It is not fair to people suffering from mental illness that MAID will not be extended to them, but we simply don’t really have objective measures of mental illness, Robyn Urback writes.Justin Tang/The Canadian Press
We have some confusing notions of autonomy in this country when it comes to issues around medical assistance in dying (MAID). Some are of the view that people should be allowed to do what they want with their bodies no matter what, and that the state should have little to no role in decisions of life and death. But there is an important difference between letting people do what they want to themselves, and allowing some people to euthanize others who may be in a vulnerable state. It is not paternalistic to try to protect those people, and for the state to err on the side of life where there are questions of capacity, coercion and consent for an act for which there is no going back.
Canada is not ready to extend MAID to individuals whose sole underlying condition is mental illness. That was the determination by The Special Joint Committee on Medical Assistance in Dying, which recommended that Canada “indefinitely exclude” such persons from MAID eligibility ahead of its planned expansion on March 17, 2027. The committee heard from 44 experts including researchers, psychiatrists, academics and people with lived experience of mental illness, and concluded in a report tabled Wednesday that Canada is not of the clinic readiness, health systems readiness, or regulatory readiness to so dramatically expand MAID access across the country.
No, this is not “fair,” in the conventional sense of the word, to people suffering from mental illness. It may even be discriminatory, which is something on which the courts will eventually have to rule. As anyone who has either suffered from mental illness or watched a loved one struggle knows, the pain can be just as bad – if not worse – than physical pain. Indeed, there’s a unique type of anguish that comes with the invisibility of mental distress.
Committee recommends Ottawa not extend MAID to people whose sole condition is mental illness
But the fact remains that we simply don’t really have objective measures of mental illness. As the committee heard, it is incredibly complex – if not impossible – to distinguish between suicidality and a request for MAID. It is also incredibly complex to assess if and when a mental illness becomes “irremediable;” we don’t have PET scans that can tell us when depression has progressed to the point where treatment is no longer possible. Conservative MP Andrew Lawton, who is on the committee, has been incredibly forthright about his own suicide attempt more than 15 years ago, and he is unequivocal: had he had access to MAID for mental illness when he was at his lowest point, he wouldn’t be here today. Proponents of MAID for mental illness insist that there would be safeguards in place to ensure that those in the midst of a crisis would not have access to the procedure, but the safeguards that are currently in place to protect vulnerable Canadians are already failing. Why would we assume that new safeguards for an entirely new stream of MAID applicants would be more successful?
So yes, it is not fair that those suffering from intolerable physical pain in Canada have access to MAID, whereas those suffering from intolerable emotional or psychological pain currently do not – and may not ever if Parliament heeds the committee’s recommendation. But the role of the state is to balance rights and interests that are occasionally in conflict, and in this case, the state’s obligation to ensure that vulnerable people are not euthanized in error must trump any obligation it has to fairness or equal access. A MAID procedure, after all, cannot be undone.
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Many Canadians will be disappointed – even angry – with the committee’s decision. They will see it as an infringement on their autonomy; an unfair double standard, and an unjust denial of their access to a medical procedure. But there is no right to access any medical procedure you want in Canada, and the decision before the committee was not about whether these people have the right to end their lives, but more narrowly about whether the state should allow others to do it for them. And it determined, rightly, that there are too many risks involved with legalizing the procedure under those circumstances. Unless and until we better understand how the brain works, how we can objectively identify treatment-resistant mental illness, and how we can reconcile being a society that at once discourages suicidality but permits MAID for mental illness, that will always be the case.
MAID for terminally ill patients has been a blessing for many Canadians, and one that doesn’t meaningfully test the morality of the state that sanctioned it 10 years ago. These people were going to die within a “reasonably foreseeable” timeline anyway; legalization simply meant they could choose to avoid a final few days or weeks of suffering. But allowing MAID for those whose sole underlying condition is mental illness would be something different entirely. Canada is not ready, and may never be.