As Canada prepares to expand its euthanasia law to include people with mental illnessSome in the country, including many doctors, wonder if assisted dying legislation has gone too far too fast.
Dr. Madeline Li still remembers the first patient she helped die, about a month after Canada legalized euthanasia in 2016. “I remember how surreal it was,” she said.
As a psychiatrist at Toronto’s Princess Margaret Hospital, she recalled consulting her patient that day, asking her if she had the right music and final meal, and if she was sure she wanted to go through with it. The patient, about 60 years old and who she suffered from ovarian cancer, she said yes.
Five minutes later, the woman was dead.
Canada wrestles with euthanasia for the mentally ill https://t.co/hy4XLHVra1
— BBC News (World) (@BBCWorld) January 14, 2023
“The first fIt was like jumping off a cliff. Then time passes and it normalizes,” said Li, who has since medically supervised hundreds of assisted dying cases.
The doctor repeatedly stressed that a doctor’s personal opinions should not influence how they evaluate a patient. However, she admitted that she has significant concerns about the expansion of euthanasia. beyond the terminally ill. Li isn’t the only one who has reservations about her.
Third modification
Since 2016, Canada’s Medical Assistance in Dying program, known by its acronym ‘MAID’, has been available to terminally ill adults. In 2021, the law was changed to include people with serious and chronic physical conditions, even if that condition was not life-threatening.
And this year it is expected to undergo a new reform to include those who suffer from mental illness.
This expansion has sparked controversy and raised concerns that betoo easy for vulnerable people to die in Canada. Those fears have been stoked by a recent spate of reports suggesting that, for some, death is an alternative to a broken social safety net.
“Presenting death as a solution puts the most vulnerable people at a disadvantage and actually relieves society of the predicament,” Li said.
I don’t think death should be society’s solution to its own failures“he added.
Medically assisted dying came to Canada through the courts. In 2015, the Supreme Court ruled that banning assisted suicide deprived Canadians of their dignity and autonomy. It also gave Parliament a year to legislate on the matter.
In 2016, euthanasia was legalized for those over 18 years of age with a serious and irreversible condition and whose death was “reasonably foreseeable”.
In its first year of application, just over 1,000 people were helped to die, a number that has grown every year since. In 2021, the most recent figures available, there were 10,064 cases, which represents 3.3% of all deaths in Canada.
mixed visions
Opinion polls indicate that Canadians broadly support access to at least some form of assisted suicide.
Death of the terminally ill can often be cruel and slow, the doctors explained to the BBC. In their last days the patients spend their time drifting in and out of a drugged consciousness. The existence of assisted death in these cases, the doctors said, became a balm.
“Almost every time I consider a patient eligible (for MAID), that patient stops worrying about how they’re going to die and starts wondering how they’re going to live,” said Dr. Stefanie Green, president of the Canadian Association of Counselors and Assisted Dying Providers.
“It is objectively therapeutic to give someone a choice”said.
MAID’s expansion last year followed another court decision, after two degenerative disease patients from Montreal filed a lawsuit.
The ruling placed Canada in the handful of countries, including Belgium and the Netherlandswhich allow medically assisted dying for those who are not suffering from a terminal illness.
The change included people whose only medical condition was mental illness, but with a caveat: Assisted suicide applications for psychiatric reasons would be delayed by two years.while the federal government established the appropriate safeguards.
The upcoming enlargement has sparked intense debate and, for some, has sown doubts about the program for non-terminal patients.
Early critics include three United Nations human rights experts, who wrote to the federal government in 2021 warning that the reform could devalue the lives of disabled people by implying that severe disability andyes worse than death.
A series of reports suggesting that some Canadians have opted for assisted dying, at least in part because they could not afford adequate housing. This has also raised fears that it could be used as solution for social problems; that is, people choosing to die due to poverty, homelessness, or extreme loneliness.
“Leaving people to make this decision (to die) because the state is not complying with fundamental human rights is unacceptable,” Marie-Claud Landry, chief commissioner of the Canadian Human Rights Commission, said in a statement issued in May.
worrisome examples
In 2019, Alan Nichols, 61, chose assisted suicide after being admitted to a hospital in the province of British Columbia.
In the days before his death, he was agitated, confused and refused to use the implant that helped him hear, his sister-in-law Trish Nichols told a Senate committee last year. In her application for MAID, the stated reason was “hearing loss”.
“Alan did not have a valid diagnosis,” Nichols denounced. “Would you feel safe taking your loved one to seek medical attention, for their recovery when they no supervision or strict security measures around a procedure that kills people?
Then, last fall, authorities launched an investigation after at least four veterans were invited to consider assisted suicide by a Veterans Affairs social worker, who now no longer works for the department. In one case, veteran and Paralympian Christine Gauthier said the clerk offered her the option after she asked that a wheelchair ramp be installed at her home.
armored law
From the federal government they maintain that the expanded reform law protects vulnerable Canadians and respects the autonomy of the patient. Applicants with serious and incurable but not life-threatening conditions must be evaluated by two independent physicians and go through a 90-day waiting period.
Assisted dying advocates insist that existing protections are strong enough.
“I see the security measures in place and I see them working,” Green said.
“I am not naive, I get it, the lack of support in our community (due to disability, income and housing) contributes to a person’s suffering,” she said. “But in and of itself, if that’s what motivates people to run, will not be eligible“.
Derryck Smith, a Vancouver psychiatrist and member of the organization Dying with Dignity, told the BBC that legal provisions ensure that only a small fraction of Canadians without terminal diagnoses are eligible for MAID. “Look at the statistics,” he said.
In 2021, the average age of an assisted suicide beneficiary was 76 years. 80% had received palliative care and 65% had cancer.
But the inclusion of mental health has raised another set of concerns. Last month, faced with mounting criticism, the Canadian government said that would defer the decision of includedgo mental illnessscheduled for March, to allow for additional studies.
“We want to be prudent, we want to move forward step by step, so as not to make mistakes,” Justice Minister David Lametti said.
Much of the controversy centers on the “irremediability” of a mental illness, that is, whether it is incurable and how it could be assessed. For a person to be eligible for euthanasia in Canada, your condition must be considered irreparable.
The Canadian Mental Health Association has warned that it is “not possible” to determine whether any particular case of mental illness is incurable. and strongly opposes the government decision.
Some leading psychiatrists, such as Karandeep Sonu Gaind of the University of Toronto, have said that the odds of predicting curability are worse than flipping a coin.
Now it is not clear when the reform of the assisted dying law will enter into force. Lametti did not say how long the suspension would last, but there are indications that it is temporary, as courts would likely find such a move unconstitutional.
“We are listening to the observations and responding,” Lametti said last month. “We know that we have to do this right“.
Li welcomed the government’s decision, saying that healthcare providers may now have the opportunity to put in place proper safeguards.
“The time to discuss doing this is over,” he said. “What we have to start talking about is when and how we’re going to get it right.”
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