Thank you, Chair and members of the committee, for the invitation to appear today.
My name is Dr. Jitender Sareen. I am speaking as department head of psychiatry at the University of Manitoba and as a provincial specialty lead for mental health and addictions at Shared Health. I have practised adult psychiatry for more than 25 years. My perspective today reflects my clinical, research and system experience, rather than a philosophical or conscientious objection to MAID itself.
MAID for mental disorders has been a difficult issue in Canada, and there are thoughtful perspectives on both sides. I respect concerns about autonomy and suffering associated with mental disorders. However, after a careful, unbiased review of the international literature, I believe Canada should not expand MAID to include mental disorders as a sole underlying condition.
First, prognosis in mental disorders is often uncertain. Individuals can remain severely ill for long periods and still improve, particularly with changes in treatment and psychosocial situation. There is no international standard that defines irremediability in mental disorders. When you're regulating something, unless you have an international standard to hold somebody accountable, you cannot regulate it.
Second, there is also no clear and reliable way to distinguish a request for MAID from suicidality when mental disorder is the sole underlying condition. Unlike physical conditions, suicidal ideation is part of the diagnostic criteria for many mental disorders, including depression, post-traumatic stress disorder and borderline personality disorder. This goes to the core psychiatric practice, which is grounded in assessing and treating hopelessness and preventing suicide.
I know you have been reassured by some other witnesses that psychiatrists are trained to make distinctions between MAID and suicide, but psychiatrists and psychiatry residents nationwide are not being taught how to distinguish MAID from suicidality, because there's simply no way to do it. Most academic chairs of psychiatry departments across Canada have similarly recommended against the expansion of MAID because of these concerns.
Third, most international professional associations and people with lived experience groups have clearly recommended against providing MAID for mental disorders. In 2025, the American Psychiatric Association's position paper explicitly opposed this, citing the difficulty in defining irremediability, the unpredictability of prognosis and the concern that mental disorders themselves may influence decision-making. The International Association for Suicide Prevention has also expressed opposition to MAID.
In Canada, both the Canadian Association for Suicide Prevention and the Canadian Mental Health Association have raised concerns about expansion, alongside organizations representing people with lived experience and disability advocates, such as Inclusion Canada and Indigenous Disability Canada.
In 2023, Quebec passed Bill 11, which established that a mental disorder other than a neurocognitive disorder cannot be an illness for which a person may request MAID. This year, Alberta has proposed Bill 18 to exclude MAID for mental illness and to restrict access to MAID to individuals with a foreseeable death in the next 12 months.
As for Manitoba, when this issue was brought to our provincial psychiatry leadership council in 2022, and again in 2026 in the context of operational planning, the council reached a clear consensus on both occasions that expansion to mental disorders should not proceed.
For these reasons, I respectfully urge this committee to recommend an indefinite pause on the expansion of MAID for mental disorders.
Thank you.