SACPA learns about psychiatric MAID debate

By Lethbridge Herald on February 20, 2026.

Herald Photo by Joe Manio Dr. Nicholas Dunn spoke to a full SACPA audience Thursday on the challenges of extending MAID to mental illness, posing questions of ethics, assessment, and social support that stirred a lively discussion.

By Joe Manio

Lethbridge Herald

At noon Thursday, another large and highly engaged crowd gathered for the weekly Southern Alberta Council on Public Affairs (SACPA) meeting to confront a question that has divided courts, legislatures, and kitchen tables: should Medical Assistance in Dying (MAID) be available to people whose only underlying condition is mental illness? 

Canada’s expansion of MAID to such cases is scheduled for March 2027, after being postponed twice.

Dr. Nicholas Dunn, assistant professor of philosophy at the University of Lethbridge (U of L), outlined the legal and ethical stakes. Since MAID was legalized in 2016 and expanded in 2021 to include “Track 2” cases—where death is not reasonably foreseeable—more than 76,000 Canadians have accessed the procedure. In 2024 alone, 16,499 deaths were attributed to MAID, roughly five per cent of all deaths nationally. Mental illness remains temporarily excluded.

“What Canada is not ready for,” Dunn said, “comes down to two central concerns: assessment and support.”

Clinically, the law requires a “grievous and irremediable” condition—a serious, incurable illness that causes ongoing, unbearable suffering. “The key difference,” Dunn said, “is whether we can know that someone’s condition is truly incurable.” 

He explained that in psychiatry, determining this is far harder: symptoms fluctuate, new treatments emerge, and long-term outcomes are unpredictable. Many psychiatrists argue it is extremely difficult—perhaps impossible—to know with certainty that a mental disorder will never improve. Critics contend that without objective criteria, assessments risk subjectivity and inconsistency.

Closely related is the challenge of distinguishing a MAID request from suicidality. “Even if the two are conceptually distinct,” Dunn asked, “how can clinicians reliably tell the difference in practice?” Some also worry that psychiatric MAID could conflict with suicide prevention efforts.

The second readiness issue is systemic. Canada’s mental health system remains underfunded and unevenly accessible. Long waits, financial barriers, stigma, housing insecurity, and social isolation all shape psychiatric suffering. 

“It’s not really autonomy,” Dunn said, “if someone is choosing MAID because they don’t have any other options.” 

Autonomy—central to medical ethics—depends on genuine choice. If adequate care or social supports are lacking, a request for MAID may reflect social failure as much as individual will. Dunn invoked the social model of disability, which locates much suffering in social structures. 

“Framing psychiatric MAID purely as a matter of legal access risks overlooking structural injustices that produce or intensify distress,” he said.

That framing cuts both ways. Proponents argue exclusion is discriminatory, especially when some people with mental illness already access MAID because they also have a qualifying physical condition. Opponents maintain that mental disorders may warrant different treatment under the law.

The Netherlands and Belgium currently permit psychiatric MAID, requiring that all reasonable treatment options be exhausted. Canada’s potential safeguards remain uncertain: would it fall under Track 2, involve additional waiting periods, or mandate specialized psychiatric assessments? Parliament could still delay or block the expansion. A private member’s bill proposing to exclude mental disorders has cross-party support, though its fate is uncertain.

Audience members raised additional concerns. Several highlighted the difficulty of determining whether a condition is truly incurable, the lack of objective tests for mental illness, and the challenge of distinguishing MAID requests from suicidality. 

Decision-making capacity, particularly in cases of psychosis or dementia, was another concern. Participants emphasized the importance of including people with lived experience in policy discussions. They also stressed that MAID access cannot be separated from social supports, as structural failures in mental healthcare may influence requests.

International comparisons were discussed. In the Netherlands and Belgium, psychiatric MAID requires that all reasonable treatments be attempted first, prompting questions about how many interventions should be mandated. 

Attendees also voiced concern that governments might deprioritize mental health services once MAID becomes available.

Overall, the session underscored the tension between autonomy, ethical obligations of healthcare providers, and societal responsibility. Audience members left with a deeper appreciation of the complexity involved in shaping policy for psychiatric MAID.