‘Hunches’ will determine life or death in MAiD cases with mental illness, critics say

In mere months, federal law will permit Canadians who are mentally ill to access the country’s already permissive assisted-suicide regime on the sole grounds that they are suffering from a mental disorder.

They will not have to show that their illness is a fatal one, nor that their death is imminent, only that they find their mental disorder to be so unbearable that they should be allowed to have themselves put to death.

As the March 2023 deadline for expansion of assisted-suicide eligibility draws ever closer, Catholics from across the country are raising their voices in opposition, with Vancouver Archbishop J. Michael Miller describing the law as “morally depraved.”

Any hope that the federal government would reverse course appeared to be dashed in late October by the Liberal government’s health minister, Jean-Yves Duclos.

Duclos released a little-noticed statement on Oct. 20 that not only appeared to ignore the Special Joint Senate-Commons Committee on MAiD’s request for more time to study the issue, but also embraced the recommendations of a government-appointed “expert panel” which reported in May that the government did not need to undertake any new legislative protections before opening assisted suicide to the mentally ill.

But at least two panel members, Jeffrey Kirby and Ellen Cohen, resigned before the panel released its report to protest its failure to recommend adequate safeguards. 

Kirby, a retired professor in the department of bioethics at Dalhousie University, told The Toronto Star that he believes “more people will end up being approved for MAiD and having MAiD performed than is warranted” because of that failure.

Similarly, Cohen, who worked for 30 years in the field of mental health, wrote in an essay that she felt the panel’s recommendations did not contain sufficient safeguards. 

While the Catholic Church opposes all forms of assisted suicide, the looming expansion of eligibility requirements has sparked renewed and deepened concern.

“Next March, unless the government is forced to change its mind, persons suffering solely from mental illness will become eligible for euthanasia,” Miller said in his homily at the recent White Mass for health-care professionals.

“In six years, Canada has gone from totally banning euthanasia to one of the most permissive euthanasia regimes in the world. And even more access could be coming, including allowing ‘mature minors’ to request it.

“The only way now to minimize the damage to human dignity caused by such morally depraved laws is to work to ensure that palliative care is affordable and accessible to every Canadian,” he said.

Every diocese in Ontario has now joined the pro-palliative-care “No Options, No Choice” initiative, which seeks to persuade provincial governments to spend more on palliative care, mental-health treatments and social and housing supports to ensure that Canadians don’t choose Medical Assistance in Dying (MAiD) out of despair and frustration.

Tthe Saint Elizabeth Health Care foundation, with funding from ShareLife and support from Catholic Charities of the Archdiocese of Toronto, has also opened a special “HopeLine” service to provide information about access to palliative care.

The Canadian Conference of Catholic Bishops told the joint parliamentary committee in May it opposed MAiD and expansing eligibility to the mentally ill.

“The legal expansion of eligibility for MAiD will only serve to erode the respect for the essential dignity of the human person and the common good of society, which must be committed to protecting and safeguarding vulnerable individuals and those without a voice,” said the submission.

While the committee heard many similar presentations from individuals and organizations opposed to allowing the mentally ill access to MAiD, the majority of its senators and members of Parliament reported in June that they supported the expert panel’s finding that sufficient policies were already in place, or were being developed, to enable the practice to proceed. At the same time, the committee asked for more time to conclude its own study of the issue.

A minority of the committee members issued a dissenting report, charging that legislation of this nature needs to be guided by science, and not ideology. 

“We have been warned by several experts that if MAID MD-SUMC (Medical Assistance in Dying where Mental Disorder is the Sole Underlying Medical Condition) is implemented as planned, it will facilitate the deaths of Canadians who could have gotten better, robbing them of the opportunity they may have had to live a fulfilling life,” the dissenters said.

Among the problems they cited was the difficulty of determining whether a patient’s desire for suicide is a symptom of their illness, or whether it is a distinct phenomenon known as suicidal ideation, or having suicidal thoughts.

“I think what is happening is that the government is throwing people with suicidal ideation under the bus,” said Alex Schadenberg, executive director of the Euthanasia Prevention Coalition. “So when a symptom of your condition is suicidal ideation, and they are offering you euthanasia, obviously, there’s a big problem here. What they really need is treatment, not death.”

Conservative MP Michael Cooper said he and the other two MPs who signed the dissenting committee report said it is extremely difficult to determine whether someone suffering from a mental disorder is irremediably ill. By law, however, for someone to be eligible for assisted suicide, a person must have a “grievous and irremediable medical condition.”

“The train has left the station, there’s no question,” Cooper said. “The government has set in motion this significant expansion without study, without consultation, without safeguards and (despite) evidence from experts that, in cases of mental illness, it’s not possible or at least very difficult to determine irremediability.”

Cooper said the May expert-panel report offered no safeguards or practice standards. “Their only safeguard was to say that these decisions, in respect to eligibility (where the sole ground was mental disorder) can be decided on a case-by-case basis. In other words, these decisions are going to be made on the basis of guesses and hunches.”

Cooper said that even in the unlikely event that the special joint committee’s final report in February recommends additional legislative safeguards, Parliament will have no time to enact them before the March implementation date.

“The Liberal government has created an untenable situation,” he said.

Ottawa psychiatrist Dr. Sephora Tang was one of the originators of the physician-led MAiD to MAD initiative in 2020 to inform the public about the dangerous expansion of MAiD eligibility. Tang said regulations expected to be in place in March will fall far short of needed protections and the inadequacies start with federal legislation that lets physicians make subjective determinations of when mental illness qualifies for euthanasia and without minimum standards of treatment before ending a patient’s life.

“When you apply this inadequate framework to people who are suicidal as a symptom of a mental disorder and who are unable to receive or who decline treatment, even for reasons of poverty or inaccessibility due to long wait lists, you get state-sanctioned and -facilitated suicide for people who under different circumstances would have gotten better and lived to see a better day,” said Tang.

Doctors who were previously expected to prevent suicide will be asked instead to facilitate it, she said. “In a health-care system as fractured as our own, with many people struggling simply to survive, Canada’s expanding laws on euthanasia and assisted suicide will lead to many wrongful deaths in a terribly conceived social experiment.”

Tang said it is not too late for the government to put on the brakes “before the MAiD train crashes. Parliament has the power to change course if they have the will and the leadership to travel down another track.”

But will they? she asks. 

“The fates of many lives are perched precariously on political thrones. If things proceed to March 2023 with no changes, as the government to date seems poised to do, the government will have taken away the last legal tool that I and my fellow psychiatrists rely upon to keep our patients alive long enough to recover from their illness.”