Canada has indefinitely suspended plans to extend its Medical Assistance in Dying (MAiD) framework to people whose sole medical condition is a mental illness.
Justice Minister Sean Fraser announced the decision on Wednesday, saying the government had concluded that the planned expansion should not proceed at this stage.
“While there is not a perfect consensus on this issue, we believe this is the correct approach,” Fraser said.
The proposed change had been scheduled for March 2027 and would have allowed some people with severe and incurable mental illnesses to seek medically assisted death where mental illness was their only underlying condition.
MAiD Rules Have Expanded Since 2016
Canada introduced MAiD in 2016 for people with terminal medical conditions.
Five years later, eligibility was broadened to include people with incurable illnesses who were not necessarily approaching the end of their lives.
The proposed mental-illness expansion became the subject of sustained debate among politicians, medical professionals, disability advocates and other groups.
Supporters have argued that excluding people whose only condition is mental illness could infringe on constitutional rights and create unequal access to healthcare.
Opponents have questioned whether medical professionals can reliably determine when a psychiatric condition is genuinely irremediable, particularly given continuing disagreements over the nature and treatment of some mental illnesses.
Fraser cited that issue directly, pointing to what he described as “a lack of consensus in the medical community about the irremediable nature of certain mental illnesses.”
Family Raises Questions Over Ontario Woman’s Death
The government announcement came shortly after the family of an 83-year-old Ontario woman, Brigitte Stegemann, publicly questioned the circumstances surrounding her death through MAiD.
Stegemann, known to relatives as “GG” or “Oma”, had stage 4 stomach cancer, a condition that made her eligible for MAiD independently of the proposed mental-illness expansion.
Her granddaughter, Brigitte Kranendonk, has alleged that Stegemann was not sufficiently capable of understanding or consenting to the procedure.
Kranendonk said her grandmother performed poorly during a cognitive assessment intended to establish whether she could provide informed consent.
According to the granddaughter, Stegemann answered every question incorrectly and believed that two of her living siblings had already died.
Granddaughter Describes Final Conversation
Two days before the procedure, Kranendonk said she spoke directly with her grandmother about what was due to happen.
She recalled using explicit language to ensure Stegemann understood that she would die.
According to Kranendonk, Stegemann reacted with disbelief before crying for about 45 minutes.
“She was bawling. Inconsolable,” Kranendonk previously said.
The granddaughter said Stegemann repeatedly expressed regret and said she had made a mistake.
Stegemann subsequently underwent the assisted-dying procedure.
Kranendonk said her grandmother died with her hands clasped in prayer.
The family has also raised concerns about the administration of the procedure, alleging that an initial attempt to establish an intravenous line was unsuccessful and left Stegemann covered in blood.
Kranendonk further alleged that the nurse involved was not wearing gloves.
Family Calls for Investigation
Kranendonk has questioned whether the people involved in Stegemann’s care appropriately assessed her wishes and capacity to consent.
“She was a vulnerable human being, and they saw an opportunity,” she said.
She has also alleged that the practitioners involved may have been motivated by ideology and said she believes the circumstances surrounding the decision to proceed should be investigated.
The practitioners and care home involved have not publicly commented, while it is understood they maintain that Stegemann had legally consented to MAiD.
Although Stegemann’s case has been cited in the wider debate, the proposed expansion for people with mental illness alone would not have determined her eligibility because she had stage 4 stomach cancer.
Doctors Question the Way MAiD Is Being Used
The debate has also involved doctors who support MAiD in principle but have expressed concerns about how the system is being applied.
University of Toronto doctors Gary Rodin and Madeline Li recently addressed the issue in an opinion article published by The New York Times.
They described MAiD as a procedure intended to provide a dignified last resort, generally for people facing terminal illness.
However, they argued that some patients are now receiving the procedure without sufficient opportunity for careful discussion and reflection with healthcare professionals.
“In some cases, patients are being approved who should not be,” the doctors wrote, referring to reports involving people experiencing circumstances such as loneliness or poverty.
Counseling Changed One Patient’s Decision
Rodin and Li described one case involving a woman in her 70s who was struggling with her inability to cook for her family.
The woman had taken pride in her role as the family matriarch and told doctors that she felt she had lost her value to her relatives.
She was approved for assisted dying, according to the doctors.
Counseling subsequently changed her perspective.
She came to understand that her family valued her presence rather than the tasks she performed for them.
The woman ultimately decided not to proceed with assisted dying at that point.
That Christmas, Rodin and Li wrote, she joined her family at the table while relatives handled the cooking and serving.
Parliament to Codify the Suspension
Canadian legislators are expected to introduce legislation formally establishing the indefinite suspension of MAiD eligibility where mental illness is the sole underlying condition.
The proposed legislation would also address another aspect of Canada’s assisted-dying framework.
Under the planned changes, people with progressive and incurable diseases would be able to provide advance consent to MAiD before their condition deteriorated to the point where they could no longer give consent.
Advance consent for MAiD is currently prohibited under Canadian law.
