 2 medical professionals — physicians or nurse practitioners — to independently evaluate someone for MAiD. Where mental disorder is the sole cause of the request, one of them would need to be a psychiatrist. In other words, it is not physically possible to receive MAiD for mental disorders before seeing a psychiatrist. If Canada were to also follow the Swiss model, then someone cannot qualify for MAiD before ever receiving any treatment for their mental disorder; in Switzerland, people must demonstrate having already thoroughly tried treatments for their mental illness yet still be suffering.

This is not like the strawman fallacy of claiming that a person who develops depression in January, and is on a waitlist to see a psychiatrist in July, could then die of MAiD in early April before they ever meet a psychiatrist. It’s not as easy as the anti-MAiD sensationalism suggests. If someone hasn’t obtained a comprehensive education — like the Canadian MAiD Curriculum (CMC) provided by the Canadian Association of MAiD Assessors and Providers (CAMAP) — then their opinion may be based on an active imagination, not the facts.

It can take years to qualify for MAiD for mental disorders in Switzerland, and it could also take years in Canada, because those with mental disorders do need to try treatments and see if that helps them get their lives back. I personally would rather see patients be healed and happy, not suffer and die. But the point is that someone should eventually have the right to say that they have had enough instead of being forced to suffer because of someone else’s arbitrary ideology that death is frightening.

To some with severe mental illnesses, continuing to suffer in life is much more frightening.