Canada has abandoned a planned March 2027 expansion of its assisted dying system that would have allowed people suffering from mental illness alone to seek medically assisted death, saying there is still no clear agreement on how such cases should be assessed.
The decision puts an indefinite hold on one of the country's most debated healthcare policies and comes after lawmakers raised concerns about whether doctors can reliably establish that certain mental illnesses are permanent and cannot be treated.
Canada's justice minister, Sean Fraser, announced the move on Wednesday, saying the government had decided that delaying the expansion was the most appropriate course for now.
"while there is not a perfect consensus on this issue, we believe this is the correct approach at this particular time", Fraser said.
The government plans to bring forward legislation in the coming weeks to formally suspend the proposed expansion. Under the move, people whose only medical condition is a mental illness will remain outside the assisted dying programme beyond March 2027.
The announcement follows a parliamentary committee's recommendation earlier this year that Canada should not extend medically assisted dying to people with mental illness as their sole underlying condition.
The committee reached its position after hearing evidence from doctors, advocates and specialists from countries where assisted dying is already available in some cases involving mental illness, including the Netherlands and Belgium.
It recommended that Canada "indefinitely exclude persons whose sole underlying medical condition is a mental illness" from the programme.
The committee also called for better access to mental healthcare, saying there was a "pressing need for increased and more equitable access to adequate mental health services".
The recommendation, however, was not supported by every member of the committee. Some lawmakers issued a dissenting report, describing the process used to reach the conclusion as "fundamentally flawed" and "biased".
The dispute has centred on whether people with severe and long-term mental illnesses should have the same access to assisted dying as patients whose conditions are physical.
Those supporting an expansion argue that excluding people because their illness is psychiatric amounts to unequal treatment. They say patients with mental illness should have the same rights and access to healthcare as people living with other incurable conditions.
The government, however, has pointed to continuing uncertainty among medical professionals over how to decide whether some mental illnesses are truly irremediable.
"When I hear that there is a lack of consensus in the medical community about the irremediable nature of certain mental illnesses, that gives me real cause for concern," Fraser said.
Canada had initially planned to include mental illness within its assisted dying system in 2023. The government postponed the change twice as officials sought more time to examine how the policy could be put into practice.
The latest decision means that those plans will not take effect in March 2027 as previously expected.
The policy is also facing a legal challenge. A federal case is currently before the courts over the government's earlier decision to delay access to assisted dying for people with mental illness.
One of those involved in the case is Claire Brosseau, who has treatment resistant bipolar 1 disorder.
Brosseau told the BBC earlier this year that medically assisted dying would provide her with "a safe death".
Her lawyer, Michael Fenrick, criticised the government's decision, arguing that the delay would leave people experiencing severe suffering without the option they are seeking.
"People will continue to suffer intolerably while the case goes through the courts," he said.
Fraser said the legal dispute could eventually reach Canada's Supreme Court, leaving open the possibility that the country's highest court could have a say in the future of the policy.
While putting the mental illness expansion on hold, the government is also preparing changes in another area of assisted dying.
The proposed legislation will allow people with a progressing and incurable illness to give consent for medically assisted dying before their condition reaches a stage where they can no longer make decisions for themselves.
Individual provinces will have the final say on whether to permit such advance requests.
Federal law currently does not allow advance requests for assisted dying. Quebec is an exception, allowing them for people with serious and incurable illnesses.
Canada introduced medically assisted dying in 2016, initially making it available to people with terminal illnesses. Such patients continue to make up the majority of cases.
The system was expanded in 2021 following a legal case in Quebec. That change opened access to people with incurable medical conditions even when death was not expected in the near future.
That category is known in Canada as "track two" Maid.
The country's approach has since become the subject of growing debate over how far assisted dying should extend and what safeguards should apply to people whose suffering may be linked to mental illness.
Some experts have warned that assisted dying could become an answer to problems that might instead be addressed through stronger social and healthcare support.
They have raised concerns about cases where people may be struggling with issues such as the high cost of housing or poor access to healthcare, arguing that such circumstances should not lead someone towards an assisted death when better support could help ease their suffering.
The parliamentary committee also examined evidence from countries that permit assisted dying for people whose only condition is mental illness before reaching its recommendation.
At the centre of the disagreement is the question of whether medical science can confidently determine that a mental illness will never improve, particularly when treatments and a person's condition can change over time.
Public opinion in Canada remains broadly supportive of medically assisted dying. However, polling shows that support becomes lower when Canadians are asked specifically about allowing the procedure for people whose only condition is mental illness.
For now, the federal government has chosen caution over expansion, keeping people with mental illness alone outside the assisted dying system while the legal battle continues and lawmakers consider the next steps.