Former NOSM U psychiatry chair and Sudbury practitioner Dr. Rayadu Koka joins a past chair and the medical school’s current of psychiatry in highlighting the issues of expanding MAiD, including that it might be impossible to distinguish a legitimate MAiD request from suicidal ideation
Editor’s note: This joint letter from three psychiatrists connected to NOSM University was originally sent to Prime Minister Mark Carney on April 2. The clinicians oppose the proposed expansion of medical assistance in dying to people for mental illness reasons. One of the signatories, Dr. Rayadu Koka, spoke of his opposition to allowing MAiD for mental health reasons in a story with Sudbury.com back in 2024. You can read that story here.
Dear Prime Minister,
We are writing as current and former chairs of psychiatry at NOSM University, with longstanding clinical, academic, and community experience across Northern Ontario. We support Bill C-218 and want to share our concern regarding the proposed expansion of medical assistance in dying (MAiD) to individuals whose sole underlying condition is mental illness.
Our work has brought us into close contact with individuals and families affected by suicide, addiction, homelessness, and severe mental illness. These experiences — both professional and personal — have reinforced repeatedly that the vulnerability in mental illness is often profound, but it is not static, predictable, or without the possibility of recovery.
As the academic chairs have highlighted in both 2022 and 2023 to the AMAD Parliamentary review on concerns for MAiD for mental illness, from a psychiatric perspective, it is not currently possible to determine with confidence which individuals will not improve over time. Equally concerning is the difficulty — if not impossibility — of clearly distinguishing between a MAiD request and suicidal ideation. In practice, both emerge from suffering, and both call for care, time and sustained support. This uncertainty introduces significant risk.
We are also mindful that many Canadians, including those in Northern Ontario, continue to face barriers in accessing timely mental health care, housing and social supports. In such a context, expanding access to MAiD risks responding to unmet needs with irreversible outcomes.
We note that this concern is widely shared. In addition to concerns raised in 2022 by the chairs of psychiatry at all 17 Canadian medical schools, and again in 2023, several provinces have called for an indefinite pause, and Quebec has moved to prohibit MAiD where mental illness is the sole condition. Public opinion similarly reflects caution.
Our position is grounded in compassion and clinical responsibility. People living with mental illness deserve care, treatment, and the continued presence of hope — even when recovery is difficult or uncertain. As a society, we must be careful not to move toward policies that may unintentionally signal that some lives are less worthy of protection.
We believe Bill C-218 represents a prudent and necessary step in safeguarding vulnerable Canadians. We would welcome the opportunity to contribute further to thoughtful, evidence-informed policy in this area.
Mariwan Husni, MD FRCPC
Chair of Psychiatry, NOSM University, Penetaguishing
John M. Haggarty MD, FRCPC
Former Chair of Psychiatry, NOSM University, Thunder Bay
Rayuda Koka, MD, FRCPC
Former Chair of Psychiatry, NOSM University, Sudbury