JAIMEE MARSHALL

Wealth of Geeks via AP

On March 17, Canada’s Bill C-7 was scheduled to go into effect, expanding the country’s Medical Assistance in Dying (MAiD) law to include those experiencing psychological suffering from mental illness.

However, after widespread condemnation of the bill by psychiatrists and physicians, justice minister David Lametti has announced Canada will now delay the expansion of MAiD until March of 2024.

MAiD was first introduced in Canada in 2016 and was available only to terminally ill patients. At the time, a patient’s demise had to be reasonably foreseeable to be eligible. However, the eligibility requirements were expanded last year to include people with serious and irreversible illnesses or disabilities that cause intolerable suffering.

This did away with the requirement that the patient’s demise be imminent. The law is being expanded once again to include purely psychological suffering. In the process, it also revokes a previous rule that required patients to be able to give final consent at their time of passing.

The Changes to Come

While eight other countries in the world allow medically assisted termination of life, as well as some states in the U.S., very few countries allow the termination of life on the grounds of psychological suffering alone. Canada’s new policy is the most liberal assisted suicide policy in the world.

Belgium and the Netherlands legalized assisted self-expiration in the early 2000s. Though they allow the procedure for mental suffering and have faced great criticism for doing so, even they have stricter requirements than Canada.

These countries have safeguards in place to discourage patients from opting to end their life instead of seeking better mental health care. In these European countries, a patient seeking medically assisted termination must prove they have explored recommended treatments before they are allowed to seek MAiD. In Canadian implementation, patients are not required to exhaust all of their options before choosing to end their life.

If a patient is dealing with any mental health condition causing them psychological anguish, they need only apply for MAiD and undergo a 90-day assessment if they are not facing imminent demise.

The expansion of MAiD to include patients with other disabilities who were not facing imminent demise sparked fears that those with disabilities would be singled out and at the highest risk of being pressured into ending their lives. Now that it includes those with mental illness, critics are concerned Canada is leaving its most vulnerable citizens to perish rather than offering help.

Concerns Over Premature Termination of Life

While proponents of MAiD initially insisted that the law would not be very popular and would only be used in isolated and extreme circumstances, Canada has fallen victim to the slippery slope of government-endorsed euthanasia as other countries have.

The popularity of MAiD in Canada has increased exponentially over the years and is expanding to more citizens. In 2021, 3.3% of Canada’s population died from assisted terminations. That’s well over 10,000 people even before this new expansion. There are concerns that those living in poverty with limited access to social programs and mental health services are at high risk of ending their life. Critics of bill C-7, including psychiatrists, are concerned that it relegates certain classes of people as ‘disposable.’

For someone to seek MAiD, they must be at least 18 years old, of sound mind, and not be externally pressured into seeking the end of their life. As of March 17, patients can end their life through MAiD if they experience physical or psychological suffering that is deemed unbearable and untreatable.

Challenges in Extending MAiD to Include Psychological Suffering

This expansion of MAiD faces several challenges in implementation. First, there is no framework to determine that someone dealing with psychological anguish is untreatable or irremediable.

Dr. Jack Haggarty, Academic Chair of Psychiatry at Northern Ontario School of Medicine, insists that there is no mental health condition where we can definitively say a patient suffering from that condition cannot get better.

Dr. John Mahar, psychiatrist and president of the Ontario Association for ACT and FACT, concurs. “I’m not all disagreeing that there are people who have an irremediable illness. What I defy you or any other person in the universe to prove to me is that it’s this person in front of you because I don’t know who that is,” Maher told W5 News.

Maher continues to explain that he’s had patients come to him who improve after 5, 10, or even 15 years. The potential for rehabilitation from a mental illness, whether it’s depression, PTSD, schizophrenia, or a personality disorder, is always there.

The new legislation also places patients with impulsive and emotional disturbances, such as borderline personality disorder or bipolar disorder, at high risk of electing to end their lives when they are not in the right state of mind. If they were offered mental health treatment rather than offered to end their lives, they might later regret their impending desires.

One of the conditions of MAiD is that the patient must be of sound mind, but the bill allows patients suffering from serious mental illnesses to sign away their life without being required to seek mental health treatment as an alternative.

Borderline Personality Disorder (BPD) is a personality disorder that disproportionately affects women. It’s characterized by an unstable sense of self and a reduced ability to regulate emotions.

Some hallmark symptoms of BPD are suicidal ideation, self-harm, chronic feelings of emptiness, extreme fluctuations in mood within a period of hours, impulsivity (including a high risk for dangerous behaviors), dissociation, and extreme interpersonal relationships that fluctuate between idealization and devaluation (splitting).

Despite the suffering many women experience from this personality disorder, the response to treatment is incredibly optimistic. It’s a highly treatable disorder. The prognosis for BPD is better than for patients diagnosed with depression or bipolar disorder.

Most people with BPD live high-quality lives and significantly improve their symptoms once they seek treatment. However, if someone with this personality disorder was to be hospitalized prior to receiving a diagnosis, under the new law, they may be offered the option to end their life – something that may feel right to them in the heat of intense emotions.

First, Do No Harm.

One of the key problems with the implementation of MAiD is this – which deaths should be prevented and which should be enabled?

A patient suffering from hopeless thoughts used to be provided mental health treatment or hospitalized, and anything they could use to harm themselves or end their life removed from them.

Now, the Canadian healthcare system provides different options.

This isn’t to say that mercifully ending a life is never warranted, but how can such a policy with the potential to prey on mentally vulnerable patients be anything but harmful?

Because healthcare is a right in Canada, excluding patients dealing with psychological suffering from MAiD is deemed discrimination, violating the Canadian Charter of Rights. This is why the bill was amended.

Even worse, mental health and medical professionals now need to inform patients about MAiD, because not informing patients of all available treatment options is discrimination. This starkly contrasts with the approach in Belgium and the Netherlands, where doctors are forbidden from suggesting MAiD.

This has led to a number of complaints of disabled and mentally struggling patients being recommended the final procedure seemingly out of the blue. One such case was a veteran with PTSD who sought help for traumatic brain injuries sustained in combat.

He was casually recommended euthanasia by an employee of Veterans Affairs Canada – something the veteran never expressed interest in and was abruptly disgusted by. This isn’t an isolated case. A woman suffering from chemical sensitivities opted to end her life with MAiD because she couldn’t find access to appropriate housing.

Others were suggested MAiD alongside information about how much money it cost to take care of them, which made patients feel threatened. A hospital was sued after terminating the life of a man without notifying the family, something the hospital, rightly, says it has no obligation to do out of respect for patient privacy.

This raises another concern, if a despondent family member secretly fills out an application for MAiD and is quickly approved, families may not have the chance to offer help before they end their life.

This places doubts over whether patients are really consenting to terminate their life or if they’re being coerced into it. Patients who could improve with mental health treatment but face barriers to care for financial reasons may seek MAiD because they lack options.

This has already been seen with disabled patients who can’t afford housing or receive disability benefits that place them below the poverty line. Canada is looking to expand the law even further to mature minors. Mature minors are children under 18 years old who meet the same requirements.

Other Concerns

Some skeptics express concern that doctors may feel pressured to suggest MAiD to patients who otherwise would not have sought it because it costs the medical system too much money to care for them.

Many Canadians face long wait times to seek the health care they need. If patients can’t afford to wait for medical treatment or mental health care, what’s stopping them from opting to end their life instead? Should medical professionals try to stop them? Under the new law, can they?

These questions have gone largely unanswered by the Canadian government.

Closing Thoughts

We rely on mental health professionals to save us from jumping off the ledge, not to push us off. While there may be a place for euthanasia for extreme cases of psychological suffering, it’s not something to be taken lightly and should be an extensive process that is not approved within just a few days.