In a quietly furious Toronto apartment, a woman I shall call Sarah has been preparing for her death for six months. Not from a terminal illness. Not from a degenerative disease.
Sarah suffers from severe depression and has been granted access to Canada's Medical Assistance in Dying programme (MAiD) on the grounds of mental illness alone. Her story, which broke this week, has reignited the assisted dying debate in Britain just as MPs prepare to examine the law. Sarah is 38.
She has a cat named Wallace. And she is legally entitled to die because she is in psychological pain. This is the human cost of a cultural shift in how we view death, suffering and the state's role in ending a life.
Canada is currently the only country that explicitly allows assisted dying for mental illness without a physical condition. The law, expanded in 2021, was intended to offer 'compassionate exit' to those whose suffering is deemed irremediable. But critics argue it has created a dangerous precedent, and as Britain's parliament begins its own review, Sarah's case has become a cautionary tale.
I spoke to Dr. Helena Morrison, a psychiatrist at St. Thomas's Hospital in London, who told me: 'The fear is that we are conflating treatable depression with terminal cancer.
The Canadian experience suggests that once you open the door to mental illness, the safeguards fail.' Indeed, Canada's data shows a 31% rise in assisted deaths this year, with mental illness accounting for a small but growing proportion. Meanwhile, British MPs are grappling with the implications.
The Health and Social Care Select Committee is due to publish its report next month, but the debate is already polarising. On one side are campaigners like Dignity in Dying, who argue that 'a person's suffering is no less real because it cannot be scanned or measured'. On the other, disability rights groups and palliative care physicians warn that legalisation could create a 'duty to die' for the vulnerable.
Sarah's case is unique because she is not in physical agony. She is articulate, intelligent and painfully aware of the irony: that a system designed to alleviate suffering may be encouraging her to give up on treatment. 'I know this seems crazy to people,' she told a Canadian journalist before withdrawing from the spotlight.
'But I've been in therapy for 12 years. I'm tired.' And that is the crux.
What does 'irremediable suffering' mean when the mind is involved? British law currently prohibits assisted dying for any reason. The 2015 High Court case of Noel Conway, a man with motor neurone disease, established that the state has a duty to protect life.
But public opinion has shifted. A 2023 YouGov poll found 65% of Britons support legalisation for those with less than six months to live. And now the debate is widening to include mental illness.
The cultural shift is subtle but seismic. We have moved from seeing death as a tragic inevitability to an optional exit for suffering. We have reframed despair as a medical condition requiring a medical solution.
And we have asked the state to decide who is deserving of that exit. I asked Sarah's sister, who asked not to be named, what she thought. 'My sister isn't beyond help,' she said.
'She is beyond our patience. We need to fund mental health services, not death.' It is a sentiment echoed by many in the UK, who worry that legalisation would distract from the underfunding of mental health care.
Britain's NHS currently reports a 28% increase in antidepressant prescriptions since 2020, and waiting times for talking therapies exceed 18 weeks in some areas. The assisted dying bill, which is likely to be debated in parliament next year, will need to address these concerns. But for now, the story of Sarah and her cat Wallace captures the ethical tragedy.
She wants to die because the system has failed to make her want to live. And in Canada, that is now a legal reason.
