No clear guidelines in report concerning MAiD (euthanasia) for mental illness 

By Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition

The Final Report of the Expert Panel on MAiD and Mental Illness was submitted to Canada’s Minister of Health, Jean-Yves Duclos and Justice Minister, David Lametti on May 6, 2022.

Similar to previous “expert” reports the Expert Panel offers recommendations but few clear guidelines.

Canada legalized euthanasia and assisted suicide under the term Medical Aid in Dying (MAiD) when the government passed Bill C-14 in June 2016. Previous to that, the Supreme Court of Canada struck down protections in Canadian law that prohibited euthanasia and assisted suicide in its Carter decision and euthanasia became legal in Québec in December 2015 with the implementation of Bill 52.

In March 2021, the Canadian government passed Bill C-7 which expanded the MAiD law by permitting euthanasia for people who are not dying, by eliminating the 10 day waiting period for people who are terminally ill, by permitting euthanasia for incompetent people who were previously approved for MaiD. At the last minute, Bill C-7 was amended to permit euthanasia for people with mental illness.

When passing Bill C-7 the government acknowledged that euthanasia for mental illness was different than other forms of MAiD, so they stated that there would be a two year moratorium on MAiD for mental illness, providing time to develop guidelines around the killing. I believe the two-year moratorium is unenforceable making euthanasia for mental illness legal already.

The Euthanasia Prevention Coalition opposes MAiD. We oppose giving doctors and nurses the right in law to kill people. But considering that the recommendations from the “Expert” Panel on MAiD and Mental Illness concern guidelines for killing people with mental illness, one would think that the guidelines would offer fixed rules . Yet the 19 recommendations for implementing MAiD for mental illness, lack clarity on key recommendations.

For instance, recommendation 2 concerning: Establishing Incurability, states

MAiD assessors should establish incurability with reference to treatment attempts made up to that point, outcomes of those treatments, and severity and duration of illness, disease or disability.

It is not possible to provide fixed rules for how many treatment attempts, how many kinds of treatments, and over what period of time as this will vary according to the nature and severity of medical conditions the person has and their overall health status. This must be assessed on a case-by-case basis.

The Panel is of the view that the requester and assessors must come to a shared understanding that the person has a serious and incurable illness, disease or disability. As with many chronic conditions, the incurability of a mental disorder cannot be established in the absence of multiple attempts at interventions with therapeutic aims.

Incurability is a requirement in Canada’s MAiD law, and yet the Expert Panel has stated that it is not possible to provide fixed rules concerning treatment.

In the Netherlands, a person requesting euthanasia for mental illness must be willing to try effective treatment. This is not an onerous request considering that the person is requesting to be killed.

Similarly, the Expert Panel deals with recommendation 3 concerning: Establishing Irreversibility in the same manner. It states:

MAiD assessors should establish irreversibility with reference to interventions tried that are designed to improve function, including: recognized rehabilitative and supportive measures that have been tried up to that point, outcomes of those interventions, and the duration of decline.

It is not possible to provide fixed rules for how many attempts at interventions, how many types of interventions, and over how much time, as this will vary according to a requester’s baseline function as well as life goals. Therefore, this must be assessed on a case-by-case basis.

The Panel is of the view that the requester and assessors must come to a shared understanding that the person is in an advanced state of irreversible decline in capability.

Once again, Canada’s MAiD law requires that the person’s condition be irreversible and yet the Expert Panel states that it is not possible to provide fixed rules.

I am concerned that the current Special Joint Committee on Medical Assistance in Dying will also follow the same direction of this Expert Panel, by offering recommendations but few clear lines.

The Special Joint Committee on Medical Assistance in Dying (AMAD) is composed of Senators and MPs who are to study and make recommendations concerning:

  1. MAiD for mature minors,
  2. Advance directives for MAiD,
  3. Regulations for Psychiatric MAiD once the C7 sunset clause is lifted March 2023,
  4. The state of palliative care in Canada (was required as part of the 5 year review after C-14 but never completed),
  5. Protections for persons with disabilities.

The mandate of the Special Joint Committee appears oriented to expanding MAiD in Canada.

The Expert Panel made some good recommendations, such as suggesting that assessments be done by independent experts, increasing the reporting requirements, providing income or housing support where necessary, having consultations with First Nations, Métis, and Inuit peoples. Nonetheless, some of these recommendations are too little or too late a response.

People have been lethally injected for loneliness, depression, poverty, chemical sensitivities, fear of isolation and more.

The Expert Panel appears to be attempting to improve Canada’s MAiD law while in reality the fundamental recommendations include no fixed rules.

Remember, the law only requires that a physician or nurse be of the opinion that the person fits the criteria of the law. Therefore, the Report of the Expert Panel on MAiD for Mental illness does not provide any assurances that people who are living with suicidal ideation will not die by euthanasia.

Sadly, Canada legalized euthanasia by giving doctors and nurses the right in law to kill their patients. It only requires that the assessors and the practitioner who lethally injects their patient be of the opinion that the person, who they killed, fit the criteria of the law.

Canada has now expanded the killing to people with mental illness alone and this “Expert Panel” suggests that the killing be done without clear rules.

When will people wake up and realize that killing people is not a solution?

Editor’s note. This appeared at Mr. Schadenberg’s blog and is reposted with permission.