Canada is delaying plans which would allow people with mental illness to access medically assisted death amid concern from some clinicians that the healthcare system is not prepared to handle the complicated cases.
Starting March 2023, Canada is expected to become one of the few countries in the world to allow physician-assisted death for chronic mental disorders.
But on Thursday, the justice minister, David Lametti, said the government would seek to delay the expansion of medical assistance in dying (Maid), following criticism from psychiatrists and physicians across the country.
“We are listening to what we are hearing and being responsive, to make sure we move forward in a prudent way. We know we need to get this right in order to protect those who are vulnerable and also to support an individual’s autonomy and freedom of choice,” Lametti said.
Both he and the country’s mental health and addictions minister, Carolyn Bennett, reiterated their belief there were adequate procedural safeguards in place.
When Canada first passed laws allowing medical assistance in dying in 2016, only patients with a terminal illness were eligible for the procedure. But in 2019, a Quebec judge found the rule unconstitutional, pushing lawmakers to amend the existing laws to include adults who didn’t have a reasonably foreseeable death.
Bill C-7, which passed in March 2021, reflected the court’s concerns, but lawmakers implemented a two-year ban on patients with mental illness as the sole cause of accessing assisted death, giving them more time to study the issue. That study would have ended 17 March.
In recent weeks, psychiatrists have spoken out about a lack of preparedness within the healthcare system. Media reports have also highlighted controversial cases, increasingly polarizing the issue.
Another delay would require new legislation, something parliament would have to take up – and move quickly on – when it returns in late January.
“We have begun to have discussions informally,” said Lametti. “We do think there is widespread support.”
Madeline Li, a psychiatrist at Princess Margaret Cancer Care in Toronto said she was relieved at the government’s decision to delay expansion.
“It makes me proud to be Canadian, knowing that our government really meant it when they committed to balancing a respect for autonomy with protecting the vulnerable,” said Li. “And I think that this actually gives clinicians time to learn and reflect and think about how we can improve the safety of our Maid practice … This gives us the time to improve our overall quality of care.
Li hopes the additional time will help clinicians develop a set of nationwide “best practices guidelines” to address what she sees as legislative gaps that are currently filled by the provinces.
Recognizing a “spectrum of opinion amongst psychiatrists”, Li feels the current rules gives too much latitude to practitioners: “I don’t think a Maid decision should be influenced by an individual clinician’s values.”
Other experts don’t see any justification for claims that there is no institutional readiness to include mental illness as a criterion.
“What does ‘readiness’ look like? Exactly what does that mean? What has to be done in order to be ‘ready’ and how are we going to know that we have accomplished it?” asked Mona Gupta, a psychiatrist at the University of Montreal and the chair of the federal panel on Maid and Mental Illness. “If we looked at all sorts of complex, high-stakes medical activities in our healthcare systems, where there are matters of life and death, you could find, across the country, pockets of lack of readiness for all sorts of things. But that doesn’t mean we don’t do it.”
Gupta cautioned that the government’s decision further delayed active recognition of rights that the federal government had previously acknowledged existed.
“If a government is going to make a decision to continue to deprive a specific group of people … a right that all other members of society are entitled to exercise, then it must be based on some compelling logic,” said Gupta, adding the term “expansion” didn’t capture her view that the federal government made a decision “to prolong the the deprivation of rights” for people suffering a chronic mental illness. “There must be specific benchmarks for when this continued deprivation of rights will cease.”
Advocacy groups also criticized the federal government’s decision.
Dying With Dignity Canada said it was “disappointed” the ban on accessing assisted death would be extended.
“The current exclusion of those with a mental disorder from end-of-life choice is stigmatizing, discriminatory and unconstitutional,” the group said in a statement. “We must avoid creating barriers that will prolong grievous suffering.”
Justice minister Lametti hasn’t indicated how long of a delay the government would seek. To pass any legislation, the governing Liberals would need support from opposition parties.
