A landmark case in Canada has reignited the ethical firestorm surrounding assisted dying, this time with a 31-year-old woman suffering from severe mental illness seeking the right to end her life. The woman, identified only as “AB,” has argued before the Quebec Superior Court that the province’s exclusion of mental illness from its medical aid in dying (MAiD) law violates her constitutional rights. The case, which has drawn international attention, exposes a deep fissure in society’s understanding of autonomy, suffering, and the very definition of a ‘safe death’.
Canada’s MAiD framework, expanded in 2021 to allow access for those with grievous and irremediable medical conditions, deliberately excluded mental disorders. The government cited concerns about diagnostic uncertainty, the potential for recovery, and the challenge of ensuring free will in patients whose conditions may impair judgement. But AB’s legal team argues that this blanket exclusion amounts to discrimination, effectively deeming her suffering less worthy of relief than that of a patient with a physical illness.
The case cuts to the heart of a growing global debate. Proponents of extending MAiD to mental illness argue that such restrictions are paternalistic, denying individuals with chronic, treatment-resistant conditions the dignity of choosing their own end. They point to jurisdictions like Belgium and the Netherlands, where the practice is legal under strict safeguards, including mandatory psychiatric evaluations and waiting periods. In 2020, 441 people in the Netherlands received assisted dying on the basis of mental suffering, a number that has tripled in a decade. Critics, however, warn of a slippery slope: in Belgium, cases involving personality disorders or chronic fatigue syndrome have been approved, raising questions about how ‘irremediable’ suffering can truly be assessed.
For AB, who has been diagnosed with conditions including borderline personality disorder and post-traumatic stress disorder, the legal path has been gruelling. She has tried multiple medications, therapies, and even electroconvulsive treatment, all without lasting relief. Her doctors say she is competent and not currently suicidal, but rather rationally desires death as an escape from unremitting anguish. “I am not asking for death,” she told the court. “I am asking for the right to choose it.”
Yet the counterarguments are formidable. Suicide prevention advocates fear that normalising assisted dying for mental illness could inadvertently send a message that some lives are not worth living, undermining broader mental health efforts. Psychiatrists warn of the difficulty in predicting long-term outcomes: studies show that many people with suicidal ideation later improve, especially when suicidal thoughts are driven by temporary crises. The Canadian Medical Association has called for more research, arguing that the current evidence base is insufficient to ensure adequate safeguards. There are also practical concerns: if MAiD is legalised for mental illness, would health systems invest less in mental health care, knowing that a ‘cheaper’ option exists?
The case also raises a deeply uncomfortable question about societal values. We have built a culture that celebrates individual autonomy, yet we recoil when that autonomy leads someone to choose death. We have medicalised dying, promising a ‘good death’ for the physically ill, but we balk at extending that same promise to the mentally ill, as if their suffering were somehow less real or less worthy of compassion. This is the Black Mirror-esque consequence of our technological and ethical progress: we have the tools to grant a controlled, painless death, but do we have the wisdom to know when to use them?
The Quebec court’s ruling is expected later this year, and it will likely be appealed, eventually reaching the Supreme Court of Canada. Meanwhile, the federal government is studying the issue separately, with a report due in 2023. The outcome will influence not only Canadian policy but also the trajectory of assisted dying worldwide. For AB, waiting is a torment in itself. For society, the wait is a crucible in which we must forge a new ethical framework, one that balances compassion with caution, and individual choice with collective responsibility.
The ‘safe death’ debate is no longer theoretical. It is here, in a courtroom, embodied by a woman who says she has suffered enough. How we answer her plea will define us as a society. Will we expand the definition of a life worth living, or will we draw a line in the sand, knowing that some will fall on the wrong side of it? There are no easy answers, only the urgent need to ask the right questions.
