As Canada prepares to expand assisted suicide, advocates warn of threat to mentally ill

Washington, D.C. Newsroom, Jul 31, 2023 / 12:25 pm

Mental health advocates and pro-life activists are expressing concerns over a possible expansion of Canada’s assisted suicide rules that would permit residents to seek fatal medical treatments even if they are not suffering from a fatal affliction.

Canada first legalized assisted suicide in June 2016 for adults suffering from irreversibly deadly illnesses. In 2021 the Canadian government said it would wait an additional two years to extend those services to mentally ill citizens to “study how MAiD [medical assistance in dying] on the basis of a mental illness can safely be provided.”

The government earlier this year extended that delay by another year. Canadians suffering from mental illnesses will be able to apply for assisted suicide by mid-March 2024. 

The looming rule change has generated protracted debate in Canada, with critics arguing that the new directives will allow people to apply for and receive assisted suicide even as they may not be on the verge of death from a terminal illness.

The likelihood of that scenario was underscored by a recent report in Reuters in which 47-year-old Canadian Lisa Pauli revealed her intent to use the state’s upcoming expansion of assisted suicide to end her own life. 

Pauli does not have a terminal illness. Rather, she has suffered from anorexia for much of her life. As she told Reuters, she hopes the soon-to-be-implemented new rules will allow her to apply for a doctor-facilitated lethal dose of pharmaceuticals so that she can kill herself. “I’m so tired. I’m done,” Pauli told the news service of her affliction.

Jeff Gunnarson, the president of Canada’s conservative Campaign Life Coalition (CLC), told CNA his group is “deeply concerned and will push against any talk or action that will see easier access to euthanasia through the so-called medical aid in dying.”

The CLC has embarked on several advocacy campaigns to head off expanded MAID eligibility, Gunnarson said, including pushing for measures such as Bill C-314, which would dictate that “a mental disorder is not a grievous and irremediable medical condition for which a person could receive medical assistance in dying.”

MAiD “is really about permitting the strong and healthy to kill the weak and sick under the veneer of autonomy,” Gunnarson argued earlier this year, with the new expansion meant to “include those who are not dying but are living with disabilities, including those living with mental illness.”

Christian Elia, the executive director of the Ottawa-based Catholic Civil Rights League (CCRL), told CNA the group “has been opposing this and we certainly will be stepping it up” in the wake of the upcoming mental health policy.

The group in a press release this month criticized what it called the “slippery slope” of euthanasia laws in Canada, along with the lack of protections afforded to Catholic doctors and other objectors to assisted suicide.

“The rights of physicians to conscientiously object to killing a patient was never properly enshrined” in Canadian law, the CCRL said, arguing that the Catholic Church has been “at the forefront” of offering dignified, non-suicidal palliative care to dying patients in Canada.

Elia told CNA that he is “hopeful” the mental illness rule will ultimately not come to pass.

“It could’ve been done already,” he said. “We’re hopeful. There has been blowback. The blowback has already caused this delay.” 

“There are many groups of health care professionals who are actually leading the charge and saying this is an ill-conceived idea,” he added. 

Even advocates who have not otherwise voiced opposition to MAiD expressed concern over its broadening to include mental illness. 

Lauren Clegg at Toronto’s Centre for Addiction and Mental Health pointed toward the group’s statements on the medical suicide law. The group has “publicly expressed concern with the federal government’s intention to extend MAiD eligibility to people whose sole medical condition is mental illness at this time,” it said. 

The group implied its concerns might be resolved if experts could answer “whether mental illness can be considered ‘grievous and irremediable’ for the purposes of MAiD, and what criteria should be used to determine if a person is suffering from an irremediable mental illness.”

Anita Federici, the clinical director at Ontario’s Centre for Psychology + Emotion Regulation, told CNA that, for many critics of the expansion, “the issue … is not whether or not MAiD should or can exist.”

“The bigger issues at present are (a) the manner in which terminality has been proposed and the harm this is causing, (b) poorly or ill-defined criteria for palliative and end-of-life decisions, (c) the complete absence of how MAiD and terminality disproportionately impact the most vulnerable in our society,” she said.

In an article for the winter 2023 issue of the Ontario Bulimia Anorexia Nervosa Association’s Be Yourself magazine, Federici argued that individuals with eating disorders are “in an incredibly vulnerable position with respect to MAiD,” in part because of “substantial systemic barriers to care in the field of eating disorders.”

“[H]ow,” Federici wrote, “does one determine whether an eating disorder is incurable or intractable if most cannot access evidence-based care?”

Asked about stories like Pauli’s, Ary Maharaj with Toronto’s National Eating Disorder Information Centre suggested the group was understanding of the desire of severely mentally ill people to want to “end their pain and suffering” using assisted suicide.

But he argued that governments “should be investing in community well-being so as to reduce the social conditions that can cause and perpetuate mental illness.”

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Elia told CNA that activist efforts to push back against broader assisted suicide in Canada could bear fruit in the future.

“There’s some hope that some ray of light can prevail in the darkness of euthanasia,” he said. 

Since its inception in 2016, more than 30,000 Canadians have used the country’s assisted suicide law to end their own lives. The majority of those who in 2021 received lethal medical doses cited cancer as their main underlying medical condition.

The Canadian government, meanwhile, estimates on its website that “1 in 3 Canadians (about 9.1 million people) will be affected by a mental illness during their lifetime.”

The government’s website also offers assistance to Canadians who may be feeling suicidal, arguing that “globally, suicide is recognized as a significant public health issue.”