On Oct. 7, Justice Minister Sean Fraser announced that the government would introduce legislation to indefinitely exclude those with mental illness as a sole underlying condition from being eligible for MAiD. But he also said the legislation will include advance requests for MAiD, permitting a person with a serious illness like dementia or Alzheimer’s to consent in advance to MAiD at a later time when they no longer have the capacity to consent.

It seems the government has not learned its lesson on MAiD, as they again try to move forward with a new MAiD expansion without the proper scrutiny and study. On MAiD for mental illness, the government is following the evidence after years of study. Instead of stopping there, they are pursuing another expansion — MAiD by advance request. And they’re combining the two in one bill, which will result in advance requests receiving less focus, public scrutiny and legislative debate.

In 2021, the federal government passed legislation to expand MAiD to those not nearing natural death, including a clause that would allow MAiD for people with mental illness as their sole underlying condition beginning in 2023.

The mental illness clause was included late in the process by the Senate and did not receive the same level of scrutiny as the rest of the legislation. However, when in-depth study over the next five years revealed grave concerns, the expansion was delayed multiple times and is now set to be delayed indefinitely.

When the topic of MAiD for mental illness first came to Parliament, the federal government approved the expansion in principle. But it became increasingly apparent that the expansion was unacceptable to a diverse array of Canadians. Experts made clear that mental illness cannot be reliably considered irremediable. And it became unclear that Canadians feeling suicidal could be protected from MAiD for mental illness.

Despite numerous efforts to show how MAiD for mental illness could be implemented “safely,” the government has now indicated that it might never be “safe” to offer MAiD to those who may be suicidal and may recover. Notably, the government’s legislation responds to a report from the Special Joint Committee on Medical Assistance in Dying tabled earlier this year, a report which did not address advance requests at all.

Advance requests for MAiD also cannot be done safely and safeguards will remain inadequate to protect the vulnerable. In fact, just last year, the United Nations Committee on the Rights of Persons with Disabilities recommended, among other things, that Canada not expand MAiD to mental illness or permit advance requests.

Though Canadians broadly supported the idea of advance requests in the federal government’s national conversation, many also fear that a person may feel pressured to make an advance request, that a health-care provider may need to make a decision based on vague criteria and that a person might make an advance request before knowing how well they might adapt to their condition.

An additional concern is that a person who has signed an advance request may no longer want MAiD when the time comes. Advance consent is not fully informed consent. A person diagnosed with dementia has never lived through the future stages of the condition and cannot know what their life will be like in the future.

These are issues that are impossible to eliminate entirely.

At the very least, these challenges with advance requests require space for focused study and debate. Of course, the federal government has not yet tabled their legislation, so details remain unclear. But Minister Fraser did say the two issues of mental illness and advance requests would be combined in the same bill.

If the government indeed wishes to move forward on both issues as planned, they must introduce separate pieces of legislation so that each can be dealt with in the appropriate manner.

Daniel Zekveld is a policy analyst with the Association for Reformed Political Action (ARPA) Canada.