This week, Health Minister Mark Holland endorsed a recommendation from a parliamentary committee to defer the enactment of the law.Christinne Muschi/The Canadian Press
The Liberal government is trying to portray its (second) delay of the expansion of medically assisted death to those suffering solely from mental illness as a mere hiccup, a brief pause that will allow Ottawa to iron out some nagging technical issues.
“It’s clear from the conversations we’ve had that the system is at this time not ready, and we therefore need more time,” Health Minister Mark Holland told reporters on Monday, as the government endorsed a recommendation from a parliamentary committee to defer the enactment of the law, likely for another year.
But Mr. Holland defended the premise of the law, saying it will help Canadians who have been trapped “in a mental-health nightmare” for decades and who want the relief of death “after trying absolutely everything.”
Those statements are misleading, both in how the government is describing the law and how it is characterizing the challenges it must surmount before it could responsibly expand medically assisted death to those suffering only from mental illness.
For a start, the legislation that Mr. Holland is defending does not require that a MAID applicant have exhausted all possible treatments. Some European countries that offer MAID to the mentally ill have stipulated such provisions. Canada has not. (Nor has this country legislated additional safeguards, such as requiring that a trained psychiatrist be included among those approving a MAID application from a mentally ill person.) Even more worrisome, the government is simply brushing aside the fundamental issue facing its MAID legislation: Is it even possible to determine if a mental illness is irremediable?
Irremediability is one of the legal standards articulated by the Supreme Court in its 2015 landmark decision opening the door for medically assisted death for physical ailments. Beyond that legal requirement, there is a moral imperative: authorizing medical officials to end the life of someone to relieve unending suffering is one thing. Ending the life of a person who might eventually regain their health is an entirely different matter.
That is the point that came up, time and again, in the parliamentary commission’s hearings in November. It is irrefutable that there is not a consensus within the psychiatric community over whether irremediable mental illness can be reliably diagnosed. (That same lack of consensus manifested itself on the committee, with a dissenting opinion from the main report.)
Trained and experienced psychiatrists correctly predicted the likelihood of a long-term recovery in just 47 per cent of cases, according to one notable study. A random person flipping a coin would do better.
Expert witnesses at the committee, who were supporters of the expansion of MAID, tried to wave away that problem, saying that clinicians deal with uncertainty as a matter of course. That is a flippant answer to the serious point that a (not quite) 50-50 chance is woefully insufficient to be deciding matters of life and death.
Such uncertainty does not diminish the very real suffering of someone afflicted with mental illness. It does not diminish the need to ensure that adequate public resources are devoted to treating mental illness.
Faced with such concerns, the Quebec government has wisely backed away from authorizing medically assisted death for those suffering only from mental illness. The province expanded its law to include neurocognitive disorders such as Alzheimer’s but continues to exclude other mental disorders.
Seven other provinces, and all the territories, are not willing to go that far, instead asking Ottawa for an indefinite pause on its MAID expansion in order to “ensure a consistent and safe approach across the country that includes appropriate safeguards.”
Those governments are also trying to avoid the unavoidable problem with the contemplated expansion of MAID to the mentally ill: there is no safe approach if there is no way of knowing if a mental disease cannot be cured a few years down the road.
A delay is not enough. Ottawa needs to withdraw its bill, until such time that it can demonstrate that there is a strong consensus among clinicians that irremediable mental illness can be reliably diagnosed.