Provinces Call on Ottawa to Pause Expansion of Assisted Dying Eligibility

Health Minister Mark Holland speaks to the media during the federal cabinet retreat in Montreal, on Jan. 22, 2024. The Canadian Press/Christinne Muschi

Most of Canada’s provinces and territories have notified the federal government that they are not ready to respond to the upcoming expansion of the medical assistance in dying (MAID) regime to include those with mental illness.

In a joint letter to Health Minister Mark Holland, health and mental health ministers from all three territories, along with Alberta, Saskatchewan, Ontario, New Brunswick, and British Columbia, have asked to pause the expansion “indefinitely.”

“It is critical that all jurisdictions, health authorities, regulators and (medical assistance in dying) practitioners have sufficient time to implement these safeguards and to address capacity concerns that are expected to result from the expansion,” the letter said.

The ministers said that they won’t have enough time to get ready to implement the expansion if the government moves forward with the legislation as planned in March.

“Therefore, we encourage you and federal Justice Minister Virani to indefinitely pause the implementation of the expanded (medical assistance in dying) eligibility criteria to enable further collaboration between provinces, territories, and the federal government,” said the letter.

Mr. Holland acknowledged that he’d heard the concerns from the provinces and territories.

“I’ve talked with health ministers from New Democratic governments, health ministers from Liberal governments, and the health minister from Quebec, all of whom say their system isn’t ready,” Mr. Holland told reporters on Jan. 29.

“So it’s not just Conservative ministers saying this. These are every single health minister from every single province, every single territory, telling me they’re not ready.”

The federal Conservatives have called on the Liberals to cancel plans for the expansion altogether.

A parliamentary committee reported on Jan. 30 that the health system is not ready for the assisted dying regime to include people whose only condition is a mental illness.

Mr. Holland said the decision to expand MAID services to those with mental illness is based on readiness, not on the question of eligibility for those suffering from mental illness.

“At the end of the day, this is delivered by the provinces,  so I rely on the provinces and territories to be able to tell us in their systems, what their requirements are for state of readiness,” Mr. Holland said, adding that he has not heard from any province or territory that its systems are prepared to handle the expansion.

MAID in Canada

Medically assisted death became legal in Canada in June 2016, after MPs voted on changes to the Criminal Code in response to a Supreme Court ruling that said the prohibition on assisted dying infringed on Canadians’ charter rights to life, liberty, and security of the person.

In 2019, the Superior Court of Quebec ruled that limiting MAID was unconstitutional. The case was brought forward by two individuals who had disabilities.

“Practitioners who assessed them were of the view that they met all eligibility criteria for MAID, with the exception of nearing the end of life,” Canada’s Department of Justice website says.

“The court declared the ‘reasonable foreseeability of natural death’ criterion in the federal Criminal Code, as well as the ‘end-of-life’ criterion in Quebec’s provincial law on medical assistance in dying, to be unconstitutional,” the website said.

Following the court decision, Ottawa developed legislation that would expand MAID services to include those who were not terminally ill. It passed in 2021.

However, the implementation of that legislation was paused by the government in 2023 out of concern that safeguards were not in place to allow health systems in Canada to handle the change.

Ottawa is expected to announce further delays to enacting the legislation at some point this week.

According to Statistics Canada, the number of Canadians opting for MAID has been on the rise.

In 2022, assisted suicide accounted for more than 4 percent of deaths, an increase of 31.2 percent.

There were 13,241 MAID deaths in 2022, compared to 10,029 in 2021 and 7,446 in 2020.

Tara MacIssac contributed to this report.