CPA Presidential Opening: Canadian Guidance for the “Grievous and Irremediable” Criterion and Suicide Risk in Persons with Mental Disorders who Request MAID
Presenting Author(s): Dr. Paul S. Links, MD, FRCPC, Dr. Lilian U. Thorpe, MSc, MD, PhD, FRCPC
Date and time: 21 Mar 2026 from 08:00 to 09:00
Location: Mount Temple Ballroom A/B
Learning Objectives
- Appreciate the legal definition of “grievous and irremediable” and apply the guidance for cases where a mental disorder contributes significantly to or is the sole basis for a MAID request;
- Outline the role of the psychiatrist acting as the “person with expertise” for cases where a mental disorder is the sole reason for or contributes significantly to the request; and
- Describe best practices to assess and manage suicide risk in patients requesting MAID.
Abstract
Bill C-7 removed the requirement that natural death be reasonably foreseeable as an eligibility criterion for medical assistance in dying (MAID) while temporarily excluding mental illness as the sole basis for a request. The mental illness exclusion for MAID eligibility is set to expire in 2027.
While Canada has a national MAID training curriculum, a model regulatory standard for MAID assessments and provision, as well as a variety of advisory and guidance documents to support clinical practice, both the federal government and psychiatrists have identified a need for additional clinician guidance specific to MAID assessments on the sole basis of a mental disorder or where a mental disorder may be a significant contributing factor in a requester’s medical condition.
This national guidance has been developed based on evidence and expert consensus to help clinicians who assess or consult on MAID requests to determine whether a MAID requester’s medical condition(s) constitutes a grievous and irremediable medical condition. It will also assist clinicians in navigating complex clinical questions, including best practices to assess and manage suicide risk in patients requesting MAID.
Literature References
- Special Joint Committee on Medical Assistance in Dying. MAID and mental disorders: The road ahead. Ottawa (ON): author; 2024.
- Ontario MAID Death Review Committee. Complex medical conditions with non-reasonably foreseeable natural deaths. Report 2024-2. Toronto (ON): author; 2024.