Medical Assistance in Dying Committee on April 27th, 2026

[The Joint Vice-Chair, Hon. Pierre Dalphond (Quebec (De Lorimier), ISG)]

Good evening.

My name is Pierre Dalphond, and I'm a senator from Quebec. Our esteemed colleague Senator Martin cannot be with us this evening and has asked me to act in her stead in my capacity as joint vice-chair of this committee.

Pursuant to the order of reference adopted by the Senate on February 26, 2026, and the order of reference adopted by the House of Commons on February 13, 2026, the special joint committee is meeting to examine the eligibility of persons whose sole underlying condition is a mental illness to receive medical assistance in dying, or MAID.

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.

On that note, before we get started, I would like to confirm that the sound tests were completed successfully. I would ask all in-person participants to consult the guidelines on the cards on the table. These measures are in place to help prevent audio and feedback incidents that could harm the interpreters.

I would 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 mike, and please mute yourself when you are 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.

A reminder that all comments should be addressed through the chair.

For members in the room, if you wish to speak, please raise your hand. For members on Zoom, please use the raise hand function.

Honourable senators and members, this is meeting number five of the special joint committee, which is charged with carrying out a comprehensive review relating to the eligibility of persons whose sole underlying medical condition is a mental illness to receive MAID.

Before we get started, I want to let you know that it was agreed that our time with each panel would be 15% shorter to account for voting. When the bells ring for a vote in the House of Commons, we will suspend the meeting for 15 to 20 minutes, so members have time to get to the right floor and back.

I would now like to welcome our first panel.

As individuals, we have Dr. Margaret McKinnon, professor, department of psychiatry and behavioural neurosciences, McMaster University, and Dr. Lilian Thorpe, full professor, department of community health and epidemiology and department of psychiatry, University of Saskatchewan. Representing the Canadian Association of MAID Assessors and Providers, we have Dr. Stefanie Green, by video conference, and Dr. Gordon Gubitz, who is with us in the room.

For our witnesses appearing by video conference, should any technical challenge arise, particularly in relation to interpretation, please signal it, and we will work to resolve the issue. Please note that we may need to suspend during these times, as we need to ensure that all members are able to fully participate.

Dr. McKinnon and Dr. Thorpe, I will invite each of you to deliver a brief opening statement of five minutes, followed by a joint statement from Dr. Green and Dr. Gubitz. Following your remarks, our members will ask questions.

Dr. McKinnon, the floor is yours.

[Margaret McKinnon, Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, As an Individual]

Thank you.

Good evening. My name is Dr. Margaret McKinnon. I'm a licensed clinical psychologist who serves as a full professor and associate chair of research in the department of psychiatry and behavioural neurosciences at McMaster University. I have secured funding for my work in the field of post-traumatic stress from the Public Health Agency of Canada, National Defence, Veterans Affairs Canada and the Canadian Institutes of Health Research. I'm invited nationally and internationally to serve as an expert surrounding post-traumatic stress injuries.

However, I am not only an expert in the field of mental health and well-being. I am also a person with lived experience and a long-term history of depression, post-traumatic stress disorder and suicidality. As such, I am here this evening as a person with lived experience, and would ask the committee to be respectful of that status in their questioning. This is very difficult testimony to give.

Finally, I am testifying tonight as an individual. I do not represent any organizations in the remarks I will provide.

I would like to emphasize here that while individual experiences are not generalizable, they are in fact illustrative and point to the potential consequences of a decision to adopt MAID for mental health. I have tremendous sympathy for individuals wishing to access MAID and great empathy for those who are suffering. I'm here tonight, however, to represent Canadians who may feel much less safe and who feel at risk with the possibility of this legislation being enacted. This is a perspective that is rarely considered.

My own history with depressive symptoms and a subsequent diagnosis of major depressive disorder now spans nearly 40 years, since I was 12 years of age. I have received continuous treatment for depression since I was 24 years of age, including gold standard therapeutic approaches. In 2001, during my honeymoon, I was aboard an Air Transat plane that ran out of fuel midway over the Atlantic, during which we were prepared for the ditching of the aircraft into the ocean over a 25-minute period. Having survived this incident, I also developed PTSD.

I am very fortunate to be part of the system, and over the years have received access to both standard and leading-edge mental health treatments. Despite this access and the ongoing support of family and very close friends, I suffered a years-long period where I wished to die, had a fully fledged suicide plan and access to means, and lived with a hopelessness that meant I saw my life as not worth living. Critically, I would have been an ideal candidate for MAID for mental health at the time, with a long-term history of mental health difficulties that I saw as both irremediable and associated with grievous suffering, despite continuous treatment.

In fact, if the proposed legislation allowing MAID for mental health conditions had existed at the time, I believe I would not be here to testify tonight. Instead, I believe I would have availed myself of this option at a time when I was also a much-loved family member and friend and functioning at the level of an accomplished faculty member and clinician at a major Canadian university and hospital. I would have chosen this option to die and would not be here. Instead, I am now in a period of primarily sustained recovery, despite my previous persistent wish to die.

In the intervening years, I have experienced periods of both relapse and recovery, with treatment ongoing. A year ago, I found many of these thoughts of suicide and the desire to die returning. Despite being a mental health professional, it was shocking to me how quickly these thoughts returned, how strongly I believed I wanted to access MAID and how irrevocable these feelings felt. While I recognize that I may have needed to wait for MAID access under these conditions, the future I envisioned for myself at that time was one that clearly included MAID.

In sharing this experience, I hope I'm illustrating to the committee the lack of safety that some Canadians feel in light of this legislation. To me, this feels like an option that, should I become ill for a long enough period of time or my life circumstances change substantially enough, I believe I may attempt to access, despite clearly recognizing when well that there is hope for recovery, as I'm experiencing now.

I am very fortunate to be a person with good access to mental health care, financial means and extensive social support, yet I feel at great risk in this situation. Moreover, as has been illustrated repeatedly in this committee’s deliberations, it is a fallacy to believe that all Canadians have equal access to treatment for mental health conditions. In the case of PTSD and depression, national and international guidelines recommend what are essentially first-, second- and third-line treatments. As incidents like Tumbler Ridge and its aftermath illustrate, access to first-line mental health care for rural community members, for example, is less available than in other regions of the country, let alone for second- and third-line treatments.

I therefore appeal to the committee on two fronts. The first is to consider Canadians who, like me, will feel at risk and unsafe should this legislation be enacted. The second is to acknowledge that not all Canadians will have equal access to all recommended gold standard treatments prior to undergoing MAID in a country marked by economic, geographic and cultural inequities that continue to persist despite marked efforts to address such wrongs.

Thank you.

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

Thank you.

Now we have Dr. Thorpe.

[Lilian Thorpe, Full Professor, Department of Community Health and Epidemiology and Department of Psychiatry, University of Saskatchewan, As an Individual]

Thank you so much for that wonderful presentation. This is what I've heard from others as well. Thank you for your courage to speak.

Thank you for inviting me to the committee.

I am happy to give feedback on the eligibility for medical assistance in dying of people whose sole condition is mental illness or disorder. I work as a geriatric psychiatrist whose interest has focused on aging among people with intellectual disabilities, as well as other disability and aging communities. I do a lot of complex capacity assessments for a health authority. I was asked to become involved in the planning process back in 2015, prior to legalization, and I've remained provincially involved now that it has become a provincial program in Saskatchewan.

I have worked with learners at many levels, and I've had involvement in a variety of research processes. We've done projects looking at the large number of medications provided to elderly patients in the last six months of their lives, with results consistent with other data showing that we often provide treatments that are not beneficial at end of life and make end of life more difficult. I've had learners explore my data on unmet needs among people applying for medical assistance in dying, as we very much want to avoid having people end their lives because they have not had appropriate access to resources.

As an approach, we have also looked at the backgrounds of people who have applied for medical assistance in dying. We found that these were largely people with high-income, high-education backgrounds. One of our other projects, from a number of years ago, was with people who had spinal cord injuries. It was about how they felt we should deal with MAID when people with new injuries approach us for it. We got lots of feedback letting us know they feel we needed to be very cautious and involve people who have personal experience and who can give feedback before it proceeds.

I'm talking about my clinical experiences. I'm not an expert on the legal interpretations others have presented on.

This has been very clinically and ethically challenging for all of us involved directly or indirectly. We initially assessed people with severe and untreatable cancers who already had involvement with a cancer clinic and palliative care. They were people with high education and high socio-economic status to whom MAID was available. There was a lot of stigma talking about this, which meant that people were often not accessing full resources because they didn't tell people they were planning to die.

Since 2021, we've largely had people with terminal illnesses and chronic conditions starting out on track 2. These cases have been much more challenging. They have chronic mental disorders, social isolation and demoralization, and they often lack a full understanding of their resources.

I'll give you an example. I saw a homeless patient in a shelter whom I had previously met in hospital. He ended up with no medical care. He did not have his insulin. He did not have his medications for severe neuropathic pain. He didn't even know there was a nurse practitioner who could get involved in this and get his medications. Of course, we did not approve him, but we did get him connected with the appropriate resources. It's sad that it sometimes takes a MAID request to be hooked up with resources.

My primary goal with track 2 patients—these are the ones who are most similar to the patients we're talking about now—has always been to improve quality of life so they don't need to die. This is very intensive. It's somewhat better now that our provincial program has hired social workers to help connect people with resources. Before that, we were doing this, and it was many hours of work. This is a very important thing—how to set up supports for those of us doing these assessments. I don't think the rest of the country has this.

In talking about MAID for mental disorders, there are even more challenges than just track 2. People are often convinced that nothing will ever get them better. Paradoxically, some of our patients tell us that knowing they could have access to a peaceful death, as long as they become engaged with appropriate treatments, might get them to engage with those treatments long enough to stabilize them. We're seeing this with track 2. They really want to die, but they are told they can only get this once they have had some appropriate engagement.

With mental disorders, we really have a hard time knowing how it will go. It often takes years to fully stabilize, and we can't really predict it. It is particularly difficult for young people who have many years left to live. They may be more impulsive and might live long enough to see improvements in many of the interventions. I was talking to a woman in her late thirties who told me, very similarly, that if MAID had been available in her twenties, she’d have long been dead.

I know I'm close to my end—

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

Thank you very much. You have to wrap up. I'm sorry.

[Lilian Thorpe]

The last thing I'll mention is that there are other people who have tried everything for many years and are older people. I would still hope that we have some way of allowing them to have a peaceful death, but this will be the minority.

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

I'm sorry, but I have to cut you off, because the time is important for everybody.

Will it be Dr. Gubitz who will speak?

[Gordon Gubitz, MAID Provider, Canadian Association of MAID Assessors and Providers]

It's going to be Dr. Green.

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

Dr. Green, we're listening to you. You have the floor.

[Stefanie Green, MAID Provider, Canadian Association of MAID Assessors and Providers]

I appreciate both of the previous speakers. Thank you.

My name is Dr. Stefanie Green. I'm a family physician with over 30 years of clinical experience, and I've been a MAID practitioner in British Columbia since June 2016. I'm here today with Dr. Gordon Gubitz, a neurologist based in Nova Scotia, who has also been a MAID practitioner since law allowed. We have both been deeply involved in MAID training, oversight, teaching, research, and curriculum and guideline development at the local, national and international levels.

We're here today as representatives of the Canadian Association of MAID Assessors and Providers, a national professional organization that I co-founded and have helped lead for nearly a decade. CAMAP is the community of diverse professionals involved in administering and delivering assisted dying across Canada. It supports MAID professionals in their work, educates the health care community about MAID and provides leadership on determining standards and guidelines of practice within the laws of the country, all of which supports our patients, their families and hopefully one another.

I'd like to emphasize that CAMAP does not advocate for change in law. We have no role in determining what the laws of this country do or do not permit. Rather, we recognize that this is the role of Parliament. We empathize with the challenging task facing this committee, and we are pleased to be able to offer insights from our 10 years of experience.

One of CAMAP's contributions to MAID practice is the Canadian MAID curriculum. This project began when CAMAP was approached by parliamentarians to lead this initiative, and it was funded through a grant obtained from Health Canada. A peer-reviewed publication describing the extensive development framework and the robust editorial review process that was undertaken has been submitted to you for your information.

The result is a rigorously developed, comprehensive, bilingual national program, fully accredited by the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada and the Canadian Nurses Association. The accreditation process of these organizations is the mechanism through which continuing professional education is determined to have appropriate quality for doctors and nurses.

The curriculum requires a significant health care background in order to understand the content. Furthermore, early modules are a foundation for later, more specialized content. This explains why, despite being asked to supply this committee with a copy of the module on MAID and mental disorders, we sent you a package outlining the entire curriculum so that you can view it in its context.

This committee's mandate is to undertake a comprehensive review relating to the eligibility of persons whose sole underlying medical condition is a mental illness to receive MAID. Part of that assessment has been to try to determine clinician and system readiness. We can attest to clinical readiness. Medical and nursing practitioners in this country are well trained and competent in assessing a patient's decision-making capacity, the voluntariness of their requests, and suicidality. These skills are, in fact, utilized every day and with every patient encounter. Professionals who have taken the Canadian MAID curriculum have further expanded and deepened their knowledge and skill set.

For the past 10 years, MAID practitioners have assessed patients with comorbid mental illness. We already have a decade of experience assessing if the mental state of an individual interferes with their decision-making capacity, if the request is truly voluntary or if they're suicidal.

When a 63-year-old woman with pancreatic cancer came to see me a few years ago for an assessment of eligibility for MAID, we also needed to discuss her lifelong bipolar disorder, the hospitalizations it required, the successful and failed treatments through the years and her history of suicidal ideation. The law required that I form a medical opinion as to whether her request for MAID was being influenced by her mental disorder, whether it was voluntary and whether or not she was suicidal. I used my training as a family physician and the extra training from CAMAP and was grateful for the input of her treating psychiatrist.

This work is doable. Also, yes, some patients may be even more complex, but as my daughter recently reminded me, some things are hard, but you can still do them.

Further readiness is evidenced by CAMAP's release of national guidance documents on assessing capacity, assessing incurability, and the approach to people with complex chronic conditions. The nationally developed model practice standard for MAID has contributed to the understanding of regulatory standards, and the Canadian Psychiatric Association has just released further guidance on evaluating eligibility criteria in persons with mental disorders and on the management of suicide risk. All of this is to say that the clinicians who are willing and interested in doing this work are ready.

Dr. Gubitz is in the room with you and will be happy to take the majority of your questions.

Thank you for your attention.

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

Thank you very much. You're right on time.

We will start with questions from members of the committee. We'll start with the MPs. Each MP will have four minutes and 15 seconds.

We'll start with Mr. Cooper.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

Thank you, Mr. Chair.

I'll direct my questions to the CAMAP witnesses.

Section 4 of module 7, on MAID and mental illness, is about specific mental disorders in MAID assessments and features the most common disorders associated with MAID requests. Common disorders featured in this section include major depression, personality disorders, trauma-related disorders such as PTSD, substance use disorder and autism spectrum disorder.

To be clear, anyone with these disorders and others, including autism spectrum disorder, substance use disorder and PTSD, could qualify for MAID in the context of having a sole underlying mental health disorder. Is that correct?

[Gordon Gubitz]

Yes, that is correct.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

Just to be clear, it could be anything in the DSM-5.

[Gordon Gubitz]

It could be, as long as it meets all of the criteria related to a grievous and irremediable medical condition.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

That would include things like anxiety, schizophrenia, etc. Is that correct?

[Gordon Gubitz]

It's entirely possible.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

CAMAP is involved in developing standards and guidelines in MAID practice, and in developing curriculum and educating MAID practitioners. Is that fair?

[Gordon Gubitz]

We prepare guidance documents.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

I take it as a given that you would agree that training and standard-setting require an objective, non-ideological, evidence-based approach.

[Gordon Gubitz]

That's correct.

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

Several recent past CAMAP board of directors members and a member of the curriculum review committee sit on Dying with Dignity Canada's clinicians advisory council. Do I have that right?

[Gordon Gubitz]

I would need to know the details. I'm not familiar with specific members—

[Michael Cooper, Conservative, St. Albert—Sturgeon River, AB]

I have a tough time believing—

[Stefanie Green]

I'm happy to speak to that.