Psychiatrists Are Right 47% of the Time on Mental Illness MAID. Canada Is Expanding It Anyway.

There is a number at the centre of Canada’s MAID expansion debate that should stop every policymaker in their tracks: 47%. That is the rate at which trained and experienced psychiatrists correctly determined whether a patient’s mental illness was irremediable — the core legal requirement for MAID eligibility. It is less than what would be expected from a random person flipping a coin. The study was cited by the Globe and Mail’s editorial board. The finding has not been contested. And Canada is proceeding to expand medical assistance in dying to people whose sole condition is mental illness in March 2027.¹

Dr. Karandeep Sonu Gaind, head of psychiatry at Sunnybrook Health Sciences Centre in Toronto and a University of Toronto professor, has been the most direct: “You’re better off flipping a coin.” Gaind, who chaired the MAID team at Humber River Hospital, has seen patients approved for MAID who later regained their will to live after reconnecting with family. “MAID allows us to pretend we’re providing death for an illness we can predict won’t get better,” he said. “But we’re not actually able to make that prediction. Every psychiatrist has had patients who are convinced they will never improve.”²

The government’s own Expert Panel on MAID and Mental Illness — the panel appointed by Ottawa to conduct an independent review — acknowledged the problem. The panel stated that “no fixed rules” can be provided to determine the incurability and irreversibility of a mental illness, and that evaluation should be made “on a case-by-case basis.” This is the panel that was supposed to provide the clinical framework for expansion. Instead, it confirmed that no reliable framework exists.³

Dr. Mark Sinyor, a suicide-prevention expert at Sunnybrook Hospital, told a parliamentary committee: “There is absolutely no research on the reliability of physician predictions of the irremediability of illness or suffering in psychiatric conditions.” The absence of research is not a gap that can be filled by good intentions. It is a structural impossibility being papered over with procedural language.⁴

A group of Canadian psychiatrists — including university department chairs and past presidents of the Canadian Psychiatric Association — published a formal response warning that “worldwide scientific evidence shows assessors cannot predict irremediability in cases of mental illness, meaning that this eligibility criterion cannot be met.” They added that evidence shows “we cannot distinguish suicidal ideation caused by mental illness from motivations for MAID for mental illness” — and that overlapping characteristics suggest there may be no distinction to make.⁵

Canada’s MAID framework for mental illness is unique in the world in one critical respect: there is no legal requirement for treatment before eligibility. Under Canadian law, what constitutes an irremediable condition is suffering that is intolerable to patients and cannot be relieved under conditions that “they consider acceptable.” A patient can refuse every available treatment and still qualify for MAID. No other country that permits euthanasia for mental illness operates this way.⁶

In the Netherlands, where psychiatric euthanasia has been available for decades, the vast majority of requests are rejected. Dutch eligibility criteria are more restrictive than what Canada is proposing. Belgian data shows that in 2021, 24 people received euthanasia on psychiatric grounds — out of a population of 11.5 million. If Canada’s more permissive criteria are applied, the number of mentally ill Canadians dying by MAID could, according to testimony before a parliamentary committee, reach into the thousands annually.⁷

Vitaly Gariev / Unsplash — Dr. Sonu Gaind, head of psychiatry at Sunnybrook Health Sciences Centre in Toronto: ‘You’re better off flipping a coin.’ A study found trained psychiatrists correctly diagnosed irremediability just 47% of the time.

The professional opposition is overwhelming. A national survey of Canadian psychiatrists found that while 72% support MAID in some circumstances, only 29.4% support MAID on the basis of mental illness alone. The objections are not ideological. They are clinical: concern for vulnerable patients, the inability to predict irremediability, and the fear that MAID would fundamentally alter the therapeutic relationship between psychiatrist and patient.⁸

Among the factors correlating with opposition: psychiatrists who had past patients who would have qualified for MAID but instead went on to recover. These are not hypothetical cases. They are documented clinical realities — patients who were convinced their suffering would never end, whose psychiatrists could not confidently say otherwise, and who recovered.

Ten provinces and territories have called for an indefinite pause on MAID for mental illness — not a delay, but a halt until the clinical evidence catches up to the legislation. Ottawa has delayed the expansion twice: first from 2023 to 2024, then from 2024 to 2027. Both delays were framed as giving provinces “more time to prepare.” The real reason, acknowledged in reporting but not in the legislation, is that the clinical foundation does not exist.⁹

The suicidality question is the one that should alarm every Canadian. Several DSM-5 disorders include suicidal ideation as an inherent diagnostic criterion. A psychiatrist assessing a MAID request from a patient with severe depression must distinguish between suicidality that is a symptom of the illness — and therefore treatable — and a desire for death that reflects genuine, informed autonomy over an irremediable condition. The expert evidence before Parliament says this distinction cannot reliably be made.¹⁰

Reports from Ontario’s Chief Coroner have shown that people with a history of suicidal ideation have been approved for MAID. Health Canada’s own data shows that many people who request MAID report suffering because of loneliness, social isolation, or feeling like a burden on others. Track 2 MAID recipients — people whose deaths are not reasonably foreseeable — are more likely to live in socially disadvantaged neighbourhoods. The system is already approving deaths that may be driven by social deprivation rather than irremediable medical conditions. Expanding it to mental illness would deepen that pattern.¹¹

Canada does not have the mental health infrastructure to make this work. Wait times for psychiatrists in many provinces exceed a year. Access to evidence-based therapies like dialectical behaviour therapy or intensive outpatient programs is severely limited outside major urban centres. Indigenous communities, rural populations, and low-income Canadians face the greatest barriers to care — and are the populations most likely to seek MAID as an alternative to treatment they cannot access.

The question is not whether people with mental illness suffer. They do — profoundly, relentlessly, and often without adequate support from a system that has failed them. The question is whether the correct response to that failure is to offer death before the system has offered treatment. And the answer from the government’s own experts, from the majority of Canadian psychiatrists, and from ten provinces and territories is the same: no.

Trained psychiatrists correctly predict irremediability of mental illness 47% of the time — worse than a coin flip. The government’s own expert panel says there are “no fixed rules” for making that determination. Only 29% of Canadian psychiatrists support MAID for mental illness. Ten provinces and territories want an indefinite pause. Canada is the only country with no legal requirement that patients try treatment before qualifying. Health Canada’s data shows MAID recipients report loneliness, isolation, and feeling like a burden — social conditions, not irremediable medical ones. And the expansion has already been delayed twice because the system is not ready. In March 2027, Canada plans to proceed anyway — to offer death to people whose conditions the country’s own psychiatrists say they cannot reliably assess, in a health system that cannot provide the treatment those patients have not yet received, under criteria more permissive than any other country on earth. The clinical evidence says this cannot be done safely. The government has set a date regardless. That is not policy. It is ideology dressed as compassion — and the people it will fail are the most vulnerable Canadians in the system.