Evidence of meeting #4 for Medical Assistance in Dying in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was equality.

A recording is available from Parliament.

On the agenda

Members speaking

Before the committee

Christopher Lyon  Visiting Research Fellow, Centre for Death and Society, University of Bath, As an Individual
John Maher  Psychiatrist, Ontario Association for ACT & FACT
Pierre Dalphond  Senator, Quebec (De Lorimier), ISG
Joint Chair  Hon. Yonah Martin (Senator, British Columbia, C)
Tony Loffreda  Senator, Quebec (Shawinigan), ISG
Pamela Wallin  Senator, Saskatchewan, CSG
Kristopher Wells  Senator, Alberta, PSG
Peters  Co-Founder, Disability Filibuster
Catherine Frazee  Professor Emerita, School of Disability Studies, Toronto Metropolitan University, As an Individual
Hewitt  Board Chair, Disability Without Poverty
Carr  Chief Executive Officer, Inclusion Canada
Kerri Froc  Associate Professor, University of New Brunswick, As an Individual
Daphne Gilbert  Full Professor, University of Ottawa, Faculty of Law, As an Individual
Elizabeth Sheehy  Professor Emerita of Law, University of Ottawa, As an Individual
Isabel Grant  University Killam Professor, Peter A. Allard School of Law, University of British Columbia, As an Individual

The Joint Chair Liberal Marcus Powlowski

I call this meeting to order.

Welcome to meeting number four of the Special Joint Committee on Medical Assistance in Dying.

Pursuant to the orders 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 special joint committee is meeting to study the eligibility for medical assistance in dying of those whose sole condition is a mental illness.

Today's meeting is taking place in a hybrid format, pursuant to the Standing Orders. Members are attending in person in the room and remotely using the Zoom application. I do see some people out there. I'd like to confirm that sound tests were made successfully.

Before we continue, I would ask all in-person participants to consult the guidelines written on the cards on the table. These measures are in place to help prevent audio and feedback incidents, and to protect the health and safety of all participants, including the interpreters, whom we thank. You will also notice a QR code on the card, which links to a short awareness video.

I'd like to make a few comments for the benefit of witnesses and members. Please wait until I recognize you by name before speaking. For those participating by video conference, click on the microphone icon to activate your mic, and please mute yourself when you're not speaking. For those on Zoom, at the bottom of your screen, you can select the appropriate channel for interpretation: floor, English or French. For those in the room, you can use the earpiece and select the desired channel.

This is a reminder that all comments should be addressed through the chair, which is me, for this meeting. For members in the room, if you wish to speak, please raise your hand. For members on Zoom, please use the “raise hand” function. The clerk and I will manage the speaking order as best we can. We appreciate your patience and understanding in this regard.

I'd like to welcome our witnesses for the first panel today. I think they are all virtual.

We have Dr. Christopher Lyon, visiting research fellow, Centre for Death and Society, University of Bath. We also have Dr. John Maher, psychiatrist, Ontario Association for ACT & FACT.

John, when you have your speaking time, you may want to explain ACT and FACT.

I'll try to get your attention when you have about 30 seconds left. You can go a bit over the time. If you find that you're running out of time, you might try to get everything in on time, but you will probably have a chance to come back to it when there are questions if you don't get through everything.

Dr. Lyon, if you'd like to commence, you have the floor for five minutes.

Dr. Christopher Lyon Visiting Research Fellow, Centre for Death and Society, University of Bath, As an Individual

Thank you very much for the invitation to appear, Chair and committee members.

My name is Christopher Lyon. I'm Canadian, a family witness to MAID, academic staff at the University of York and a visiting fellow at the Centre for Death and Society at the University of Bath.

Since my father's death, I've researched and published on MAID. I speak as an individual. My dad, John Lyon, lost his life to a MAID provider in Victoria, B.C., in July 2021, one week after he moved into an assisted living apartment. With a low income, he was very anxious about how much assisted living would cost. The day he moved in was the first day of the record-setting but transient heat dome event that hit B.C. Five days later, potentially affected by the extreme heat wave, he fell in his new apartment. On day seven, as the heat dome broke, my dad received a lethal injection.

When he found out about MAID, he told me a doctor told him he should have it. He was approved for track 2 MAID for rheumatoid arthritis, frailty, recent falls, chronic pain and conditions he often coped with. Halfway through the mandatory 90-day assessment period safeguard for track 2, his providers labelled him track 1, foreseeable natural death, three days before he was killed. His medical certification of death indicates this track change was for early sepsis NYD. NYD is medical shorthand for “not yet diagnosed”. However, the Criminal Code for both tracks first requires a person to have a grievous and irremediable medical condition, stating they must have a serious and incurable illness, disease or disability. Track shifts like this won't be easy to see in the data Health Canada uses.

When he first applied, I sent the local MAID coordinator a family document of collateral information detailing his history of mental health issues, including bouts of strong suicidal ideation during life transitions like moving homes. The heat crisis, combined with the move to assisted living, was absolutely in keeping with when he would struggle with his mental health the most. A few months before he died, my family arranged a call with the suicide prevention hotline, and he seemed to back away from this ideation, which was a recurrent pattern for him. The day he was killed was also the birthday of a family member who was present. I cannot begin to describe the horror.

Dad's provider permitted him to drink wine both the evening before and the day of his death. At the same time, he was prescribed prednisone, eszopiclone, trazodone and hydromorphone, all of which have severe psychotropic capacity-impairing effects and can mimic early sepsis markers and mental disorders. He had trouble remembering when or if he scheduled his death, or even if he had been assessed. “Get me out of here” was the flimsy assent interpreted as his final consent.

I pressed for a last-minute psychiatric assessment and was told the psychiatrist would just agree with the provider. They were right. The assessment was full of errors. It denied suicidality, minimized his history of depression, denied he was a smoker and claimed he'd been living in his assisted living flat for a month, not four or five days. His provider told me he'd probably just kill himself anyway, and that she knew she was good at MAID because she'd never lost sleep over her deaths and later told me not to raise my concerns.

Attempts by his executor and me to file complaints and access his medical records, which might confirm or refute non-compliance, proved mostly futile. We obtained only a somewhat redacted copy of his psychiatric evaluation and his medical death certificate.

B.C.'s system is a pinball machine of deflection among colleges, police and coroners, with records protected by privacy law that extends to deceased persons, though this does not seem to apply to the MAID providers, who may use them for self-promotion and commercial ventures. If this is already the de facto standard of care for MAID when mental illness and psychotropics are involved, what will happen if sole mental illness is permitted?

In my research, I found evidence that the charity lobbyist and constitutional litigant, Dying with Dignity, or DWD, cares little for safeguards around people's mental health status, historically and now. A large body of archived evidence from DWD sources suggests that it ran a—so far—unprosecuted scheme of payment-based pro-suicide counselling, assisted suicide and homicide of adults in the decades up to Carter and Bill C-14, and potentially, children. It hosted open-access workshops on suicide methods amenable to assistance, homicide and concealment from investigators. Its public website still describes alternatives for those who are ineligible for MAID, like stopping eating and drinking, refusing treatment and options in Switzerland. This web page is accessible to all, including those with mental disorders and children.

Last year, Philip Nitschke, the inventor of the Sarco pod, who gives speeches alongside CAMAP founders and DWD leaders at the World Federation of Right to Die Societies conferences, claimed to the British press that he provided material support to Kenneth Law. After facing first-degree murder charges, Law had just agreed to plead guilty to aiding suicide in 14 deaths. Nitschke claims to have met him at a more recent suicide workshop he ran in Toronto. Law's alleged victims were typically teenagers and adults with mental illness.

I find myself forced to ask very uncomfortable questions about what happens in those secret encounters with patients, despite all the MAID laws and safeguards meant to protect them from negligent care or unlawful death.

The Joint Chair Liberal Marcus Powlowski

Thank you, Dr. Lyon.

Dr. Maher, you have five minutes, please.

Dr. John Maher Psychiatrist, Ontario Association for ACT & FACT

Good evening.

Thank you very much for inviting me to appear before you.

I am chief of psychiatry at an Ontario hospital, a medical ethicist, editor-in-chief of the Journal of Ethics in Mental Health and president of both the Ontario and the global associations of tertiary care ACT teams. They are the teams that take care of the very sickest mentally ill patients.

For the last 23 years, I have treated patients that other psychiatrists told me could not get better, yet they get better. Suffering can always be reduced. With dozens of validated psychotherapy modalities, hundreds of medication combinations and myriad psychosocial interventions, there is absolutely no such thing as “everything has been tried”, despite what some patients say and despite what some psychiatrists who lack skill, knowledge or perseverance say. Death is being falsely presented as the only option.

You seek my evidence because I have particularly relevant experience and knowledge. How do you know who is right when my statements conflict with others? Tragically, ableism and stigmatization are never defeated because of clear logical points made about social fairness. Ideology pays lip service to reason while amplifying misinformation.

I presented on this same issue at a Senate hearing in 2021. My rage has since given way to profound sadness because the same misrepresentations keep being repeated by the same players. The issues have not changed in five years. The facts, however, have been made clearer. People are getting MAID for psychiatric reasons under the guise of flimsy medical excuses. Prolific MAID providers are happy to assist with suicides while people are on wait-lists for effective treatment. MAID is being offered to veterans, disabled people and people with very treatable illnesses. Irremediability is clearly known to be impossible to predict for mental illnesses. Patients will doctor-shop until dead.

Orwellian doublethink has been rampant. MAID activists say MAID is not suicide, that “irremediable” means you can't get better right this minute, that suffering is best relieved by death and that the health care system cares about you so much it will help you kill yourself. People need lifeguards, not someone to push them under.

Only one in three adults and only one in five children in Canada have access to the mental health care they need. The general public is not aware of this appalling and intentional lack of services. The Mental Health Commission tells us we could save billions by paying for upstream services that we know work. Instead, we let people get sick downstream, and it costs us billions more than necessary.

Why don't we provide care that we know works and is extremely cost-effective? Why are any of you supporting suicide instead of the care that prevents suicide?

The answer is stigma, ableism, false economic claims and a distorted view of autonomy. Please stop pretending that autonomy is some detached, rational enterprise. Very sick people are actually driven by fear, desperation and hopelessness borne of the illnesses we undertreat and don't treat. If you have to help someone kill themselves, then they are not acting autonomously. I am tired of the farcical news stories citing people who have been trying to kill themselves for decades and are demanding that a doctor help them.

There is a laughable conceptual distinction put forward by MAID activists that MAID is well thought out and true suicides are impulsive. Decades of suicide research put the lie to this. Eighty per cent of suicide attempters thoughtfully plan their suicides. MAID is suicide par excellence, like having a wedding planner to make it all as easy as possible, even with same-day service.

The Harvard school of public health showed that 90% of people who attempt suicide do not go on to complete suicide following treatment. With the right treatment, suicidal thinking disappears. The rates of suicide in jurisdictions that have MAID—specifically Oregon, Switzerland, the Netherlands, Belgium and Australia—rose much faster after it was legalized than before. Suicide contagion is a well-proven reality. Don’t pretend it won’t happen in Canada.

Seventy-two per cent of Canadians oppose MAID for mental illness. Over 90% of psychiatrists are opposed. You should listen, but mostly, you should stop and try to imagine what it is like to be given up on. If you have never tasted raw, hopeless despair, then stand boldly behind the claim that we should all be entitled to suicide facilitation, but if you have known suffering, the suffering of those you are inviting to death, then you can’t pretend that this planned social travesty is anything but accursed ignorance.

The Joint Chair Liberal Marcus Powlowski

Thank you, Mr. Maher.

For the first round of questioning, I will go to Mr. Lawton for five minutes.

6:45 p.m.

Conservative

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

Thank you very much, Chairs.

Thank you, witnesses, for your testimony.

I'd like to start with you, Dr. Maher. Just to put a fine point on this, the MAID regime we have in Canada did not exist as a health care policy. It is an exemption to murder in the Criminal Code. When you describe mental health as already qualifying people for MAID in the eyes of some assessors and practitioners, you're describing criminal misconduct, are you not?

6:45 p.m.

Psychiatrist, Ontario Association for ACT & FACT

Dr. John Maher

I absolutely am. I had a patient with schizophrenia who was approved for MAID on the basis of a skin condition that a dermatologist said could be treated by cream and with a sore ankle following not co-operating with physiotherapy after a broken ankle. I had a fierce argument with the MAID provider, who said that was sufficient. My patient had schizophrenia and was psychotic and delusional at the time. That is what's happening. These are already happening.

6:45 p.m.

Conservative

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

From your understanding of the case of Kiano Vafaeian, which was reported in media, would that fit the bill of what you're describing, of someone who was dealing with only a mental illness and who had a very flimsy physical condition appended to justify MAID?

6:45 p.m.

Psychiatrist, Ontario Association for ACT & FACT

Dr. John Maher

I won't comment on that particular case. All I know is from the media, but I do stand by my statement. I and other colleagues are experiencing this. People are clearly getting MAID for reasons that are frankly illegal.

6:45 p.m.

Conservative

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

We have heard a variety of views from psychiatrists before our committee thus far. Somewhat counterintuitively, we have psychiatrists saying that there's a general consensus that mental health conditions can be irremediable, at the same time as other psychiatrists are saying this isn't the case, which would prove that there is no consensus on this.

Explain to me how you view irremediability in the context of mental illness.

6:45 p.m.

Psychiatrist, Ontario Association for ACT & FACT

Dr. John Maher

I certainly don't view it the way MAID activists have argued, which is that if you can't get a cure or relief in the moment, that should qualify you.

The Benelux countries, which at least require that standard treatments be tried first, has a fine safeguard, but then it begs the question of what “standard treatments” are. I'm a subspecialist psychiatrist. I'm a psychiatrist's psychiatrist. People get referred to me whom other psychiatrists say can't get better and they don't know what to do, and those people get better. Irremediable... We're not talking about a cure, although I have patients we could easily say are cured in the sense that diabetes is cured if you take your medications for the rest of your life; it will have no significant impact on the quality or longevity of your life. That certainly happens all the time in psychiatry.

Do I have patients for whom symptom persist? Absolutely. Do I have patients for whom symptoms can never be ameliorated? Never, not once.

I stand here representing the 70 ACT psychiatrists who do subspeciality work in Ontario. There are always ways to reduce suffering. I don't mean to break the rules of the club, but not all psychiatrists are subspecialists. Not all cardiologists are cardiac surgeons.

6:45 p.m.

Conservative

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

Thank you.

When you talk about suicide contagion, I want to make sure I understand the point you're making. Are you saying that just by the act of permitting this—what Parliament already has done—if that's what proceeds, that will basically normalize or legitimize suicide as an option for people who might not avail themselves of MAID but may just commit suicide on their own because the government has basically said that this is a legitimate answer to mental illness? Is that what you're saying?

6:45 p.m.

Psychiatrist, Ontario Association for ACT & FACT

Dr. John Maher

Yes, it's the Werther effect, a well-known phenomenon, which is why newspapers agreed not to publish articles about famous people and how they killed themselves, yet we have MAID articles in the press daily. I had a patient today with schizophrenia very cavalierly saying that if he didn't get a job and a girlfriend, he's going to request MAID. It's been normalized. Suicide contagion is a well-established phenomenon.

Interestingly, we didn't start looking at this data until the MAID legislation euthanasia program started emerging in some countries. The rates of the countries I named where their rates have gone up and those of the countries around them have gone down is a very legitimate, significant concern. It's modelling. Not only—

6:50 p.m.

Conservative

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

Thank you, Dr. Maher.

Very briefly, Dr. Lyon, when you talk about conversions and people going from track 2 to track 1, the lack of Health Canada having adequate data on that would, in and of itself, indicate that there is no readiness to expand track 2. Is that correct?

6:50 p.m.

Visiting Research Fellow, Centre for Death and Society, University of Bath, As an Individual

Dr. Christopher Lyon

It's a good question. No, I don't think there is any readiness to expand track 2. I think right now, based on my own experience, if we're able to track-shift like that and record deaths that have been moved for reasons such as undiagnosed illnesses, and those are showing up as track 1 in the data, we don't know what is really a track 2 case and what is really a track 1 case. It would be very difficult to expand under those circumstances.

The Joint Chair Liberal Marcus Powlowski

Thank you.

Dr. Jaczek, you have five minutes.

Helena Jaczek Liberal Markham—Stouffville, ON

Thank you so much, Chair.

Thank you to both witnesses. You've certainly made your positions exceptionally clear on where you stand. As has been referenced, of course, we have heard from other psychiatrists and experts in ethics and so on who feel differently.

From your point of view, Dr. Maher, if MAID were to be approved in our country for the sole underlying condition of a mental illness, what kinds of safeguards could you envisage might be reasonable in such a situation, or are you completely saying that it's impossible to have any safeguards?

April 21st, 2026 / 6:50 p.m.

Psychiatrist, Ontario Association for ACT & FACT

Dr. John Maher

I am saying that safeguards are going to fail because the cultural ethos, the suicide contagion, is already permeating our society. My teams are pulling their hair out over people planning to refuse medications so that they can get MAID. These are people who have healed and recovered. We're doing suicide prevention, and people are being presented with “suicide is coming”.

As for safeguards and standard treatments being tried, which the Benelux countries do, it begs the question of what counts as a standard treatment. I do subspecialist care. I have literally limitless options. It's because of this that my patients get better. It's because we can continue to try. The average treatment time for me to help people recover from severe schizophrenia is three years. It's not a short process. It's like a long chemotherapy protocol for people with certain types of cancer. How do you maintain hope in the face of that?

I have a patient, and in the middle of treatment, a family doctor came and offered her MAID. She said, “Oh, thank goodness my family doctor cares enough about me to relieve my suffering.” I wanted to relieve her suffering by treating her. She was 35.

Are there safeguards? The fundamental value question here is that you either support suicide or you don't. If you're opposed to suicide, if you think the suicide taboo provides protection, and if you think there's merit in supporting life, then clearly this is my fundamental argument here: Provide the basic services. I work in an ACT team, one of the subspecialist teams caring for the sickest. There are 80 in Ontario. There should be 150 by population. Right now we have 5,000 people with degenerative illnesses waiting for care. They're going downhill. They're waiting up to five years. If I asked you about the cancer field, would you be okay with funding 60% of the cancer centres and letting everybody else kind of flounder and hopefully live?

I think safeguards are fanciful, given the clinical reality. This is my great frustration. I can stand here and tell you that you don't get what it's like on a daily basis. I don't know if I'm the only person in the room who spent yesterday listening to a patient in emergency tell me why she took an overdose. I don't know if I'm the only person in the room who's listened to thousands of people after the fact tell me why they wanted to kill themselves and about the help they wished they'd had.

Offering suicide before they get the help—I don't know how you can do it.

Helena Jaczek Liberal Markham—Stouffville, ON

Dr. Maher, I'm sure you're an extremely compassionate physician, but have you not had your own patients commit suicide?

6:50 p.m.

Psychiatrist, Ontario Association for ACT & FACT

Dr. John Maher

Of course I have.

Helena Jaczek Liberal Markham—Stouffville, ON

What happened—

6:50 p.m.

Psychiatrist, Ontario Association for ACT & FACT

Dr. John Maher

The suicide rate for schizophrenia is 10%. The suicide rate when people are in ACT teams is under 2%. What does that tell you?

As I said, there's the Harvard stuff and there's Canadian research from the Canadian suicide prevention society. We know that treatment prevents trying again. Four thousand people in Canada will kill themselves this year. Those four thousand are only 7% of all the people who tried. That means 93% of people didn't try again. Why is that? When you're in crisis, you get the help, which frustrates me profoundly. You should get the help long before you get to that crisis point. When I say—

Helena Jaczek Liberal Markham—Stouffville, ON

Excuse me.

We had a psychiatrist here who absolutely agrees with you that MAID should never be allowed or this considered irremediable unless the person is not in crisis. Obviously, if the person is in crisis, this is not the time to make any such request.

Do you think that's at least a reasonable position?

6:55 p.m.

Psychiatrist, Ontario Association for ACT & FACT

Dr. John Maher

Rational suicide is absolutely a thing that occurs—there's no question. Most people have capacity. They're able to make their own treatment decisions.

If you're making a decision at a point in time when you are still suffering and can't get help, when you don't believe that help is going to be possible or when you're fed up with and tired of it, I understand that. When you look at the 4,000 suicides in Canada this year, you will see that 90% will be people with a mental illness.

Yes, there's rational suicide, but why do we have to help people kill themselves if they can do it themselves? I don't mean to be callous—

The Joint Chair Liberal Marcus Powlowski

Thank you, Dr. Maher.

Mr. Thériault, you have the floor for five minutes.