This article originally appeared in The Hill Times.
By Ramona Coelho, May 20, 2026
As Canada seemingly moves to halt medical assistance in dying for mental illness as a sole underlying condition, parliamentarians are beginning to recognize what clinicians and experts have warned for years: the system is not safe enough, and there is insufficient evidence to continue with Canada’s expansive MAID practice.
Halting MAID for mental illness is not enough.
Parliamentary hearings exposed a deeper problem: Canada already lacks adequate MAID safeguards and oversight.
Based on two decades as a family physician caring for patients with complex disability, mental illnesses, chronic pain, and profound social vulnerability, and my recent experience on Ontario’s MAID Death Review Committee (MDRC), I consider these risks serious and under-recognized.
Suffering is shaped not only by illness, but also by trauma, poverty, isolation, and lack of access to care. The ethical obligation of medicine is to respond to that complexity with treatment, supports, and time. Yet assisted death is already occurring in cases where suffering is driven by unmet medical needs, psychiatric illness, trauma, isolation, and socioeconomic vulnerability.
In MDRC cases, eligibility determinations were shaped by treatment refusal, system gaps, and inadequate supports. In one case, an obese woman with depression and long-standing disengagement from care was deemed eligible for MAID after refusing interventions documented to potentially improve or reverse her conditions.
Another case involved a man in his late 40s who experienced significant suffering and unexplained functional decline following COVID vaccination. He had a history of depression and trauma, and experienced suicidal ideation requiring involuntary hospitalization. Psychiatric assessments raised concerns about mood disorder, trauma-related illness, and somatic symptom disorder. Despite this, he was deemed eligible for MAID, with assessors attributing his condition to a post-vaccine syndrome. Significantly, no pathological findings were identified on post-mortem examination.
These are not isolated concerns. MAID eligibility assessments vary across clinicians, and there is no standardized oversight system ensuring consistent evaluation of capacity, voluntariness, or adequate treatment of underlying distress.
Parliamentarians heard testimony from psychiatrists across Canada and the Netherlands warning Canada not to expand MAID. The heads of psychiatry at 13 medical schools have publicly called for the expansion to be halted.
With mental illness, it is not possible to reliably determine that someone will not recover. Prognosis is inherently uncertain and strongly shaped by social supports, including community connection, meaning, and purpose. Many Canadians wait prolonged periods for specialized psychiatric care, extending suffering and delaying recovery. Suicidality, lack of insight, and impaired judgment are symptoms of many psychiatric conditions. They fluctuate, and recovery often occurs with time and support.
Because there is no scientific basis to determine whether a person’s mental illness is truly irremediable, MAID assessments lack an objective standard. Bias and discrimination will inevitably shape who receives MAID and who receives suicide prevention.
The United Nations Committee on the Rights of Persons with Disabilities criticized Canada’s MAID regime, called for the repeal of Track 2 MAID, and urged Canada not to expand the practice to sole mental illness, mature minors, or advance requests. Canada’s emphasis on autonomy without adequate safeguards and supports was criticized. The International Association for Suicide Prevention has similarly warned there is “a strong potential for overlap or equivalence” between suicide and MAID, and that MAID should not be provided for sole mental illness.
The ethical issue is not theoretical. When individuals lack care and supports, requests for assisted death are not neutral. Structural vulnerability often drives desires to die, and this cannot be confused with free choice.
Some argue that excluding mental illness is discriminatory. In fact, including mental illness as a sole underlying condition for MAID is discriminatory and unsafe.
In medicine, we do not offer every intervention to every patient. We follow standards of care based on evidence of benefit and harm. Refusing a harmful or non-beneficial intervention is not discrimination. Excluding MAID in this context is not saying mental illness is less real. It is recognizing the limits of our knowledge, and prioritizing recovery and patient safety.
If Parliament indefinitely pauses MAID for mental illness, that should only be the beginning. Canada urgently needs stronger safeguards, improved oversight, better monitoring of social and psychiatric vulnerabilities, and far greater transparency about the factors driving MAID requests. We need to stop further efforts to loosen safeguards, such as advance requests, and we need to repeal Track 2 MAID.
We should seize this opportunity to reaffirm that the role of medicine is not to abandon people to hopelessness, but to respond to suffering with care, support, treatment, and protection.
Ramona Coelho, MDCM, CCFP, is a senior fellow at the Macdonald-Laurier Institute, an adjunct research professor of family medicine at the University of Western Ontario’s Schulich School of Medicine and Dentistry, and the co-editor of Unravelling MAiD in Canada: Euthanasia and Assisted Suicide as Medical Care.
