The debate over medically assisted suicide continues because of safety concerns for the mentally ill

John Sikkema: Assisted suicide stalled over concerns for mentally ill“The suffering of individuals with mental disorders is no less important than the suffering of those with physical conditions, and is deserving of relief.”

So says the majority report of a Canadian Parliamentary committee this week, which considered whether Canada is ready to allow doctors to euthanize patients who have a mental disorder, but not a physical illness or disability.

The “relief” the committee is talking about here is access to state-approved, publicly funded, voluntary homicide, performed by a doctor. Or as Canada calls it now, “medical assistance in dying” (MAiD).

The Liberal government was so committed to offering MAiD as “relief” for mental illness that they, in effect, pre-legalized it twice. First, in early 2021, the government passed a law to allow MAiD for mental illness starting in March 2023.

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Why the two-year delay? Healthcare providers and regulators alike knew in 2021 that Canada was nowhere near ready to begin offering MAiD for mental illness. Doing so conflicts with promoting and providing mental health supports. Wishing to die by MAiD is not categorically different than wishing to die by other means. It is suicidal.

As the committee’s majority report recognized this week, “governments, regulators, professional associations, and practitioners have worked very hard to prepare for MAiD [for mental illness].” Indeed. They did so because they had to. And they had to because Parliament had pre-legalized it. The message was clear: get ready, it’s coming.

But as 2023 approached, despite all this hard work, it was clear Canada was still not ready. Leading psychiatrists and disability rights advocates raised the alarm. Parliament responded by passing a new bill to prevent MAiD for mental illness from becoming legal in 2023, only to make it legal in March 2024.

Unsurprisingly, the same show repeated itself in late 2023 in anticipation of the impending, pre-legislated expansion of MAiD coming into effect in March 2024.

The majority report, though supporting MAiD for mental illness in principle, concedes that, based on expert testimony, “the healthcare system would not be prepared to safely and consistently provide [it].” Doctors aren’t ready to safely kill the mentally ill.

So what’s the remaining danger? Not death per se. Indeed, the patient’s death is the point of MAiD. Rather, the danger is that people might be euthanized who might have changed their minds about wanting to die. This danger, and not the practice of lethally injecting people, is the “safety” problem the committee has in mind.

But this danger is also present for many people whose MAiD deaths are already permitted by law. Canadian law says anyone with a physical condition, illness, or disability that causes “enduring physical or psychological suffering” may be eligible for MAiD, even if that person is not dying and may have many years of life ahead.

As the majority report notes, “the presence of a mental disorder did not prevent a person from accessing MAiD, provided they also had a qualifying condition.” This is an understatement. Under current law, mental illness may, in fact, be what drives a disabled person to request and receive MAiD.

While depression per se doesn’t qualify you for MAiD, being depressed about being paralyzed does because it is “psychological suffering” caused by your disability. Our law permits MAiD to “relieve” the psychological suffering of disabled people but not of the able-bodied. In other words, the law protects able-bodied people whose psychological suffering makes them suicidal but does not equally protect the disabled.

This is why many disability rights advocates were horrified when, in 2021, Parliament expanded MAiD to people whose natural deaths are not reasonably foreseeable. As Catharine Frazee, a former Ontario Human Rights Commissioner and professor of Disability Studies, remarked, “To reinvent MAiD, so that it is no longer an alternative to a painful death, but for some, an alternative to a painful life, is to embrace uncritically the notion that suffering associated with disability is a burden greater than death.”

The committee majority is right in saying that the suffering of mentally ill persons matters no less than the suffering of the physically ill. They should also affirm that the lives of the physically disabled or chronically ill matter no less than others.

The committee is to be commended for recommending that Parliament delay indefinitely the impending legalization of MAiD for mental illness. But Parliament should restrict MAiD further.

Providing MAiD “consistently and safely” to people with disabilities, chronic illness, or mental disorders should not be the goal we’re working towards as a society. Instead, we should be invested in alleviating the suffering associated with long-term disabilities and illnesses in life-affirming ways.

John Sikkema is an Ottawa lawyer and the Director of Law and Policy of ARPA Canada.

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