Final Report of the Expert Panel on MAID and Mental Illness

The Expert Panel on Medical Assistance in Dying and Mental Illness Final Report was tabled in Parliament on May 13, 2022. As required by former Bill C-7, the most recent legislation on Medical Assistance in Dying (MAID), the Ministers of Health and Justice established the Expert Panel to undertake an independent review of the recommended protocols, guidance and safeguards that apply to requests made for MAID by people who have a mental illness.

The Final Report of the Expert Panel on MAID and Mental Illness was tabled in Parliament on May 13, 2022.

As required by former Bill C-7, the most recent legislation on Medical Assistance in Dying (MAID), the Ministers of Health and Justice established the Expert Panel to undertake an independent review of the recommended protocols, guidance and safeguards that apply to requests made for MAID by people who have a mental illness.

The Expert Panel dedicated the past nine months to carefully considering Canada's existing legal framework, safeguards in other jurisdictions and those proposed by Canadian organizations on this topic, international experience, and current evidence from the academic literature and professional practice community.

The members of the Expert Panel were chosen for their expertise in their respective fields and come from a broad range of disciplines, spanning clinical psychiatry, MAID assessment and provision, law, health professional training and regulation, mental health care services, as well as lived experience with mental illness.

The members are:

• Mona Gupta (Chair)
• Rose Carter (Vice-chair)
• Jennifer A. Chandler
• Justine Dembo
• Sara Goulet
• Karen Hetherington
• Trevor Morey
• Leora Simon
• Donna Stewart
• Cornelia (Nel) Wieman

More information on the Expert Panel, including member biographies, is available in the Expert Panel's report.

Although the Expert Panel's mandate refers to "mental illness", in order to support greater clarity for practitioners, the Expert Panel chose to use the term "mental disorder" throughout its report. This is because "mental disorder" is the term used by major diagnostic classification systems in Canadian psychiatric practice.

The Expert Panel has made 19 recommendations for establishing a MAID regime that addresses situations regarding incurability, irreversibility, individual capacity, suicidality and the effect of structural vulnerabilities (structural vulnerabilities being the effects of interactions between a person's sex, gender, socioeconomic status, race/ethnicity, sexuality, or institutional location, with one's position in society). The recommendations address these concerns in a manner that respects individual autonomy and Charter-protected rights, while at the same time supporting safety and equity.

The Expert Panel also concluded that many of these concerns are neither unique to requests for MAID from persons with a mental disorder, nor applicable to every requestor who has a mental disorder. In the view of the Expert Panel, their recommendations should apply to any case where similar concerns may arise, regardless of the requester's diagnosis. However, in keeping with their mandate, the Expert Panel did pay particular attention to the concerns in the context of mental disorders.

The 19 recommendations are explained in the executive summary of the report and focus on:

• developing MAID practice standards,
• interpreting the grievous and irremediable medical condition eligibility criterion,
• addressing potential vulnerabilities including an individual's capacity, structural vulnerability, whether the decision has been made voluntarily, and suicidality,
• supporting a robust assessment process, and
• implementing measures to improve the functioning of MAID.

While some of the Expert Panel's recommendations are directed at federal, provincial and territorial governments, the Panel suggests that the current framework and safeguards for MAID in Canada's Criminal Code are sufficient and that its recommendations can be fulfilled without further legislative amendments.

The Government of Canada is reviewing the recommendations of the Expert Panel as it shapes future direction in this area. The report will be referred to Parliament's Special Joint Committee on MAID. The work of the Expert Panel will assist the Committee as it continues its hearings and deliberations in the lead up to its own interim report and recommendations on MAID and mental illness later in June 2022.