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In response to the letter from the ministers, the office of federal Health Minister Mark Holland said it has been consulting with key partners and provinces and territories.Christinne Muschi/The Canadian Press

Health ministers from a majority of provinces and all the territories have signed a letter to their federal counterpart urging Ottawa to “indefinitely pause” the implementation of medical assistance in dying for individuals whose underlying medical condition is mental illness.

Ministers from British Columbia, Ontario, Alberta, New Brunswick, Saskatchewan, Prince Edward Island, Nova Scotia, Nunavut, the Northwest Territories and Yukon sent the letter to Health Minister Mark Holland on Monday saying that expanding eligibility for MAID requires co-ordination between the levels of government to “ensure a consistent and safe approach across the country that includes appropriate safeguards.”

“We encourage you and federal Justice Minister [Arif] Virani to indefinitely pause the implementation of the expanded MAID eligibility criteria to enable further collaboration between provinces, territories and the federal government,” it said.

The letter also says jurisdictions, health authorities, regulators and practitioners of medically assisted death need sufficient time to implement those safeguards and to address capacity concerns.

“The current March 17, 2024, deadline does not provide sufficient time to fully and appropriately prepare all provinces and territories across Canada,” the letter stated.

MAID provisions for individuals with mental illnesses were previously set to kick in back in March, 2023.

Ottawa had delayed that to March of this year. It reconvened a special joint committee of MPs and senators to verify that there could be “a safe and adequate application” of the planned expansion.

The committee released a report on Monday saying Canada is not ready for such an expansion of MAID. Mr. Holland responded shortly afterward, agreeing with the report and announcing another delay. He emphasized the importance of getting “it right.”

PEI and Nova Scotia are “more prepared for these changes” but support the request for additional time for other provinces and territories, the letter from the provincial and territorial ministers notes.

In response to the letter, Mr. Holland’s office said Tuesday it has been consulting with key partners and provinces and territories.

The minister has indicated he intends to bring forward legislation in the coming days but can’t say more on the details owing to parliamentary privilege.

“With a deadline fast approaching, we know we will need to act expeditiously to respect the committee’s assessment on health system readiness, an assessment we agree with and share with our provincial and territorial counterparts,” said Christopher Aoun, a spokesperson for Mr. Holland.

Helen Long, chief executive officer of Dying With Dignity Canada, said Tuesday that the letter from the provincial and territorial health ministers is “surprising” since regulators said during testimony before the special committee that they were ready.

“There have been three productive years of preparations, and the necessary steps are complete,” she said, adding that extensive work has been done by provincial and territorial health services and MAID co-ordination teams across the country.

In its report, the special committee said that members heard “significant testimony” from stakeholders about whether the country’s medical system is adequately prepared for the expansion of MAID.

“Many practitioners remain concerned, particularly regarding the challenges of assessing irremediability,” the report read.

Some witnesses told the committee about the difficulty in distinguishing requests for medical assistance in dying from suicidal thoughts.

Conservative MP Michael Cooper, who was a member of the committee, said Tuesday that the letter from the provinces and territories underscores what the federal opposition wants the government to do.

“If the government were to follow the evidence and apply common sense, the Liberals would introduce legislation to put a permanent pause or an indefinite pause on this expansion,” Mr. Cooper said.

NDP MP Alistair MacGregor, who served as a vice-chair on the special committee, said the letter is in keeping with the committee’s report, though MPs and senators did not stipulate how long the pause should be and instead said certain conditions should be satisfied.

The committee recommended that MAID in this area not be available in Canada until the ministers of health and justice are satisfied “based on recommendations from their respective departments and in consultation with their provincial and territorial counterparts and with Indigenous peoples, that it can be safely and adequately provided.”

Mr. MacGregor said: “If you have ministers of health expressing discomfort with this, I think that’s a very strong signal that the government should be paying attention to and it’s in line with what a parliamentary committee also recommended.”

A dissenting report was filed by some members of the committee: Senators Stan Kutcher, Marie-Françoise Mégie and Pamela Wallin.

They released a statement saying that despite the fact the majority of witnesses testified that readiness had been achieved, the majority report says that the Canadian medical system is not ready and recommends an extension. The senators are scheduled to hold a news conference about their report on Thursday.

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