Alarm bells don’t get much louder than the written brief from the heads of psychiatry at 13 Canadian medical schools urging Ottawa to stop the expansion of medically assisted death to those whose only condition is mental illness.
The 16 names at the top of the brief, submitted to the Special Joint Committee on Medical Assistance in Dying, are from prominent medical schools across the country. Their objections to the expansion of MAID to those suffering from mental illness are not philosophical; their objections are concrete and clinical.
And their words bear heeding, as Ottawa decides whether to proceed with expanding MAID next March, as is currently legislated. (The provisions for mental illness have been paused since March, 2021.)
“As a society, we must provide hope and support to individuals during periods of despair and psychological suffering. In our clinical and academic experience, 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,“ they wrote, adding they ”strongly believe" that expanding MAID would result in preventable deaths and would undermine suicide prevention efforts.
Psychiatry chairs at medical schools oppose expanding MAID for mental illness
That scenario would not just be a series of individual tragedies, but would be an epic failure of public policy.
Reiterating an earlier submission, those experts flag a series of concerns about allowing euthanasia for those whose sole underlying condition is mental illness: the involvement of a psychiatrist is not mandatory; there is a lack of safeguards to protect vulnerable groups, such as low-income Canadians; geographic inequities in mental health services; there is no broadly accepted definition to differentiate between a request for MAID and suicidal ideation; in other countries, MAID has been used for “common and treatable” mental disorders rather than being limited to rare conditions; and most important, psychiatry does not have an “international or broadly accepted definition of irremediability in mental disorders.”
All of those points raise disturbing questions, but the last one should give every Canadian – particularly those who are federal legislators – pause. The entire legal edifice rests upon the notion that Canadians cannot be expected to live with “a grievous and irremediable medical condition that causes enduring and intolerable suffering,” as the Supreme Court wrote in its landmark 2015 Carter decision.
But if that condition is remediable – if there is a cure or an effective treatment – then the purpose of the MAID law is subverted. People snared in temporary despair, people who could with the right treatment emerge from that despair, would be allowed to have a medical professional kill them.
To this, the supporters of the expansion of MAID to those with mental illness wave a dismissive hand. All diseases are difficult to diagnose; mental illness is no different, they say. Why should those who have exhausted all treatments not have access to MAID, they ask. And it is a violation of the Charter rights of those with mental illness not to have the same right to medically assisted death as those with physical ailments, they contend.
Editorial: The guardrails of MAID need vigilant scrutiny
The first point is fatuous. The question is simple: can it be definitively established that a person’s mental illness is irremediable? Rhetoric is not an answer.
The second point is disingenuous. The actual legislation carries no requirement of an extensive course of treatment. Instead, the law merely stipulates that a person requesting MAID “has been informed of the means available to relieve their suffering.”
And the third counterpoint is overly simplistic. It is beyond dispute that a ban on MAID for reasons of mental illness would be a infringement of Charter rights. But the very first clause of the Charter makes it abundantly clear that such infringements are constitutional, if they are “reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society.”
It is reasonable, surely, to prevent Canadians from being killed if medical science cannot tell if they would or would not recover from their illness.
Sixteen psychiatric experts have sounded the alarm. Ottawa should listen, and permanently shelve the expansion of MAID due to mental illness.