Stop MAiD expansion in its tracks

The timeframe to extend medical assistance in dying (MAiD) to those living with a mental illness is fast approaching. From March 17 onward, people whose sole condition is a mental illness are expected to be eligible to end their suffering through MAID.

This was supposed to occur last March. Following outcry from mental health professionals, the federal government announced a one-year delay to “provide additional time to prepare for the safe and consistent assessment and provision of MAID” and to fully examine the Expert Panel on MAID and Mental Illness’s May 2022 final report.

Almost one year later, have the concerns of mental health professionals been resolved? Is most of the mental health community on board with the mentally ill being able to access MAID?

Judging by some recent news reports — no, and no:

A Dec. 17 Canadian Press report quotes Dr. Tarek Rajji, chair of the Centre for Addiction and Mental Health’s medical advisory committee: “At this time, the health-care system is not ready and health-care providers do not have the resources they need to provide high quality, standardized and equitable MAiD services.”

A Nov. 6, 2023 report in the National Post quotes Dr. Sonu Gaind, chief of the psychiatry department at Sunnybrook Health Sciences Centre in Toronto: “… at least half the people who assessors say, ‘You’re not going to get better from your mental illness, and you can get MAiD,’ at least half of those people would have gotten better. Meaning, we would have provided death under a false pretence.”

A December 6, 2023 report in Policy Options says “… offering MAiD for mental illness — especially if there are indications of suicidality — could transform psychiatry’s approach from suicide prevention to suicide assistance.”

Yet, despite these and other objections, the federal government seems determined to push ahead with the MAiD expansion, as it notes on its MAiD website.

The seemingly innocuous acronym MAiD hides an ugly truth: the practice itself is state-sanctioned suicide. Says the Policy Options article: “MAiD is viewed as rational not because it is necessarily distinct from suicide, but because Canadian law and policymakers have agreed a desire to die in certain circumstances is understandable. And, therefore, it is appropriate for the state to facilitate.”  

In its early days, aided by heart-wrenching accounts of intolerable suffering, doctor-assisted suicide was portrayed as a compassionate, merciful way to end the agony of those on death’s doorstep.

The goalpost shifted to include those whose death was not immediately foreseeable and then, not foreseeable at all; “compassion” and “mercy” expanded to embrace ideas of agency and self-determination. Heartwarming stories of people choosing to “die with dignity” on their own terms has romanticized and glorified the practice.

Opening the door to mental illness is extremely worrying.

Experts widely agree MAiD requirements of proving irremediability — a condition impossible to remedy or cure — and irreversible decline can’t be made for mental illness, with one research paper concluding that “clinicians cannot accurately predict long-term chances of recovery in a particular patient with TRD (treatment-resistant depression).”

Mental illness can cloud one’s rational thinking, so the full knowledge and consent requirements for people with a mental illness seeking doctor-assisted suicide would be difficult to enforce. Suicidal thoughts and actions are frequently part of the mental illness processes but are often temporary and stop with proper treatment. Psychologists note that opening up doctor-assisted suicide to mental illness makes the line between euthanasia and suicide indistinguishable.

Yet resources to deal with suicide ideation and other challenges are stretched to the limit. The Canadian Mental Health Association says its focus is on making sure people living with mental illness have all the support they need to be well: “An absence of affordable housing, income supports and/or food security must not be the reason someone chooses MAiD.” This is already occurring with alarming frequency.

Mental illnesses and their cures are still not widely understood, with the difference between a mental health challenge and an illness being unclear. For example, youth struggling with chronic stress and anxiety may see their suffering as being similar to people living with a diagnosed mental illness and may seek doctor-assisted suicide or take matters into their own hands. The practice then becomes a way to end suffering of all types. 

Doctor-assisted suicide manifests the culture of death pervading our society, clearing the way for the disposal of the elderly, sick, disabled and mentally ill by those who deem such “lives not worth living.” MAiD must be stopped in its tracks now.

(Majtenyi is a public relations officer specializing in research at an Ontario university.)