Sen. Pamela Wallin (left), Sen. Stan Kutcher and Sen. Marie-Françoise Méghie attend a press conference in Ottawa in February to discuss medical assistance in dying (where mental health is the only underlying condition). We urge governments to meet their obligations regarding access to MAID. .1.Patrick Doyle/Canadian Press
If you’ve ever wondered why we haven’t seen major changes in health care, look no further than how the federal and state governments handle medical assistance for death and mental illness.
Whenever we have to make a somewhat difficult decision, we seem to end up punting it. Don’t do anything because you’re “not ready” without defining what it means to be ready. The institutional and political cowardice is disheartening.
In 2015, the Supreme Court ruled in the Kathleen Carter case, stating that Canadians have a right to MAID, but gave lawmakers time to legislate. A year later, Parliament passed Bill C-14, legalizing MAID, but under the condition that people suffer from a “serious and irreversible condition” and their death is “reasonably foreseeable.” This is limited to cases where The latter condition was struck down in a 2019 Quebec court ruling.
The federal government was given one year to adjust MAID regulations, but it took two years. In March 2021, Bill C-7 removed the “reasonably foreseeable” clause, creating two tracks for MAID requests. However, lawmakers delayed access until March 2023 for cases where the only underlying medical condition is a mental health disorder (MAID-SUMC for short). It was postponed for a further year to give the committee time to consider the issue. With that deadline looming, a joint committee of MPs and senators decided last week that more time is again needed. The federal government jumped on that recommendation and proposed extending the postponement of MAID-SUMC legalization until 2027.
There is no question that granting people with mental illness access to MAID is a complex and challenging issue. We need to balance individual rights with the protection of the vulnerable. However, these decisions must be made on a case-by-case basis between the individual and their health care provider.
The government’s role here is primarily to stay out of the way. Politicians should no more decide who gets access to MAID than they should decide who gets a heart transplant.
We constantly hear that Canada is “not ready” for MAID-SUMC. But in preparation she has two sides. Legally, the government must respect the court’s ruling and ensure that there is no discrimination in her access to MAID by law. Medically speaking, preparation for the expansion of MAID means that a doctor is ready to address three key issues next. Establish that the condition is incurable. Verify that the requester is competent. and distinguish between suicidal patients and those who reasonably and consistently request MAID.
None of these problems are unique to people with mental illnesses, but some are a little more complex. Although some psychiatrists claim that no mental illness is untreatable, there are patients who have suffered for decades who challenge that view. Ultimately, a balance must be found between individual autonomy and the protection of the vulnerable.
There are approximately 96,000 doctors in Canada. At last count (2021), only 1,577 of them had provided MAID. By all accounts, they have done this in a responsible and ethical manner, and as of 2022, they have saved the suffering of approximately 45,000 Canadians.
There are standards of practice for medical assistance in dying that need to be coordinated. Physicians will receive additional training on how to address some of the most difficult issues when reviewing requests from mentally ill patients.
The same applies to processing MAID requests from adult minors and advance requests from people with dementia. (Incidentally, both of these were approved by a joint committee of congressmen and senators, but received little media coverage.)
MAID is an emotional issue with many political, moral and social entanglements. We repeatedly hear concerns that people with mental, physical and developmental disabilities may seek assisted dying because they have difficulty accessing care and social support.
There is no question that access to mental health care needs to be strengthened, especially for the sickest people. According to the latest data from Statistics Canada, there will be 3,593 suicides in 2022, so if you’re worried about suicide rates, why doesn’t Canada have a national suicide strategy? Is it?
Without a doubt, too many people with disabilities live in poverty. But that doesn’t mean MAID should be denied to people who are eligible and request assisted dying. No one should be forced to. But we must not hold individuals hostage until we solve systemic problems.
If there is any doubt about a member’s ability to draft a bill, the matter should be referred directly to the Supreme Court of Canada. This is a very wise recommendation by Senator Pierre Dalphon.
There is no reason to wait until 2027 to change the law when solutions are at hand. The job of legislators is to legislate, not to procrastinate.