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Making a case for the inclusion of refractory and severe mental illness as a sole criterion for Canadians requesting medical assistance in dying (MAiD): a review
  1. Anees Bahji1,
  2. Nicholas Delva2
  1. 1 Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
  2. 2 Department of Psychiatry, Queen's University, Kingston, Ontario, Canada
  1. Correspondence to Dr Anees Bahji, Department of Psychiatry, University of Calgary, Calgary, AB T2N 1N4, Canada; anees.bahji1{at}


Background Following several landmark rulings and increasing public support for physician-assisted death, in 2016, Canada became one of a handful of countries legalising medical assistance in dying (MAiD) with Bill C-14. However, the revised Bill C-7 proposes the specific exclusion of MAiD where a mental disorder is the sole underlying medical condition (MAiD MD-SUMC).

Aim This review explores how some persons with serious and persistent mental illness (SPMI) could meet sensible and just criteria for MAiD under the Canadian legislative framework.

Methods We review the proposed Bill C-7 criteria (capacity, voluntariness, irremediability and suffering) as well as the nuances involved in separating a well-reasoned request for assisted suicide from what might be solely a manifestation of a SPMI.

Findings In this paper, we argue against the absolute exclusion of patients with SPMIs from accessing MAiD. Instead, we propose that in some circumstances, MAiD MD-SUMC may be justifiable while remaining the last resort. Conducting MAiD eligibility assessments removes the need to introduce diagnosis-specific language into MAiD legislation. Competent psychiatric patients who request MAiD should not be treated any differently from other eligible candidates. Many individuals with psychiatric disorders will be incapable of consenting to MAiD. The only ethical option is to assess eligibility for MAiD on an individual basis and include as legitimate candidates those who suffer solely from psychiatric illness who have the decisional capacity to consent to MAiD.

  • suicide/assisted suicide
  • mentally Ill and disabled persons

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  • Contributors Both authors contributed equally to all phases of this essay’s development, including conceptualization, structure, writing, revisions, and identifying citations.

  • Funding AB is supported by the 2020 Friends of Matt Newell Endowment in Substance Use Research from the Cumming School of Medicine at the University of Calgary.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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