Ottawa's Next MAID Bill: Mental Illness and Advance Requests Explained

Ottawa plans to introduce a bill later this year on two unresolved issues in medical assistance in dying, or MAID. The Globe and Mail

Justice Minister Sean Fraser laid out the plan. The first issue is whether a person whose sole underlying medical condition is a mental illness should be eligible for MAID. The second is whether a person who risks losing the capacity to give final consent should be able to make an advance request.

Current criminal law is restrictive on both points. The Criminal Code, the federal law that sets out crimes and exceptions, expressly excludes mental illness where it is the sole underlying condition. That exclusion lifts in March. Federal health guidance puts the current pause until March 17, 2027. The Code also does not now allow MAID on the basis of an advance request, a request made well before MAID would be provided.

If Parliament does not pass new legislation before that expiry date, eligibility would change automatically under existing law.

The mental illness file has a history of delays. Bill C-62 received royal assent, or formal approval, to postpone expansion. On February 1, 2024, the government introduced legislation to delay expansion by three years. In 2024, the Liberals paused eligibility where mental illness is the sole condition for three years and required a committee review.

That review went to a joint committee of the House of Commons and Senate. It tabled its final report in June. Most members recommended that the government pause MAID where mental illness is the sole underlying condition indefinitely.

Earlier reporting described the coming proposal as legislation to exclude mental illness as the sole basis for assisted dying. Reuters Other coverage described plans for eligibility on that basis in March 2027 as paused indefinitely. The most recent federal position is narrower. It commits only to a bill addressing the two issues later this year.

On advance requests, Bill C-7 dealt with a related consent rule by allowing words, sounds or gestures to count as refusal of MAID at the time it would be given.

Quebec has acted already. The Globe and Mail In 2023, Quebec passed a law allowing advance MAID requests from people diagnosed with a serious and incurable illness that will lead to incapacity. That creates an uneven picture. Provincial health law can set out a clinical path that the Criminal Code does not yet protect at the federal level.

The broader context here is how responsibility is divided. Parliament controls the criminal prohibition and its exceptions. Provinces deliver health care, assess capacity and regulate doctors and nurse practitioners. Quebec's law tests how far a province can go before Ottawa changes the criminal law to match. Practitioners caught between the two face legal risk that only a change to the Code can resolve.

What this means for Parliament is that putting both issues in one bill may save time but adds complexity. Mental illness eligibility turns on questions such as whether the condition is irremediable, whether the person can make decisions, suicidality and whether psychiatric safeguards are adequate. Advance requests turn on different questions, including prior capable consent, clear trigger conditions, suffering at the time and withdrawal. The evidence is different. The stakeholder groups are different. The Charter considerations, or rights issues under the Constitution, are different. Even in one bill, each issue would still need its own eligibility rules, safeguard regimes and start dates, with precise drafting on competence, conditions and duties for assessors and providers.

In practical terms, the timetable is demanding. A bill introduced later this year must clear committee study, Senate review and possible amendments before March. That process leaves limited scope for extended federal-provincial consultation or for alignment with Quebec's existing regime.