The heads of psychiatry at 13 Canadian medical schools are calling on the federal government to halt the expansion of assisted dying to people whose sole condition is mental illness.
In a letter addressed to the parliamentary committee that is exploring this issue, the chairs argue that there is no accurate way to determine when a mental disorder is incurable, no way to distinguish between suicidality and a MAID request, and no way to adequately protect vulnerable patients.
Following its final meeting May 5, the committee is expected to issue its recommendation to the government on whether to go ahead with the expansion in March.
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The signatories argue that allowing those suffering from mental illness alone to access MAID will lead to preventable deaths.
“People can and do recover from prolonged suffering related to mental disorders such as depression, anxiety, schizophrenia, and substance use when provided with appropriate, evidence-based treatments and supports,” states the letter, which was obtained by The Globe. The document was signed by the 13 psychiatry chairs, as well as three former chairs.
Based on the current guidance, they add, patients in underserved areas may “receive MAID rather than evidence-based care.”
“We strongly recommend an indefinite pause on expanding Medical Assistance in Dying (MAID) to include mental disorders as the sole underlying medical condition.”
When Canada legalized medical assistance in dying in 2016, it was limited to people whose deaths were reasonably foreseeable. In 2021, following a Charter challenge, it was broadened to those whose deaths were not naturally imminent. Now Canada is set to expand MAID to patients whose sole condition is mental illness.
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The Liberal government is weighing whether to allow this expansion to go ahead. The proposal is controversial, and has exposed a deep divide within the medical community. Some argue that chronic sufferers of severe mental illness should have the same access to MAID as those whose suffering is physical in nature. But an increasingly vocal group of physicians is warning the field lacks the tools and guardrails to safely assess such requests.
Both Alberta and Quebec have passed legislation barring MAID when the sole condition is mental illness.
To date, the Liberal government has not said what it plans to do.
The committee co-chair Marcus Powlowski told The Globe that they will vote this spring to recommend expanding MAID for mental illness, delay it, or stop it indefinitely.
Dr. Powlowski, an Ontario physician, said he won’t pre-judge the committee’s work but conceded that he has been critical of psychiatric MAID in the past.
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In a 2023 Facebook post, he wrote that in medicine, a “tincture of time is sometimes the best approach,” and that granting MAID to people “in the depths of depression and despair” is “not doing them or their loved ones a favor, nor is it good medical practice.”
“I’m not denying the very useful baggage I come with.” As an acute care physician in Thunder Bay, he routinely treated suicidal patients, he added. “I think that is useful, real-world education.”
He said the committee is under pressure to report to Prime Minister Mark Carney quickly, given the looming summer hiatus in June.
One of the letter’s signatories, Jitender Sareen, the head of the University of Manitoba’s psychiatry department, said his colleagues are asking the government to stop the expansion.
“The main point is that we don’t think that in two years or five years we’ll be able to resolve this,” he said.
Dr. Sareen, who has 25 years of experience as a psychiatrist, including treating marginalized patient populations, noted that he signed a similar statement by department chairs in 2022, calling for a delay in expanding MAID to cover mental illness. “Many of our concerns have not been addressed.”
Chief among them, he said, is that there is no broadly accepted definition of irremediability — meaning the patient’s suffering can not be improved — in mental disorders and that there is no accepted mechanism for distinguishing suicidal ideation from MAID requests.
Dr. Sareen, who is also the co-chair of the Manitoba Provincial Psychiatry Council, said that psychiatrists in that province have asked its legislature to exclude mental illness as a sole basis for accessing MAID.
Karin Neufeld, the chair of McMaster University’s psychiatry department and signatory to the written brief to the parliamentary committee, said many of her peers are convinced there is no way to fix “the two fundamental problems” related to irremediability and distinguishing between suicidal ideation and a MAID request.
But not everyone agrees.
Jocelyn Downie, a professor emeritus at Dalhousie University’s faculties of law and medicine, is among them. She warns that barring patients with mental illness from accessing MAID is a breach of their Charter rights.
However, at a hearing at the committee on Tuesday night, lawmakers heard testimony from physicians, researchers and Indigenous leaders who overwhelmingly suggested caution.
Sanjeev Sockalingam, the chief medical officer at Toronto’s Centre for Addiction and Mental Health, the country’s largest mental health teaching hospital, testified that CAMH continues to be “concerned” about the expansion of MAID to those with mental illness alone.
The committee also heard from Prof. Brian Mishara, who heads the Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices at the Université du Québec à Montréal. Dr. Mishara has studied psychiatric euthanasia in the Netherlands, where it has been legal since 2002.
Initially, just one or two requests were approved each year, he explained. However, after news stories about people with depression receiving euthanasia, requests began to spike. There were 138 deaths in 2023 and 219 deaths the following year, he said. “Most were depressed women living alone, under the age of 24.”