Medical Assistance in Dying Committee on March 24th, 2026

[The Joint Chair, Liberal, Marcus Powlowski]

I call this meeting to order. Let's get this show on the road.

Welcome to meeting number two of the Special Joint Committee on Medical Assistance in Dying. This is meeting number two, and this is probably about the third or fourth chapter. Many of you have been through previous incarnations of a similar committee.

Pursuant to the order of reference of the Senate adopted on February 26, 2026, and the order of reference of the House of Commons adopted on February 13, 2026, the committee is meeting to study the eligibility for medical assistance in dying of those whose sole condition is mental illness.

Today's meeting is taking place in hybrid format, pursuant to the Standing Orders. Members are attending in person in the room. We have no one attending remotely, which makes my life easier.

I'd like to make a few comments for the benefit of witnesses and members.

To begin with, please wait until I recognize you by name before speaking. I will remind you that all comments should be addressed through the chair. That's me. If you wish to speak, please raise your hand.

With that, let me welcome our initial panel, our first two witnesses.

Appearing today as individuals are Dr. Sonu Gaind, professor of psychiatry, faculty of medicine, University of Toronto, and Dr. Mona Gupta, full clinical professor, department of psychiatry and addictions, Université de Montréal.

Welcome.

The floor is yours for opening remarks of up to five minutes. When there are about 30 seconds remaining, I will try to indicate that your time is almost up. You can go a little bit over afterwards, but if you go on too long, I'll have to cut you off, unfortunately.

Who would like to go first? You're looking at each other.

Okay, Sonu, you start.

[Dr. K. Sonu Gaind, Professor of Psychiatry, Faculty of Medicine, University of Toronto, As an Individual]

Thank you, Mr. Chair and committee. I will endeavour to stay within the five minutes.

My name is Sonu Gaind. I'm a psychiatrist and professor at the University of Toronto, a past president of the Canadian Psychiatric Association and the former chief of psychiatry of two large Toronto hospitals. I've written chapters on suicide for international medical textbooks, and I was the physician chair of the Humber River hospital's MAID team. I'm not a conscientious objector.

Thank you for the chance to speak here.

As you know, the prior AMAD committee concluded that we were not ready to provide MAID solely for mental illness, because MAID assessors could not predict irremediability. They'd actually be wrong more often than they'd be right, and they could not filter out suicidality. This particularly risked marginalized individuals seeking death as a treatment for social suffering.

In 2024, the committee recommended an indefinite pause, and Parliament enacted a three-year delay. Since then, none of those issues have been resolved. Instead, we have even more evidence showing we are not ready to provide MAID for mental illness. In fact, doing so would be the height of irresponsibility.

MAID reporting data mostly tracks illness suffering and ignores many known suicide risk factors, so we can't know the full scope of how much suicidality fuels MAID requests. Despite this limitation, we have evidence showing strong suicide risk factors fuelling especially track 2 MAID. This would get even worse if MAID was provided for solely mental illness.

Feeling a burden, loneliness and isolation are known suicide risk factors that we already see as significant drivers in about half of all track 2 cases. Those with mental illness have higher rates of psychosocial suffering. It is impossible to filter this out, since these factors related to life suffering are actually the same as suicide risk factors. There is nothing to filter. It's the same thing.

Data also shows signals of marginalization associated with track 2 MAID. In 2024, the Ontario coroner concluded that those getting track 2 MAID were much more likely to live in neighbourhoods with higher residential instability, higher material deprivation and greater dependency. Despite using less sensitive geographic-based proxy data rather than individual-level markers, we still see those signals emerge.

Dr. Gupta previously testified that she was not concerned about twice as many women as men getting psychiatric euthanasia in Europe. We're already seeing more women than men getting track 2 MAID. All these things would get even worse if MAID was provided for mental illness and addictions.

Since 2023, international groups looking at Canada have warned against MAID for mental illness. In 2025, the International Association for Suicide Prevention concluded that due to the inability to predict who will have “a poor or hopeless prognosis, and [who] will substantially improve, with or without treatment” for mental illness, “we should not allow” psychiatric euthanasia. Also in 2025, the American Psychiatric Association released its position opposing physician-assisted death solely for mental illness.

This is not about partisanship. This is about evidence.

In contrast, the same people who wrongly claimed in 2024 and earlier in 2023 that we were ready then are again claiming that we are ready now. The accumulated evidence shows they are even more wrong now than they were in the past.

Last time, I called prior assurances of readiness “reassurance theatre”. Unfortunately, this has continued, with expansion ideologues suggesting we just need a consensus or to engage in a Delphi process to sort these things out.

[The Joint Chair, Liberal, Marcus Powlowski]

Dr. Gaind, I'm sorry to interrupt. Could you just slow down a little? We have to give enough time to the interpreters.

[K. Sonu Gaind]

If anything, this highlights the absence of actual data supporting the safe provision of MAID for mental illness. On one hand, we have increasing evidence that we're not ready to safely provide psychiatric euthanasia. On the other hand, you may get a consensus of ideologues ignoring that evidence and proposing ways to provide MAID for mental illness anyway. That is not readiness. That's snake oil.

Some have argued that since we already have challenges with nebulous track 2 assessments, it would be discrimination not to extend those assessments to those with mental illness. Those ideological experts have it precisely backward. It would be the ultimate discrimination to expose those struggling with mental illness and addictions to assessors who cannot filter out suicidality, who cannot predict prognosis and whose unscientific assessments would particularly risk the most marginalized with suicide risk factors from social suffering.

We are not ready. If anything, the past three years show it is not a matter of simply thinking we can be ready in three, four or five years. This expansion should be paused until evidence—not constructed consensus—demonstrates that expansion can be done safely.

Thank you.

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you.

Next is Dr. Gupta. You have five minutes.

[Dr. Mona Gupta, Full Clinical Professor, Department of Psychiatry and Addiction, Université de Montréal, As an Individual]

Dear members of the Special Joint Committee on Medical Assistance in Dying, thank you very much for inviting me to appear before you today.

I am a psychiatrist and researcher in the Department of Psychiatry and Addiction at the Université de Montréal. I have been involved from the outset in the discussion on medical assistance in dying, or MAID, for people with mental health conditions, as a member of the Council of Canadian Academies’ working group, and as chair of the Expert Panel on MAID and Mental Illness and the working group on the Model Practice Standard for Medical Assistance in Dying. In my clinical practice, I act as a consultant to colleagues who assess requests for MAID. I assess requests myself.

Stakeholders in Canada’s MAID system have achieved several objectives in their preparations for providing MAID to people with mental health conditions. I outlined these in my submission, but today I will highlight three that have been achieved in the period since the committee’s meeting in 2023.

Firstly, psychiatrists have reached a consensus that mental disorders can develop into serious and irreversible health problems. On this subject, the Canadian Psychiatric Association, or CPA, has developed clinical guidelines based on sound methodology and supported by a review of the scientific literature. This work, which is due to be published in early April 2026, complements the clinical recommendations made by the Canadian Association of MAID Assessors and Providers, or CAAMEP, in its document entitled “Assessing Incurability for Requests for Medical Assistance in Dying“. This report clarifies that a person who has not received adequate care or support may not be eligible for MAID.

Secondly, the document drafted by the CPA provides clear recommendations on the assessment and management of suicide risk in the context of a request for MAID. These recommendations reflect Canadian best practice in this area.

Thirdly, the CPA and CAAMEP have developed clinical guidelines on assessing capacity to consent to MAID for people with mental health conditions. In other words, clinicians from various disciplines agree on how to assess the relevant aspects of a request for MAID, and they are prepared to do so.

In this same period of time, several other countries have decriminalized assisted dying. Some have MAID regimes similar to Canada's in that they allow assisted dying for persons whose natural deaths are not reasonably foreseeable. These include Germany, Austria, Spain and Colombia. All of these countries, as well as those where the practice preceded Canada's—the Netherlands, Belgium, Luxembourg and Switzerland—have considered the question of whether their regimes apply to people with mental disorders. They have all reached the same conclusion. There is no justification on clinical, ethical or legal grounds to exclude all people with mental disorders from the possibility of accessing assisted dying. Canada now stands alone among permissive jurisdictions to do so.

As for the things that have not been accomplished over the last two years or, indeed, the last five years since the exclusion first came into force, I submit that it has never been explained why it is acceptable to allow MAID for a person with a physical condition with an uncertain prognosis, yet this is a justification to exclude those with mental conditions.

It has never been explained why it is acceptable to allow MAID if a person with both a mental disorder and a physical disorder has experienced suicidality, yet this is a justification to exclude those with mental disorders as their sole condition.

Most importantly, it has never been explained why this debate continues to conflate serious mental disorders with life problems such as sadness following a relationship breakup or a job loss. These kinds of statements deny the existence of severe, chronic and treatment-refractory mental disorders and tell Canadians who suffer from them, as does the law in this country, that a mental illness is not an illness.

Throughout the committee process, I would urge you to consider two questions that are essential in formulating policy on this issue. One, are the justifications offered for exclusion grounded in the assumption that mental disorders, no matter how serious, are merely life problems? Two, are any of the justifications for exclusion really only applicable to persons with mental disorders?

Thank you for your attention.

[The Joint Chair, Liberal, Marcus Powlowski]

Thank you. That was under time.

For the first round of questioning, I will start off with Mr. Lawton from the Conservative Party of Canada.

Go ahead, Mr. Lawton.

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

Thank you, Chair.

Thank you, witnesses, for being here.

I'll start with you, Dr. Gupta. You were clear in your comments that you don't think it's reasonable to deny people with only a mental illness access to MAID if it's permitted for people with a physical condition.

Do you believe all mental health diagnoses could lead to someone being eligible for MAID?

[Dr. Mona Gupta]

Mr. Chair, it's an excellent question. I think the Canadian legislation is quite clear—

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

If I may reclaim my time, it was a yes-or-no question, Doctor.

[The Joint Chair, Liberal, Marcus Powlowski]

I will allow you to briefly finish your response, Dr. Gupta.

[Dr. Mona Gupta]

Yes.

The legislation is clear that it's trying to capture people in certain kinds of clinical circumstances rather than point to specific diagnoses. I would say that what's important is the circumstances of the person, not the medical category we classify them with.

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

Just for clarity, though, do you believe there are certain diagnoses that could never rise to that level of being “grievous and irremediable” and justify medical assistance in dying as far as diagnostic mental illnesses are concerned?

[Dr. Mona Gupta]

There are certainly diagnoses that, by definition, are intended to be time-limited or reactive to certain kinds of circumstances. I think we can safely assume that those would not meet the legislated criteria as they are currently written.

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

Do you believe an eating disorder could qualify someone for MAID?

[Dr. Mona Gupta]

Again, I think the legislation is clear that it really depends on the circumstances of the person.

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

It could.

[Dr. Mona Gupta]

Potentially.

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

Could a major depressive disorder as well?

[Dr. Mona Gupta]

Again, it depends on the clinical circumstances of the person.

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

Is there a consensus amongst psychiatrists on how many treatments one needs to try, or for how long one needs to seek treatment, for it to be classed as treatment-resistant?

[Dr. Mona Gupta]

The use of the term “treatment resistance” in the clinical research literature is meant to capture different populations, depending on the goal of the study being undertaken. There's a range of different definitions, but of course, as we know, treatment-resistant is not the term used in the legislation. It is a different term that describes a different set of circumstances than what recent researchers are interested in when they want to identify a population they consider treatment-resistant.

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

Would it be reasonable to expect someone in a situation like this, where they have a diagnosis of a mental illness, to try all available treatments before qualifying for MAID?

[Dr. Mona Gupta]

Again, I think it is difficult to make rules about a diagnosis. I think we have to look at the individual person. Certainly, ordinary clinical practice would be that you would pursue all the usual standard, accepted treatments for a condition and then some—proposed experimental treatments, innovative treatments, etc.—but an individual may have reasons that they can't take advantage of those treatments. They may not tolerate them. They may not be available. Really, it may be so experimental that it's available in only one centre in the country. It may not really be considered safe for that person in light of their other health circumstances. There are some variables there.

If what you're suggesting is the standard suite of recommended treatments, that's what people ideally would have, absolutely.

[Andrew Lawton, Conservative, Elgin—St. Thomas—London South, ON]

In terms of choice, though, I know that shock therapy is something that someone may find to be very helpful for them. Someone else may be put off by it. Would you ever suggest that a patient has to try it, if there is a legitimate justification to use that therapy for their condition, or would you say that a patient has a choice to say, no, they don't want that treatment even though it's available, and they would rather go through the MAID process?