A special parliamentary committee is set to release a report this week that could shape the federal government’s decision on whether to allow those suffering solely from a mental illness to obtain medically assisted deaths.
Conservative and NDP members of the joint committee on medical assistance in dying (MAID) say they want an indefinite pause on the pending expansion of MAID eligibility to include cases of mental illness. That expansion is set to take place on March 17.
“Canada isn’t ready,” said committee member Michael Cooper, Conservative MP for St. Albert—Edmonton.
The committee, made up of 15 MPs and senators, was tasked by the federal government last fall with determining whether the health-care system is prepared for the expansion.
Witnesses from legal and medical backgrounds gave committee members a wide range of perspectives on both sides of the highly charged issue.
Cooper said he was swayed by psychiatrists who told the committee it would be difficult — if not impossible — for medical professionals to decide whether a mental illness is beyond treatment, or whether someone’s request for MAID is rational or motivated by suicidal ideation.
“These Liberals have put ideology ahead of evidence-based decision making,” Cooper said.
Another committee member, Nova Scotia Sen. Stanley Kutcher, disagrees.
Kucher said Canadians suffering from irremediable mental illnesses deserve the same rights as those with grievous physical illnesses.
“What I think we need to be led by is … compassion,” said Kutcher, a psychiatrist who pushed for MAID to include mental illness.
“We can’t discriminate against some people being allowed to make an end-of-life choice.”
Committee playing catch-up
The committee was formed back in 2021 after Parliament passed a bill that expanded MAID to include people with mental illnesses. The bill was amended when senators voted to impose an 18-month time limit on the bill’s proposed blanket ban on assisted dying for people suffering solely from mental illnesses.
B.C. NDP MP Alistair MacGregor, one of the committee’s vice-chairs, said the law was changed without proper consultation, leaving Parliamentarians and many different sectors of Canadian society struggling to catch up.
“It feels like on this issue, [the government has] been building the plane while it’s flying mid-air,” said MacGregor, who represents the riding of Cowichan—Malahat—Langford.
“It all speaks to the Liberals’ mismanagement on this file from the get-go, which has now left us in some kind of legal limbo.”
The government has paused the expansion of MAID once already — to March 17. Health Minister Mark Holland is not ruling out another delay.
An extended pause would require the government to introduce legislation, which would need to obtain royal assent by the March 17 deadline.
Holland said the government will make a decision after the committee’s findings are tabled. The committee’s deadline for submitting its report is Jan. 31.
“We certainly recognize that there is equivalency between physical suffering and mental suffering,” Holland said. “But we need to make sure that the supports are there, that the training is in place.”
Is Canada ready?
Holland acknowledged the concerns raised by both experts who testified at committee and by provincial and territorial governments.
The Quebec government is not planning to expand MAID to those with a mental disorder. The province has stated that mental illness is “not considered to be an illness” for the purposes of MAID.
Helen Long, CEO Dying With Dignity Canada, said the government fulfilled three main preconditions for extending MAID eligibility to mental illness: expanding data collection, establishing a national curriculum for medical professionals and developing practice standards.
“They are prepared to move ahead,” Long said.
Only a small number of people whose sole medical condition is a mental illness would be eligible for MAID, said Long. She said they’re individuals who have endured many years of suffering and have tried multiple treatments.
Dr. Jitender Sareen is part of a group of eight university psychiatry chairs who wrote to federal ministers and urged the committee not to expand MAID to include mental illness.
Sareen said practice standards to guide psychiatrists and clinicians are inadequate, and Canada is lagging behind other countries in mental health and addictions funding.
“Offering death when the person has not had the opportunity to get better, with or without treatment, is, in our opinion, not acceptable,” said Sareen, a professor and head of the department of psychiatry at the University of Manitoba.
Protecting the most vulnerable
Dr. Sonu Gaind, a professor at the University of Toronto and chief of psychiatry at Sunnybrook Health Sciences Centre, said there aren’t enough safeguards in place to protect the most vulnerable.
“If it were to go ahead as planned currently, it would be quite irresponsible,” Gaind said.
Green Party Leader Elizabeth May said she supports the expansion but does not think it should go ahead until there are better social and economic supports in place, such as a guaranteed livable income.
“Right now, we could never say with any degree of certainty that no one in Canada would seek MAID because they were unhoused, because they couldn’t afford the rent,” May said.
Health Canada reported 13,241 people received medically assisted deaths in 2022 — a 31.2 per cent jump over 2021.
It says 44,958 people have received medically assisted deaths since the introduction of federal legislation in 2016.
