OTTAWA — The Carney government introduced legislation Tuesday to permanently exclude mental illness as the sole basis for medical assistance in dying (MAID), while allowing provinces to authorize advance requests for patients who may eventually lose the ability to consent.Justice Minister Sean Fraser and Health Minister Marjorie Michel outlined the proposed Medical Assistance in Dying Safeguards Act at the National Press Theatre in Ottawa, where Fraser acknowledged that Canadians could face different rules depending on where they live.Alberta has already indicated it will not permit advance requests, raising questions about whether the legislation would create uneven access across the country.“We've not decided to force provinces into this conversation, but we'll leave it to them to determine the extent to which they wish to embrace the next frontier on medical assistance in dying,” Fraser told reporters.Under the bill, provinces would need to establish their own legislative frameworks before advance requests could be carried out. Those frameworks would include safeguards governing medical assessments, consent and the storage of advance directives.Fraser said the federal government was exercising its authority over criminal law while leaving the delivery of health services to provincial governments..The legislation would require two independent medical assessors to determine whether a patient meets the conditions outlined in an advance request, including whether the person is experiencing intolerable suffering.Fraser rejected suggestions that a patient who had previously requested MAID could receive the procedure simply because their condition had deteriorated.“A person in those circumstances under this legislation would not have access to medical assistance in dying,” he said, referring to patients who remain content with their lives despite meeting conditions outlined in an advance directive.The bill would also establish procedures for revoking consent and require a 30-day pause where assessors encounter uncertainty about whether consent remains valid.Asked about the prospect of different rules across provinces, Fraser said he was more concerned about expanding access without adequate protections.“I would far prefer that scenario to a scenario where you universally expand access without first having those safeguards in place, given the nature of the consequences being quite literally life and death,” he said.Quebec has permitted advance requests under provincial legislation since October 2024. Fraser said he expects Quebec's existing framework would comply with the federal proposal if Parliament adopts the bill in its current form..He could not identify another province that had committed to introducing similar legislation.The government's other major proposal would make the existing exclusion for mental illness as the sole underlying medical condition indefinite.That exclusion is currently scheduled to expire on March 17, 2027, after successive delays to the planned expansion of MAID eligibility.Fraser said the government had concluded that medical experts still lacked consensus on whether some mental illnesses could be considered irremediable.He also cited concerns about access to community mental health services.“The reasons that the committee pointed to, which we accept include the lack of consensus around the irremediable nature of mental illnesses that would justify medical assistance in dying,” Fraser said.The minister said the bill would also address circumstances in which physical symptoms arise solely from an underlying mental illness, while preserving eligibility for people who independently qualify because of a physical condition..Michel said the government had considered consultations with medical professionals, stakeholders and Canadians before deciding to maintain the mental illness exclusion.“In the absence of a clear consensus after years of study, we feel that maintaining this exclusion is the most responsible decision,” she said.During the press conference, a Canadian Affairs reporter challenged the government over concerns raised by the United Nations about advance requests and the rights of people with disabilities.Fraser defended the proposal, pointing to earlier parliamentary studies and Health Canada's consultations in 2025. He said parliamentary committees would have another opportunity to examine the legislation.The justice minister also urged MPs to move quickly, warning that the existing mental illness exclusion will expire unless Parliament acts before March 17.“The consequences of not meeting this timeline are extraordinarily serious,” Fraser said.He said he wants the House of Commons to finish its consideration of the legislation during the current sitting, leaving time for the Senate to review it before the deadline.“We need this to be in place before March 17,” he said.The bill must pass both chambers of Parliament and receive royal assent before its proposed changes can take effect.
