Experts warn Canadian medical suicide law is 'most permissive in the world'

Ottawa, Canada, Feb 14, 2020 / 15:00 pm

A new report has warned against expanding access to euthanasia in Canada to those with mental illnesses. The Expert Advisory Group released the report on Medical Assistance in Dying on Thursday, suggesting various safeguards the Canadian government should adopt in order to protect vulnerable populations. 

The Feb. 13 document was written in response to a recent assessment released by a think tank that endorsed MAiD for patients who have a mental illness as their sole underlying medical condition. "MAiD" is the legal term in Canada for the procedure commonly referred to as euthanasia or assisted suicide.

"Unlike other medical conditions with a known, predictable course, evidence shows that mental illnesses can never be predicted to be irremediable," says the report, titled Canada at a Crossroads: Recommendations on Medical Assistance in Dying and Persons with a Mental Disorder.

"MAiD policy and legislation should explicitly acknowledge that determinations of irremediability and irreversible decline cannot be made for mental illnesses at this time, and therefore applications for MAiD for the sole underlying medical condition of a mental disorder cannot fulfill MAiD eligibility requirements," says the report's core recommendation. 

The EAG report was released in response to recommendations from the Halifax Group, published Jan. 30, was titled "MAiD Legislation at a Crossroads: Persons with Mental Disorders as Their Sole Underlying Medical Condition." That report was published by the Institute for Research on Public Policy. 

Dr. K. Sonu Gaind, a psychiatrist from Toronto who coordinates the EAG, said as "evidence shows it's impossible to predict irremediability of mental illnesses," it would dilute the public's view of MAiD, and result in discriminatory practices. 

"Society would think people were being helped to die with MAiD to relieve suffering from an irremediable illness, but in reality we would be ending their lives because of loneliness, poverty, and all sorts of life suffering," Gaind said in the release.

Unlike an illness such as terminal cancer or degenerative neurological disorders, it is possible to get better from a condition such as loneliness, he added.

"I don't think Canadians would support that sort of discrimination," he said. 

Unlike the Halifax Group, which is made up of panelists from the Council of Canadian Academies, the EAG sought to include those with "lived experience with mental illness." None of the members of the Halifax Group met this criteria, which the EAG deemed a "key omission." 

Mark Henick, a member of the EAG who has lived with mental illness and depression for two decades, said in a press release that he would have "absolutely" chosen to end his life through MAiD had the option been available at the time. 

"My suicidal-self wouldn't believe my well-self now," he said in the release, "but that's exactly why I'm so glad that I didn't have access to an immediate solution to my suffering. I would have lost out on so much that I then never imagined could someday be possible, but now am very, very grateful for life."

"Everybody deserves that opportunity," said Henick. 

The EAG's report refuted the Halifax Group's claim that denying euthanasia to those with mental illnesses would be discriminatory.

"In fact, allowing MAiD for mental disorders that cannot actually be determined to be irremediable, while claiming it is being provided for an irremediable condition, would be the ultimate form of discrimination," says the report. 

In September, the Quebec Superior Court ruled that MAiD should not be restricted only to those with a terminal illness or a "reasonably foreseeable death." The Canadian federal government announced that they do not intend to appeal the decision and will let it stand. The law will go into effect in March. 

Prior to this decision, a Canadian would have to be an adult with a "reasonably foreseeable death" in order to be eligible for an "assisted death." There is no legal requirement for a patient to receive a prognosis of a certain number of months or weeks left to live in order to receive "assisted death." 

The EAG report warned that these incoming changes will result in Canada becoming "the most permissive jurisdiction in the world for MAiD, with the fewest safeguards against unwanted deaths, unless additional safeguards are introduced." 

In other countries, the report explains, patients are required to show a "lack of reasonable alternatives" prior to being approved for euthanasia. Canada would be the only jurisdiction to lack this safeguard. 

The EAG is recommending that a "non-ambivalence criterion should be required for MAiD in situations when death is not reasonably foreseeable," as well as a criterion for "lack of reasonable alternative" for potential MAiD patients who do not have a reasonably foreseeable death. 

During the first 10 months of 2018, about 1.1% of all deaths in Canada were a result of euthanasia. Unlike in the United States, where assisted suicide patients must self-administer the drugs, a patient can opt to have the doctor administer the lethal medication, and the vast majority of Canadian MAiD patients do not self-administer.

If a similar ratio of deaths were recorded in the United States, approximately 30,000 people--the equivalent of the total number of gun deaths each year--would die each year at the hands of doctor or nurse administered dosages.