MAID for MD-SUMC Task Force

In March 2021, with Bill C-7 amendments to the Criminal Code, eligibility for Medical Assistance in Dying (MAID) was extended to those who deaths were not reasonably foreseeable, and several safeguards originally built into Bill C-14 were eliminated.  

Due to concern about expansion of MAID without sufficient safeguards, the OPA successfully advocated - alongside other organizations - to delay the initial expansion date of March 2023. The temporary exclusion of MAID eligibility due to Mental Disorder as Sole Underlying Medical Condition (MD-SUMC) was extended by 1 year, meaning that Federal legislation would permit MAID for mental disorders as a sole underlying medical condition by March 17, 2024. 

Health Canada published their Model Practice Standards for MAID with an accompanying "Advice to the Profession" document in March 2023, with the purposes of providing information to assist in understanding the eligibility criteria, procedural safeguards, and reporting requirements for MAID; setting expectations for healthcare professionals involved in MAID; and outlining specific legal requirements for MAID assessors and providers.

In December 2023, OPA Councillor Dr. Sephora Tang launched a Canada-wide survey to gather psychiatrists' and psychiatry residents' perspectives on the Health Canada Model Practice Standards and current Federal MAID legislation, as they would apply to MAID for MD-SUMC [STUDY TITLE: Survey of Psychiatrists and Psychiatry Residents' perspectives on Medical Assistance in Dying (MAID) where a Mental Disorder is the Sole Underlying Medical Condition under the current Canadian Federal Legislative Framework and the Health Canada Model Practice Standards for MAID]. The OPA disseminated the survey through various provincial psychiatric and medical associations and psychiatry residency training programs across Canada. 

Preliminary analysis of the OPA’s survey found that a majority (80%)  of psychiatrist/psychiatry residents disagree that the Canadian medical system is prepared to support safe expansion of MAID for MD-SUMC. On January 30, 2024, the OPA presented a Brief outlining these concerns to the Special Joint Committee on Medical Assistance in Dying, to better inform its processes and public policies on this issue.             

On January 29, 2024, the Special Joint Committee on Medical Assistance in Dying released its third report which concluded that the medical system in Canada is not prepared for medical assistance in dying where mental disorder is the sole underlying medical condition 

Dr Sephora Tang
MAID Task Force Lead 
Ontario Psychiatric Association

OPA IN THE NEWS

• 2024 CBC article "Misunderstanding of mental illness clouds MAID expansion, patient and psychiatrist say: Psychiatrists divided on extending MAID to those suffering solely from mental illnesses"
• 2022 Globe & Mail article with OPA call for delay of expansion of MAiD for mental illness
• 2022 CBC Ottawa Morning radio interview featuring Dr Angela Ho, OPA President, on concerns with expansion of MAID by March 2023
• 2024 OPA Brief to the Joint Committee on MAID; Press Release

Background information:

• Background Document: The Work of the MAID Practice Standards Task Group
• Section 241 of the Criminal Code of Canada
• N.B.:  In Quebec, only “clinician-administered medical assistance in dying” is permitted where a medical practitioner administers a lethal dose of medications to an eligible person to induce death.  “Self-administered medical assistance in dying” where a medical practitioner provides or prescribes a lethal drug that the eligible person takes themselves is not legal in Quebec.
• January 2024, Third Report of the the Special Joint Committee on Medical Assistance in Dying:        

"WHEREAS the Committee concludes that the medical system in Canada is not prepared for medical assistance in dying where mental disorder is the sole underlying medical condition (hereinafter “MAID MD-SUMC”), the committee recommends:

That MAID MD-SUMC should not be made available in Canada until the Minister of Health and the Minister of Justice are satisfied, based on recommendations from their respective departments and in consultation with their provincial and territorial counterparts and with Indigenous Peoples, that it can be safely and adequately provided; and
                         
That one year prior to the date on which it is anticipated that the law will permit MAID MD-SUMC, pursuant to subparagraph (a), the House of Commons and the Senate re-establish the Special Joint Committee on Medical Assistance In Dying in order to verify the degree of preparedness attained for a safe and adequate application of MAID MD-SUMC “

Updated Jan 30 2024