On Oct. 7, Justice Minister Sean Fraser announced that the federal government will not proceed with plans to expand MAiD (medical assistance in dying) to people whose sole underlying medical condition is mental illness. Legislation will be introduced this fall to maintain their exclusion indefinitely. Until that legislation is passed, the current exclusion is still scheduled to expire on March 17, 2027.

But questions remain, and the ‘right to die’ debate will continue before, during and long after legislation is in place.

After all, we live in a society where it is easy to help people die, and so much harder to help them live. Most significantly, the debate over allowing MAiD for mental illness raises two key questions: Is the request for MAiD always a desire to die? Or could it be a veiled ask for help to live?

An Ontario court recently upheld the rules barring those with mental illness as the sole underlying condition from accessing MAiD. It’s somewhat surprising given our courts’ past propensity to reframe the Charter rules governing social policies based on individual circumstances.

Claire Brosseau is a 49-year-old Toronto woman who has lived for decades with bipolar disorder, an eating disorder, substance abuse and post-traumatic stress disorder. She says she is in constant pain, experiences unrelenting torment and that denying her access to MAiD is a violation of her bodily autonomy. So, she asked the court to grant her “emergency” access to medical help in dying.

The Ontario court said no, but Brosseau’s case also raises the question of whether courts should override medical determinations related to mental illness. The courts are there to uphold the law; it is not their role to assess an individual’s mental status and grant emergency requests for MAiD.

Brosseau, along with the activist group Dying With Dignity Canada, has also sued the federal government for barring MAiD for those with mental illness. That broader constitutional challenge remains before the courts and could ultimately determine whether Parliament can continue excluding mental illness as a sole underlying condition.

How can doctors determine that a mental illness is irremediable when there is no medical consensus on how to do so? And how can we conclude that someone has exhausted the possibility of recovery when timely treatment may never have been available in the first place? Even Mr. Fraser acknowledged that there are legitimate concerns about whether Canadians have adequate access to the mental health services and supports they need. Until those questions can be answered with confidence, MAiD should not be available when mental illness is the sole underlying condition.

When Parliament first legalized physician-assisted death in 2016, strict guidelines were supposedly in place to prevent MAiD for mental illness, and access was limited to those whose death was reasonably foreseeable. In 2021, Parliament removed that requirement in favour of intolerable suffering and/or an incurable illness. Parliament has twice opened the door to MAiD for the mentally ill, only to delay its implementation, even as evidence mounted that existing MAiD safeguards were being abused.

Now, Ottawa intends to halt that expansion indefinitely. It is the right decision, and one that should have been made long ago.

The demand for MAiD is inextricably linked to Canada’s fragile and increasingly inaccessible health-care system. The average wait for mental health care is six months or more. When compared to 28 other universal health-care systems, Canada ranks 16th for number of psychiatrists and 22nd for availability of psychiatric beds.

Many Canadians lack primary care physicians, leaving crisis care at emergency departments as the only option. Those experiencing a serious psychotic episode will likely receive urgent care, while those suffering from depression or anxiety may face hours of waiting for help.

When adequate care is unavailable, it becomes harder to know whether a request for MAiD reflects an irremediable condition and a genuine desire to die, or desperation for help that has not been available. A person should not be considered beyond treatment simply because the treatment they need is unavailable.

A June 2026 report by a special parliamentary committee investigating MAiD for mental illness acknowledged the need for increased and more equitable access to adequate mental health services before expanding MAiD. It urged Parliament to “indefinitely exclude” persons whose sole underlying medical condition is a mental illness.

The Centre for Addiction and Mental Health and more than 90 disability rights and mental health groups have expressed reservations or outright opposition to expanding MAiD when mental illness is the sole factor.

Then there is the difficult question of autonomy. Canadian law requires MAiD applicants to have decision-making capacity and make a voluntary request. But how is that capacity determined when mental illness is the sole condition?

Mental illness does not automatically mean that someone lacks the capacity to make decisions. But serious mental illness can affect judgment, perception, hope for recovery and even the desire to continue living. That can make assessing capacity and voluntariness extraordinarily difficult.

Think about it: a patient may be emotionally exhausted, in pain, depressed, taking multiple medications and unable to see any prospect of improvement. Is a request to die in those circumstances necessarily an expression of autonomy? Or could it be a symptom of the illness itself? Until we can reliably distinguish between the two, autonomy alone cannot settle the question of whether MAiD should be available.

Years ago, The Globe and Mail carried a memorable profile of Ken, a Montreal man who had a rare, paralyzing form of Parkinson’s. When a friend visited each week, Ken would repeatedly ask for right-to-die literature and a lethal supply of sleeping pills.

But that changed when his friend found that Ken had painstakingly written a note saying that he no longer wanted to die. He wrote, “Life is beautiful and I haven’t lost my appetite for life… but if I do not get help, I cannot continue to survive.”

Finances, social supports, family and the availability of health care all play a role in the demand for MAiD. So, is a request for MAiD truly the voice of patient autonomy? Or is it the anguish of mental illness crying out for help?

Canada cannot safely expand MAiD to mental illness while it remains unable to reliably distinguish between the two. But preventing MAiD from becoming an answer to mental illness is only half the job — governments also need to ensure that Canadians asking for help to live can actually get it.

Susan Martinuk is a Senior Fellow at the Frontier Centre for Public Policy. A Vancouver-based researcher and communications specialist, she has written more than 1,500 published columns, articles and reports on health care, bioethics and public policy. She is the author of Patients at Risk: Exposing Canada’s Healthcare Crisis and the forthcoming Patient Rights: Restoring Trust in Canada’s Healthcare System.