Peter Oliver could have qualified for medical assistance in dying in Canada. The law that would have made him eligible never took effect, and Mr. Oliver is working to keep it that way.

“I struggle with mental health and have done so for the course of most of my life. In some respects, I would be a candidate for assisted suicide if that legislation had gone through,” Mr. Oliver said. “I found that to be disturbing.”

Mr. Oliver is the executive director of the Catholic Health Association of Saskatchewan, a Canadian ministry representing Catholic hospitals and long-term care facilities. 

For more than five years, Canada was on track to extend medical assistance in dying, known as MAID, to people whose sole condition is mental illness. On Oct. 7, the federal government said it would halt that expansion indefinitely.

“What I require as a person with a mental health condition is to be surrounded by people that are absolutely convinced that my condition is treatable, that wellness is a possibility for me,” Mr. Oliver said.

MAID has been legal in Canada since 2016. The expansion to cover people whose sole condition is mental illness was initially proposed by Prime Minister Justin Trudeau in 2021 and scheduled to take effect in March 2023. Concerns and blowback from medical experts and the public delayed the criteria expansion until March 2024 and then again until March 2027.

This fall, the government plans to introduce legislation that would exclude eligibility for MAID indefinitely for those who suffer solely from mental illness. That suspension will likely be challenged in court. 

Mr. Oliver sees the decision as a small victory, but it is one that has been overshadowed by the announcement that the federal government is introducing legislation to legalize “advance requests” for assistance in dying.

Advance requests allow people suffering from illnesses of progressive cognitive decline like Alzheimer’s disease to pre-apply for medical assistance in dying before they lose capacity to consent to the process. While such requests are already accepted in Quebec, doctors have expressed apprehension because of the absence of federal legal protection for advance directives. The federal government’s move to add advance directives to Canada’s approved MAID protocol allows each province to decide whether or not to permit them.

Advance requests have considerable public support in Canada.

“That is actually more concerning than the mental health issue,” Mr. Oliver said.

According to Mr. Oliver, advance requests are one of the many ways the contemporary health system in Canada has come to conflate palliative care—a medical approach designed to relieve physical and emotional pain for increased quality of life—with MAID, which emphasizes personal agency at death above all else. 

Palliative care and MAID are “philosophically radically distinct from each other,” he said. “Palliative care is an approach which basically helps you to live well [while dying], and you could even receive palliative care if you have some expectation of recovering from the condition that you are diagnosed with.”

Ten years of MAID in Canada

Canada’s MAID laws were first brought before the Canadian Parliament a year after the country’s Supreme Court ruled in 2015 that blanket prohibition of physician-assisted death violated the Canadian Charter of Rights and Freedoms.

The legislation initially only permitted people with terminal illness access to assisted death, but that expanded in 2019 after a judge in Quebec ruled it unconstitutional to prevent those with a “reasonably foreseeable death” from accessing assistance in dying.

Legislation later allowed adults who received confirmations of incurable and painful physical conditions from two doctors to petition for medical assistance in dying. Lawmakers have been debating further MAID expansion to include people with disabilities and mental illnesses ever since.

The option for medical assistance in dying has expanded considerably around the globe over the past decade as well. Today, medical assistance in dying is legal in nine countries in Europe and four Latin American countries, as well as New Zealand and Australia.

MAID is legal in Washington, D.C., and in 13 U.S. states.

Local laws differ on whether assisted suicide, in which a clinician provides patients with the means to end their lives, or euthanasia, in which the clinician directly administers life-ending medication, is allowed. Laws also differ on what constitutes a terminal illness that would allow medical assistance in dying.

In Canada, the Catholic Church has remained on the front lines of opposition to MAID. 

In February, the Canadian Conference of Catholic Bishops called for the permanent suspension of MAID for those suffering from mental illness alone. 

“Human life is a gift that must be protected and valued at every stage and in every circumstance,” the bishops wrote in a statement. “Empirical research, together with the expert judgment of many mental health professionals and suicide prevention organizations, affirms that it is not possible to determine whether a mental illness is irremediable.”

On the 10th anniversary of the legalization of MAID in Canada last June, the bishops renewed their condemnation of the practice and called on all “the Catholic faithful and people of goodwill” to oppose it, pray for the conversion of its supporters and support the “sick and vulnerable.”

Delivering a speech to Spanish legislators on June 8, Pope Leo XIV denounced civil support for euthanasia and MAID, both legal in Spain, and the “throwaway culture” they represent.

He asked Spanish legislators: “Can a community that casts into the shadows the unborn child, the elderly, the sick, those who suffer in silence, or those who depend entirely on the care of others be called fully just?”

Mr. Oliver said it is increasingly important that people have conversations about illness, chronic pain and end-of-life care with their families and loved ones before they reach circumstances in which they may be offered medical assistance in dying. He knows people seek MAID under conditions of intense suffering, but he believes that people struggling with mental or physical illnesses should always be able to rely on comfort, assistance and dignity.

Rather than creating new openings for medical assistance in dying, he believes Canadians should focus on expanding opportunities for palliative and home care while building a stronger safety net for people struggling with isolation and despair because of mental illness.

“We need to tie hope to creating the circumstances where hope can flourish,” Mr. Oliver said.

Will Martino is a Joseph A. O’Hare, S.J., fellow at America Media.