System reform matters. But MAiD eligibility should not depend on it

In June, Parliament’s Special Joint Committee on MAiD recommended that Canada indefinitely exclude people whose sole underlying condition is mental illness. Some disability organizations frame this as necessary to preserve the exclusion so we can keep pressure on governments to improve supports or permit eligibility and risk that pressure disappearing.

This is a false choice.

Yes, Canadians have sought MAiD while unable to obtain appropriate mental health care, stable housing, income support, employment or access to justice – and they continue to advocate for it because this is a reality. This demands urgent reform. But the answer to failing systems is to fix them; it is not to make the people they fail carry the burden of preserving political pressure to do so. Canada has obligations both to strengthen supports and protect equality, dignity and autonomy.

We do not exclude someone with irremediable cancer because system failures such as late diagnosis, missed screening or geographic and economic inequities contributed to their condition. We recognize these issues as system failures requiring correction and look to them as evidence of injustice, but we do not use them as reasons to deny a person access to legal and medical processes.

The strongest objection is clinical: capacity and irremediability can be especially difficult to establish when the sole condition is a mental disorder, and suicidality may be a symptom rather than a separate, enduring and considered choice. That is a serious challenge. But difficulty is not impossibility, nor does it justify refusing to consider every member of one group. That mental suffering is harder to see, understand and trust contributes to the exclusion.

But we must note: Psychiatry already evaluates decision-making capacity, treatment resistance, prognosis and criminal responsibility. None of these judgments are infallible, and they are often difficult calls to make. Because a MAiD death is irreversible, assessments must be exceptionally rigorous. This is a reason to invest in specialized expertise, clear standards and robust oversight – not to decide the answer before an individual assessment begins.

The fear that someone might receive MAiD who, with the right support, would have chosen to live is legitimate. But exclusion from a dignified death alone will not and does not create safety. Some people experiencing severe and enduring mental illness will continue to die by suicide, often alone and outside any structured assessment or support.

The Netherlands is frequently invoked as a warning. Yet its official 2025 figures show 174 reported euthanasia cases in which suffering arose largely from psychiatric disorders out of 10,341 total cases – about 1.7 per cent. The number also fell by nearly 21 per cent from 2024. International evidence deserves careful study, but it does not by itself justify an indefinite Canadian exclusion.

MAiD is a deeply sensitive and complex issue, and we respect and hear the discussion and debate. We stand with the community and work for equity, inclusion and human rights. It is within this context that it is important to clarify that disability communities do not speak with one voice on MAiD. That disagreement should be represented honestly. There are many community members who want to maintain their right to die with dignity in cases of mental health as the sole underlying condition.

The exclusion for mental illness as the sole underlying condition is scheduled to end March 17, 2027. It should end on that timeline as planned and with the safeguards we have outlined in place. The need for safeguards should not become a reason to permanently bar people with irremediable mental suffering from a dignified death. That their suffering looks different, their capacity harder to assess and the systems impacting them failed are reasons to build robust safeguards. They are not grounds for a permanent exclusion.

System reform matters most to us – and we work hard for it. Neurodiversity Change Foundation is working with partners to develop solutions to improve health care, employment and access to justice for our community. What these efforts need is support – not risking the additional suffering of people to exert political pressure, nor the lack of fair and equitable assessments for legal and medical processes for a protected group.

Neurodivergence is not itself a mental illness or a basis for MAiD, but neurodivergent people are disproportionately affected by mental illness and system failures. We are rarely heard directly in this policy debate. Our federal submission proposes specialized training in mental illness and neurodivergence; condition-sensitive assessment guidance; meaningful exploration of treatment and social supports; and oversight informed by people with lived experience and deep clinical expertise.

We believe Canada can strengthen systems and uphold equal rights at the same time. A government serious about safety, dignity and equality must commit to both – and stick to its timelines.

If you or someone you know is struggling, support is available: BC Crisis Line 1-800-784-2433 (1-800-SUICIDE), or the Canada Suicide Crisis Helpline – call or text 988.