Canada’s ever-accelerating expansion of physician-assisted suicide gained significant momentum with the government’s March 2021 decision to allow mental illness as a qualifying reason to seek physician-assisted suicide (PAS), referred to in Canada as Medical Assistance in Dying (MAiD).
While MAiD advocates originally insisted that adequate safeguards were in place to prevent the dramatic expansion of PAS and to prevent abuse of populations vulnerable to coercion, those safeguards have been routinely and rapidly dispatched in the years since MAiD’s 2016 legalization. Euthanasia and assisted suicide deaths jumped 17% in Canada in just one year, from 5,631 citizens in 2019 to 7,595 in 2020.
Previously, precluding mentally ill individuals from accessing physician-assisted suicide was understood to be a necessary safeguard against abuse of a vulnerable population, as substantial mental duress can cloud a person’s judgment and ability to think clearly. Additionally, individuals battling depression or other mental illnesses did not qualify for PAS because time of death related to mental illness is not “reasonably foreseeable” as was stipulated by the law. But the government swept out the “reasonably foreseeable” death requirement in March, and with seemingly no regard for mentally ill individuals or those with disabilities.
While many Canadian politicians are fully on board with the expansion of MAiD, one member of Parliament (MP) Michael Cooper recently expressed strong reservations about the March 2021 erasure of the “reasonably foreseeable” clause from the books without due process to explore the potential implications of such a decision. Cooper was recently named to the Special Joint Committee on Medical Assistance in Dying, which addresses “issues surrounding palliative care, advanced directives, protections for persons with disabilities, mature minors, and mental illness.”
He commented, “The government has opened the door and this without any comprehensive study … instead of studying the issue first … the government recklessly has moved ahead.” He noted, “We have a special committee that is studying, among other issues, the issue of mental illness, even though the train has left the station… Many mental health professionals have said that it is not possible to determine your irremediability, and it’s not possible to determine whether someone’s underlying mental health condition can get better.”
Cooper expressed concern that “[w]e are opening the door to rendering permissible medical assistance and dying to very vulnerable segments of Canadian society. It raises, obviously, questions that have to be addressed to ensure that there are appropriate safeguards. But again, before we can analyze and assess what sorts of safeguards should be provided for, I reiterate, the first question is, ‘should we have gone down this road in the first place?'”
The president of the Canadian Psychiatric Association, Dr. Grainne Neilson, dismissed Cooper’s concerns by conflating mental illness with medical illness, which has qualified individuals for MAiD under certain conditions for years. In fact, though, mental illness cannot simply be lumped in under the ‘medical illness’ category because it is often related to an interplay of psychological, social, physiological, and other factors, whereas medical illnesses are understood to have primarily biological cause(s) and thus biological treatments. Neilson’s words regrettably absolve society of the responsibility to address the undeniable social support needs of individuals living with mental illness, who deserve competent and compassionate mental health care.
Dr. Brendan Leier, an ethics professor at the University of Alberta, expressed concern that despair is what leads individuals with mental illness to seek recourse to MAiD. He stated, “I don’t think that anyone should ever end their life simply from despair – despair of either hope, or despair of alleviation from pain. Despair is never a great situation that anyone should act from. That’s my concern and that’s my consideration that any decision from despair should be avoided, and we should facilitate avoiding.”
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