Canada’s Health Minister Mark Holland says some provinces will stand opposed to expanding medical assistance in dying for ideological reasons, but the government wants to ensure a majority feel ready. 

Holland recently acknowledged provinces have expressed fears that the country may not be ready for the change to take effect in March. 

The governments of Manitoba and Saskatchewan say they are concerned about the potential risks of allowing Canadians to seek medical assistance in dying solely on the basis of a mental illness. 

Holland said there is a need to make sure the right number of professionals have been trained, and to hear from provinces about whether their systems are ready, though he said some provinces will have “ideological objections.”

The federal Liberal government passed legislation last year to delay the expansion for 12 months, and will soon have to decide whether to do so a second time. 

Liberal ministers say they are waiting to hear next week from a parliamentary committee that held hearings last fall about whether Canada is ready for the expansion. The witnesses who appeared offered a range of opinions, giving parliamentarians an up-close look at the divisions that persist within the legal and medical communities.

Providers currently trained to administer medically assisted deaths say they are ready and that guidelines and practice standards have been developed. People with mental illness should also be able to access the same care as those with debilitating physical conditions, advocates argue. 

Others aren’t so sure. 

A group of law professors from across Canada has urged the government to take its time, insisting there is nothing in federal law forcing it to take urgent action.  

Some psychiatrists, too, have lingering questions: how to determine if someone with a mental disorder is likely to get better, for instance, or what happens if someone is living in poverty and unable to access mental health care. 

The Manitoba government says it shares the concerns of clinical experts and other provinces. 

“We agree with those calling for further consideration and consultation to ensure appropriate clinical standards and safeguards are in place to protect vulnerable Canadians,” a spokesperson wrote in a statement. 

Saskatchewan says it cannot commit to following the expansion “without carefully considering the risk that this may pose to people suffering from mental illness.”

“Saskatchewan remains concerned with both the pace and scope of the federal government’s proposed expansion,” said spokesman Matthew Glover.

Tim McLeod, Saskatchewan’s mental health and addictions minister, raised the issue during a roundtable meeting with the federal government last year, Glover added.

Officials in B.C. and P.E.I. declined to comment, citing ongoing talks with Health Canada.

Newfoundland and Labrador said in a statement that the province is working with health care regulators to prepare for the upcoming change. The Ontario and Alberta governments did not respond by deadline. 

Quebec passed a law in June excluding adults from accessing a medically assisted death solely for a mental disorder.

Speaking to reporters on Thursday in Ottawa, Holland said the government wants to ensure the proper systems are in place when it comes to training and evaluations.

“You’re never going to get to a point where everybody agrees that it’s ready,” Holland said. “But you do need to make sure that preponderance of reasonable opinion is in that direction.”

Broadening the criteria is not designed to capture individuals who are having suicidal thoughts or dealing with mental health issues. 

“This is for long, long standing mental illnesses where people have suffered over an extremely long period of time where everything has been tried and exhausted.” 

“That’s the intention so we need to make sure the system can manifest that intention.”