Recent comparisons between Canada’s annual Medical Assistance in Dying (MAiD) deaths and U.S. gun violence deaths have drawn renewed attention onto Canada’s MAiD regime. Critics, however, have noted the two data points are hardly comparable. Fair enough. Perhaps a better comparison point would be other countries which have legalized euthanasia and assisted suicide.

Canada legalized euthanasia/assisted suicide as MAiD in 2016. We were far from the first country to do so, but our MAiD regime has since expanded at extraordinary speed. Eligibility has broadened, safeguards have been weakened, and governments have chosen expansion over restraint. In 2016, 1,018 Canadians died via euthanasia or assisted suicide. In 2025, that number was 16,499.

MAiD has become the sixth-leading cause of death in our country; Canada’s MAiD program is the fastest-growing program of its kind in the world, and, on a per capita basis, jurisdictions like Quebec are international leaders.

Having loosened restrictions on MAiD in 2021, leading to a significant increase in the number of deaths per year, parliamentarians now face another consequential decision. A parliamentary committee has recommended indefinitely delaying MAiD for people whose sole underlying medical condition is mental illness. As Canadian lawmakers consider how to enact this recommendation into law, they should look at what other countries have done and what Canada can learn from them.

Our experience has already influenced debates abroad. Canada’s MAiD regime featured prominently in the recent debate over assisted dying in the United Kingdom, where critics pointed to our country as evidence of how quickly eligibility can expand and the tragic cases that can be the result. Canada set out on its own course and other countries have had the benefit of watching where it led. In Britain, a private member’s bill was recently defeated. Despite the Canadian experience, France and American states such as Illinois have pushed forward in recent months.

At Cardus, we have been conducting a series of international comparisons examining Canada’s MAiD legislation alongside assisted-dying regimes elsewhere. Our first study looked at who qualifies for MAiD. Our second examined the safeguards intended to protect patients once they seek it.

Both comparisons should give Canadian lawmakers, and lawmakers in places that recently legalized MAiD, important factors to consider when making or refining MAiD laws.

Despite the controversial cases, our eligibility criteria remain considerably more permissive than those in Australia, New Zealand, and the American states where assisted dying is legal. Canada also gives considerable weight to a patient’s own assessment of whether suffering is intolerable and requires only that patients seriously consider reasonable and available means of alleviating their suffering.

Other jurisdictions require more. In Belgium and the Netherlands, physicians must assess the suffering themselves, determine that it is intolerable and confirm that reasonable alternatives are lacking. Whatever one thinks of assisted dying, these requirements place greater responsibility on medical professionals before a patient’s life is ended.

Our second comparison study found significant gaps in Canada’s safeguards as well. A patient found ineligible for MAiD can continue seeking other assessors, including across provincial boundaries, until finding someone willing to approve the request. There is no national mechanism preventing this kind of “assessor shopping.”

That possibility is not theoretical. Canadian families have already raised questions about cases in which a patient was denied MAiD by some clinicians before eventually receiving approval elsewhere. Such cases should prompt lawmakers to ask whether a system designed to protect vulnerable patients can do so when a refusal from one medical professional can be bypassed, time and again, through another assessment, even from someone who has no prior history with the patient.

Those concerns become more serious as Parliament considers MAiD for mental illness.

Belgium and the Netherlands have allowed assisted death for psychiatric conditions since 2002, giving Canada more than two decades of experience to examine — including troubling cases. In Belgium, a 38-year-old woman received euthanasia shortly after being diagnosed with Asperger’s syndrome. As argued by many experts and advocates in Canada and internationally, MAiD for mental illness undermines suicide prevention and degrades patients’ hope in treatment and support for their conditions by allowing death as an alternative.

That experience matters for Canada. If countries with longer experience and more stringent safeguards continue to confront difficult questions about psychiatric euthanasia, Canada should be especially cautious about proceeding within a system where our research has already identified significant gaps.

Few countries permit assisted dying when mental illness is the sole underlying condition. Canada does not need to join them.

Canadian lawmakers have an opportunity to show leadership this fall. Parliament should accept the committee’s recommendation and indefinitely halt the expansion of MAiD to mental illness. After a decade spent pushing Canada’s assisted-dying laws further than many of our peers, we have accumulated enough experience to recognize the risks.

Leadership now means learning from them.

Rebecca Vachon is the director of the Health Program at Cardus. A policy expert with a PhD from the University of Ottawa, she is dedicated to researching and advancing health policy that upholds human dignity. Her academic background includes expertise in federal morality policy and public administration.