Medical Assistance in Dying Committee on April 27th, 2026

[Gordon Gubitz]

Briefly, no. If the person is actively suicidal, assessments for MAID are off the table.

We need to ensure that the person has been referred to the appropriate mental health services. We occasionally encounter a circumstance where we find somebody ineligible and they say, “Well, I'm just going to kill myself, then.” My response to that is to telephone the police and do a wellness check on them to ensure they are going to get the care they require, in addition to speaking to the care providers who have referred them to me.

[Claude DeBellefeuille, Bloc, Beauharnois—Salaberry—Soulanges—Huntingdon, QC]

Would a person experiencing depression who tries to kill themselves, ends up in hospital and requests MAID be eligible to receive it?

[Gordon Gubitz]

Once again, I think the clinical scenario would have to allow for some degree of stability over time to ensure that they are outside of the crisis that resulted in the suicidal ideation. Referring to the Canadian Psychiatric Association document around how clinicians go about assessing patients for suicidality would be a reasonable standard for across the entire country. It's very well laid out.

[Claude DeBellefeuille, Bloc, Beauharnois—Salaberry—Soulanges—Huntingdon, QC]

We can assume, then, that access to MAID would not be easily granted to someone experiencing suicidal ideation, because clinically, it would have to be shown that every attempt had been made to provide the person with support and get them through the crisis.

[Gordon Gubitz]

I agree, and once again, that depends upon the individual circumstances of a patient. We have encountered people who have—

[The Joint Chair, Liberal, Marcus Powlowski]

The time is up.

[Gordon Gubitz]

I'm terribly sorry.

[The Joint Chair, Liberal, Marcus Powlowski]

We'll now go to Senator Moodie for one minute and 42 seconds.

[Rosemary Moodie]

Thank you, Mr. Chair.

I want to ask Dr. Green and Dr. Gubitz a question.

I'd really hate for the general public who are listening to the discussion this evening to come away with the idea that physicians in Canada are reckless and uncontrolled and they practice procedures and medicine that they're untrained for—essentially, that they're unethical.

The first part of my question is this: In your opinion, will practitioners who are not properly trained and do not adhere to professional standards get involved in complex MAID cases?

The second part of my question is this: Is it not the case that physicians have a professional obligation to only practise within their scope of practice, i.e., within their professional competencies?

[Gordon Gubitz]

Thank you for the question.

[Rosemary Moodie]

I'm sorry to interrupt, but is there not a process by which people can complain if any physician is found to be acting outside their scope of practice?

[The Joint Chair, Liberal, Marcus Powlowski]

Dr. Gubitz, you have 30 seconds.

[Gordon Gubitz]

Physicians are obligated to practise within their scope of practice and their standards according to their provincial or territorial college. Medical assistance in dying is no different.

Unethical people practise across the sphere of medicine and will do what they will. We do not encourage them to be involved with our work.

[Stefanie Green]

May I add something?

[The Joint Chair, Liberal, Marcus Powlowski]

No. I'm sorry; we're out of time.

We'll go to the next senator.

Senator Osler, you have one minute and 46 seconds.

[F. Gigi Osler]

Thank you, Mr. Chair.

My question is for Dr. Green.

To follow up on something you mentioned in your opening remarks, is there peer-reviewed, empirical evidence that talks about socio-economic vulnerability and marginalization as drivers of requests for MAID?

[Stefanie Green]

There's actually some very good data on this exact question, and it has been grossly misinterpreted and put out there. Dr. James Downar has a number of publications in which he reviews the data and clearly states that those who are receiving MAID in this country are socio-economically advantaged. It's very clear that they're more likely white, that they're more likely well-educated, that they're more likely socio-economically and financially stable, and that they are less likely to live alone.

There are a number of parameters that he has proven over a number of papers. I think that's been very clear.

[F. Gigi Osler]

I'm going to ask you a question I asked in the first panel about the criticism that the CAMAP curriculum has not dealt appropriately with the ableism embedded in our society. Can you respond?

[Stefanie Green]

There's been some question about that. I think working group four, which Dr. Gubitz pointed out, did the most work on this. We had about 18 months to two years of work. We had input from a witness who came before this committee, which was very valuable and was incorporated. We're better off for that.

I think we've dealt with it. I think the outline will demonstrate to you the number of times that vulnerability and ableism are commented on and dealt with in the curriculum. I think Dr. Gubitz has addressed the rest of that question.

[F. Gigi Osler]

Finally, can you tell us how many hours—

[The Joint Vice-Chair, Hon. Pierre Dalphond]

Actually, your time is up.

I wish to thank our witnesses.

I will now suspend in order to proceed with our second panel.

[The Joint Vice-Chair, Hon. Pierre Dalphond]

We'll resume with the second panel.

As an individual, we'll hear from Dr. Eliana Close from Australia. Representing 9-8-8: Suicide Crisis Helpline, we have Dr. Allison Crawford. From the College of Physicians and Surgeons of Nova Scotia, we have Dr. Douglas Grant.

The floor is yours, Dr. Close.

[Eliana Close, Senior Research Fellow, Australian Centre for Health Law Research, Queensland University of Technology, As an Individual]

Members of the committee, thank you for the opportunity to appear before you today.

I'm a researcher at the Australian Centre for Health Law Research at Queensland University of Technology in Brisbane, but I'm originally from Calgary. I did my undergraduate degree at the University of Calgary and my law degree at Oxford as a Rhodes Scholar. I articled at the Alberta Court of Appeal and was a Crown prosecutor in Alberta, and then I immigrated to Australia and entered academia.

I have a Ph.D., and I have been researching end-of-life law, policy and practice for the last 14 years, with a focus on assisted dying. Over the past five years, I led a Canadian case study on MAID as part of a major Australian Research Council project on the optimal regulation of assisted dying. The study included law and policy analysis and qualitative interviews with persons engaged in MAID delivery and regulation. I have published extensively in this area, and I appear today in my personal capacity as a researcher.

I want to offer the committee three interconnected messages that have come out of my research.

First, the regulation of MAID is much broader than law alone, and that matters enormously for assessing readiness. A recurring error in public debate is to treat the Criminal Code as the only regulatory tool for MAID. Regulation is about shaping and steering behaviour and encompasses far more than just legal rules. Guidelines, training, institutional practices and communities of practice are all part of regulation. Optimal regulation includes both detecting transgressions and promoting best practices and continuous quality improvement. One cannot and should not put everything in the law. Readiness for MAID for mental illness as a sole underlying condition should therefore be examined holistically by looking at the whole regulatory ecosystem.

Second, oversight and monitoring of MAID in Canada are robust, and the system already has considerable strengths. I've published several articles on oversight and monitoring, and here it is worth being precise about terms, because conflation of monitoring and oversight is common. Monitoring is about aggregate data: tracking who's accessing MAID and under what conditions. Oversight is about review of individual cases for compliance with law and applicable standards. Both are important.

Regarding monitoring, Canada's federal system is rigorous. Preliminary assessors, MAID assessors and providers, and pharmacists all report to Health Canada. MAID is one of the most comprehensively reported medical practices in the country. All requests are reported and multiple practitioners report on every single case, and Health Canada's annual reports on MAID are among the most detailed in the world.

Regarding oversight, over 90% of MAID cases have some form of retrospective oversight, and this is because the most populous provinces have bodies that do this. Quebec's commission on end-of-life care reviews every MAID case and publishes reports. Ontario's chief coroner has a MAID review team, the MRT, which is different from the MAID death review committee, which has a different role. The MRT is a team of nurse coroners that reviews every case and produces annual reports. British Columbia and Alberta also review every case. These are meaningful mechanisms of accountability and scrutiny.

Third, the coal face regulation is a critical and underappreciated component of MAID regulation. Some of the most powerful regulation in medicine occurs at the clinical coal face—in other words, the front line of health care delivery. Coal face regulation extends formal regulation into day-to-day practice and includes clinical practice recommendations, peer consultation and best practices established by MAID teams in institutions and health authorities. For example, Nova Scotia has a single province-wide team that is aware of every MAID case and provides prospective support and retrospective quality review.

In summary, Canada's MAID system has real regulatory strengths, strong oversight, comprehensive monitoring and a layered ecosystem. The challenges for mental illness as a sole underlying condition are genuine, and they call for targeted regulatory responses. While the Criminal Code sets the framework, it is mechanisms like clinical guidance and coal face regulation that are best placed to deliver them.

I welcome the committee's questions.

[The Joint Vice-Chair, Hon. Pierre Dalphond]

Thank you very much, Dr. Close.

Dr. Crawford, you have four and half minutes for your remarks.

[Allison Crawford, Chief Medical Officer, 9-8-8: Suicide Crisis Helpline]

Good evening, committee members. My name is Dr. Allison Crawford. I'm a psychiatrist and the chief medical officer for 9-8-8: Suicide Crisis Helpline. I'm a professor at the University of Toronto and also the principal applicant on a CIHR-funded study examining MAID and suicide in the crisis line context.

I'll be direct. I do not believe Canada should expand MAID to include those whose underlying condition is a mental disorder. I'm basing that on four core points: what we're seeing at 988, the absence of evidence that requests for MAID for mental disorder can be reliably distinguished from suicidal intent, shortcomings of recent clinical guidance, and public health and media risks.

First, on frontline signals from 988, up to 7% of interactions on the service refer to MAID. Critically, among those who reference MAID, 74% endorsed thoughts of suicide in the past two days, compared with 48% among other contacts. In short, interactions with our national suicide crisis line that reference MAID are associated with substantially higher suicidal ideation. That's not a theoretical concern; it's a real, measurable, elevated risk among people who mentioned MAID to Canada's suicide prevention service.

Second, we know that suicidal thoughts and behaviours are very common across psychiatric diagnoses, and they are treatable. Our systematic review of peer-reviewed literature found no credible evidence that suicidal intent can be reliably distinguished from an interest in MAID when the sole underlying condition is a mental disorder. Both suicide and MAID represent an intention to die. Both often stem from the same underlying drivers: psychiatric disorder, intolerable suffering, hopelessness, perceived burdensomeness, and often social adversity. We also found no validated tools or assessment instruments that can reliably discriminate suicidality from a reasoned wish to die in the MAID context.

Third, recent guidance from the Canadian Psychiatric Association does not resolve these clinical or operational gaps. The guidance is largely aspirational. It asks assessors to differentiate acute suicidal risk from a well-considered wish to die, but offers no operational framework, no clear criteria and no specification of structured tools. The guidance also fails to incorporate a standardized equity assessment to determine when social determinants and remediable needs are driving suffering. In practice, this leaves clinicians without the evidence-based procedures needed to safely assess risk or to embed suicide prevention into MAID pathways.

Fourth, there are public health risks in the way that MAID and suicide are discussed publicly and in the media. Our recent research, currently submitted for peer review, highlights that the media often conflates MAID with suicide, or fails to use established, responsible media guidance for reporting on suicide. We lack guidance on safe communication about MAID and on preventing contagion effects, which should be a concern in making MAID for mental disorder an option. As it becomes more visible, the absence of responsible public messaging increases the risk that people will see MAID as a means of alleviating their mental suffering. This will undermine suicide prevention efforts.

Additionally, we must also [Technical difficulty—Editor] all the services across Canada remain under-resourced, with long waits and inequitable access. These circumstances can produce or exacerbate the suffering that may drive MAID requests and suicidal thoughts and behaviours.

My recommendation is straightforward. Do not expand MAID to cases where the sole underlying condition is a mental disorder. This recommendation aligns with the position of the International Association for Suicide Prevention that the overlap between MAID requests and suicide makes distinguishing between them impossible. MAID for mental illness will undermine suicide prevention by positioning MAID as a viable alternative to treatment.

Suicide is preventable. The vast majority of people who contemplate or attempt suicide do not go on to die by suicide. Public health approaches to suicide prevention have been a priority in Canada, which is one of the reasons that the establishment of 988 received unanimous support in the House of Commons. Given the significant overlap between suicidal thoughts and behaviours in MAID, we will best serve those who are suffering by enhancing suicide prevention efforts and by shifting our focus to medical assistance in living. That is what Canadians deserve.

Thank you.