‘A stab in the back’: How it feels to be barred from accessing MAID for mental illness

TORONTO — For Lisa Marr, the government’s decision to ban people from accessing medical assistance in dying for mental illness feels like “a stab in the back.”

“They’re not thinking about those people who have lived with it their entire life and have treatment-resistant conditions,” Marr said from her bedroom in Eastern Passage, N.S.

“Like myself,” she added.

Justice Minister Sean Fraser introduced a bill Tuesday that, if passed, will stop a scheduled expansion of MAID access to those suffering solely from a mental illness.

Fraser told reporters there is a lack of consensus about the irremediable nature of mental illnesses within the medical community. Irremediability is a criteria for MAID that requires a person have an incurable illness, be in an advanced state of irreversible decline, and intolerable suffering in order to be considered eligible. The justice minister said he also worried the lack of access to mental health care could cause people to turn to MAID.

Marr responded to Fraser’s reasoning by writing him a letter about her more than five decades of mental illness, beginning from the age of five. She said she told him about her treatment resistant depression, suicidal ideation, generalized anxiety disorder, bipolar II disorder, and the complex post-traumatic stress disorder that has gripped her since retiring as a paramedic in 2017.

“I believe that it should be an option for those that cannot get better no matter how much therapy, medications, and other treatments one endures for years and years. I have had 20-plus psychiatrists and have been seeing a psychologist weekly for the last 10 years,” she wrote.

“Fighting with every ounce of strength you can muster just to get out of bed each day is not quality of life.”

The irremediability of a mental illness has been debated by health-care providers and politicians for years, ever since the government asked a group of experts in 2021 to study safeguards to safely introduce mental illness to Canada’s MAID regime. That expansion was repeatedly delayed, until Fraser announced that it wouldn’t happen at all.

Based on the evidence to date, the Centre for Addiction and Mental Health’s chief medical officer Dr. Sanjeev Sockalingam said studies show mental health diagnoses can change, as can prognoses for people believed to be treatment resistant.

“It is very difficult for MAID assessors and individuals assessing people living with mental illness for MAID to truly appreciate and prognosticate or predict if someone is going to recover from their mental illness,” Sockalingam said.

Testifying at a parliamentary committee hearing in April, Sockalingam described the circumstances he believes need to be in place in order to offer MAID to people whose sole underlying condition is a mental illness.

“Only when we have evidence-informed, consensus-based criteria for determining the irremediability of a person’s mental illness and for distinguishing between a request for MAID and suicide intent — and only when such criteria can be introduced into a well-resourced mental health system,” he said.

Dr. Tim Holland, who has been providing MAID since it became legal in Canada, said “irremediability, incurable, irreversible,” are always hard to define in medicine, whether that’s in relation to mental or physical health.

It can be more challenging to determine irremediability in depression versus metastatic lung cancer, but there are also people who will disagree on when a metastatic cancer is considered incurable, he said.

“It’s not like we don’t have any understanding of these conditions. We do have a very robust understanding of mental health and what responds to certain treatments,” said Holland, who is also the head of the bioethics department at Dalhousie University.

“It’s a challenge in both and it’s doable in both,” he said. “To say that MAID assessors can’t do it is false.”

Psychiatrist Dr. Mona Gupta said the yearslong policy debate about MAID has unfolded as though the exclusion of people with mental disorders comes with no negative consequences for those who planned to apply.

“As a society, we have chosen to pretend that people with severe, chronic, treatment-refractory mental disorders simply do not exist.”

This report by The Canadian Press was first published Oct. 28, 2026.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

Hannah Alberga, The Canadian Press