Canada will face a “suicide contagion” if medical assistance in dying (MAID) becomes an acceptable alternative for individuals suffering from mental distress, a psychiatrist specialized in severe mental illness told a parliamentary committee this week.
Barrie, Ont., psychiatrist John Maher told the Special Joint Committee on Medical Assistance in Dying in testimony on April 21 that MAID is effectively normalizing state-assisted death for people with mental illness.
“I had a patient today with schizophrenia very, very cavalierly saying, if he didn’t get a job and a girlfriend, he’s going to request MAID,” Maher said. “It’s been normalized. It’s suicide contagion.”
He cautioned that legalizing MAID for mental health problems would result in a rise in overall suicides, citing potential for the spread of a phenomenon known as the “Werther Effect” in which publicized suicide cases motivate more people to want to end their lives.
Suicide rates in countries such as Switzerland, where physician-assisted death has been legalized, “have risen much faster after it was legalized,” said Maher, who specializes in severe mental illness and is the editor-in-chief of the Journal of Ethics in Mental Health.
Maher also said Canadians with mental illnesses are already receiving assisted death “under the guise of flimsy medical excuses.”
“Patients will doctor-shop until dead,” he said, referring to those who diligently search for a physician willing to validate a condition so they can qualify for MAID.
“Prolific MAID providers are happy to assist with suicides while people are on wait lists for effective treatment,” he said. “People need lifeguards, not someone to push [them] under.”
Access to Care
Canada first legalized euthanasia for the terminally ill in 2016. In 2021, the requirement that natural death be “reasonably foreseeable” was removed, significantly expanding eligibility to include those with serious and incurable conditions who are not near death. MAID may be expanded further to people whose sole condition is mental illness in 2027, though that move has already been delayed due to concerns about safeguards.
The Special Joint Committee on Medical Assistance in Dying is examining what such an extension would look like to determine whether MAID should include those struggling with mental health issues.
The committee began hearing testimony in March from a new round of academic experts and witnesses after hearing from more than 20 witnesses in late 2023. It has received contradictory testimony on the safety of such an expansion, particularly concerning whether a mental disorder can be deemed incurable, and if so, how such a classification could be made.
Maher said the evidence, however, shows that treatment for mental illness almost always works.
“For the last 23 years I’ve treated patients that other psychiatrists told me could not get better and they get better,” he told the committee, noting that the right care “works and is extremely cost effective.”
Part of the problem, Maher said, is that only one in three adults and only one in five children in Canada have access to the mental health care they need. He said Canada should expand mental health resources instead of allowing people to languish on waiting lists until they lose hope.
MAID Safeguards
Maher also argued that current MAID safeguards will not prevent curable people from accessing assisted death.
He told the story of a former patient with schizophrenia who received MAID approval on the grounds of a treatable dermatological issue and an ankle injury, caused by failing to cooperate with physiotherapists to recover from a broken bone.
“That is what’s happening,” he said. “These [cases] are already happening.”
He was questioned further on the issue by Conservative MP Andrew Lawton.
“When you describe mental health as already qualifying people in the eyes of some assessors and providers for MAID, you’re describing criminal misconduct, are you not?” Lawton asked.
“I absolutely am,” Maher replied.
Maher said he tried to file a report about his concerns to a provincial college and was told “until the patient is dead there is no malpractice.”
“My teams are pulling their hair out over people planning to refuse medications so they can get MAID who would have healed, recovered,” he said.
University of Ottawa law professor Daphne Gilbert told the committee only a “very limited” number of people would be eligible for MAID solely based on mental illness.
“This matters, because one justification for continued exclusion is the speculative claim that large numbers of people will become eligible if the ban is lifted,” Gilbert said during her testimony before the committee. “There is no evidence to support that claim.”
Gilbert, who is also vice chair of the board of Dying with Dignity Canada, said excluding those with mental illness from MAID eligibility is harmful because it suggests their suffering is less real than those with physical illnesses.
She said the current law “continues to infantilize those with mental illness” by suggesting they must be protected from themselves.
She also said existing safeguards “are more than adequate” to deal with adding mental illness as a sole underlying condition. She also said it was “troubling” to hear MAID providers being accused of performing the procedure on inappropriate patients.
“We don’t know of any disciplinary proceedings that have successfully resulted in a sanction for a MAID provider,” she said. “So, I think the existing safeguards are very strong.”
According to the federal government’s most recent data, 15,767 Canadians received medical assistance in dying (MAID) in 2024, accounting for about 5.1 percent of all deaths in Canada that year.
Since MAID was legalized in 2016, the cumulative number of assisted deaths has continued to rise and is expected to surpass 100,000 this year.
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