The federal Liberal Party faces a choice in early 2024. It could allow for a sunset clause to extend eligibility for medical assistance in dying to adults whose only reason for death is mental illness.
Or we could do what we did in 2023 and postpone it further, or even indefinitely.
Justice Minister Arif Virani said the government was considering its options as the March deadline approaches.
The first step, he said, is to see what congressmen and senators recommend after the committee hearings that investigated the issue this fall.
To find the answers, The Canadian Press spoke to many medical and legal experts who participated in the process.
Here are five questions at the heart of the discussion.
Is Canada ready?
Assessors and providers of medical assistance in dying, as well as medical regulators, say they are open to expanding eligibility.
“I hope the government isn’t influenced by concerns that regulators aren’t ready,” said Gus Grant, CEO and registrar of the College of Physicians and Surgeons of Nova Scotia. Stated.
Since medical assistance in dying became legal in 2016, many voices have sounded the alarm about whether medical professionals are ready for the changes.
A new bill introduced in Quebec would allow people with serious and incurable illnesses to give their prior consent to end their lives with medical assistance in dying.
“Those voices have been proven wrong each time,” Grant, a former president of the Canadian Federation of Healthcare Regulatory Authorities, said in an interview.
“Medical regulators and relevant medical professionals were ready.”
Claims that the system cannot accommodate change typically come from people who don’t want to see the program expand at all, Grant and others said. It also ignores the reality that some patients with mental illness already qualify for assisted dying if they have other medical conditions.
“It’s a bit like Lucy and Charlie Brown and football, right?” said Jocelyn Downey, a professor at Dalhousie University in Halifax.
“You put the soccer ball down and it goes, ‘Okay, I’m ready, boom.’ And the next time it’s going to pull the soccer ball out from under you.”
Sonu Gained, head of psychiatry at Sunnybrook Health Sciences Center and a professor at the University of Toronto, is among those calling on the government to pause expansion plans and “reassess how we got here.” .
He said there were questions that were “not at all” close to being resolved, including how practitioners could assess factors such as poverty and whether people suffering from mental disorders would get better.
“You mean you’ve been sick for decades and tried everything and nothing worked? Is that what you mean?” he said.
“Or are you suffering right now and you live in a rural community, a First Nation, and you don’t have access to care and society isn’t going to provide you with access to care?”
Is consensus important?
Conservative MP Ed Fast asked the House of Commons to change the criminal law to say that mental disorders are not included in “serious and incurable medical conditions” under the Assistance Act, on whether the expansion should go ahead. The reason for this was that there was no consensus among experts. A dying government.
Although Fast’s private member’s bill was ultimately defeated, congressmen and senators who served on the special joint committee saw the disagreement for themselves.
“There’s too much debate,” said Jitender Sareen, a physician in the department of psychiatry at the University of Manitoba.
He said many psychiatrists oppose assisted dying for people with solely mental illness, and groups such as the Canadian Mental Health Association and the Canadian Association for Suicide Prevention have also raised concerns about this.
Mr Saleen said the hearing had revealed “considerable concerns among psychiatrists” and suggested the government should instead focus on improving access to mental health care.
Stephanie Green, one of the first doctors to provide medical assistance in dying after it was legalized, said in an email that while the public, clinicians and academics have a right to oppose the expansion, said that does not mean Canada should not proceed with expansion. .
She told the committee that other medical treatments were available, including hormone replacement therapy for menopausal women and supervised injection sites for drug users, despite a lack of agreement. Ta.
States are also divided
New Brunswick said it was working to make sure it was ready, and a spokesperson for Ontario’s Ministry of Health said there were no concerns, while Quebec announced in June that an adult with a mental illness alone passed a law excluding the use of medically assisted dying.
A spokesperson for the Saskatchewan government said the province is also concerned about the planned expansion and is “committed” to implementing it “without carefully considering the risks this may pose to people suffering from mental illness.” I can’t do that.”
Has the issue been sufficiently researched?
In 2021, Congress passed an updated version of the Medical Assistance in Dying Act that expands eligibility to people with only mental illness and includes a two-year sunset clause before it goes into effect.
The government has convened an expert committee to investigate whether further safety measures are needed and make recommendations on the assessment.
The commission’s final report in May 2022 recommended that the government develop standards of practice, but suggested no further legislative changes. The report never delved into the question of whether there should be an expansion, and the seven-month deadline precluded widespread consultation.
Gained and others warn that it is too narrow in scope and that there has been too little scrutiny of how this part of the law came to be.
Opposition leader Pierre Poièvre said he was “delighted to support” Conservative MP Ed Fast’s private members’ bill “to ensure that medical assistance in dying is not the solution for people suffering from mental health problems” .
The 2021 bill follows a 2019 Quebec Superior Court ruling that requiring an individual’s death to be reasonably foreseeable to qualify for assisted dying is unconstitutional. It was established as a result.
The bill initially did not extend eligibility to people with only mental disabilities. The Senate added the clause to the amendment that the government decided to approve.
Earlier this year, Parliament passed legislation adding another year to the sunset clause, which would come into effect in March 2024, but Liberals argued the system needed more time to prepare. .
Tord Lemens, a professor of health policy and law at the University of Toronto, said he believes the government is moving too quickly and that a more careful investigation is needed. He added that recent committee hearings were too short and at times overly combative.
“I understand they felt they had to be fast. [March] The date is approaching very quickly. ”
Quebec’s funeral homes provide space for medical assistance in dying, filling a gap in services the company claims. As more people choose this option, there are concerns that businesses could profit from this method.
What if there are further delays?
In a recent interview with the Canadian Press, Virani expressed openness to adding more time to the sunset clause that slows eligibility expansion.
But in the meantime, those who say it’s time to move forward say people are suffering intense pain as they wait to see what happens.
Mona Gupta, a psychiatrist at the University of Montreal who chaired the government’s panel of experts, said the conversation would encourage people with mental illnesses, their families, and society as a whole to “take a closer look at the position of people with mental illnesses. about how their rights are considered optional.”
Downey noted that another pause could mean the spread doesn’t occur. He said the government would likely be taken to court if qualifications were further delayed or banned altogether.
Conservative leader Pierre Poièvre has vowed to abolish the policy if he forms the next government, and federal elections must be held by autumn 2025 at the latest.
“The very individuals who endure intolerable suffering are the ones who must go to court and force governments to follow the law. [Charter of Rights and Freedoms] That’s what’s needed,” Downey said.
Can I appeal the ban?
In amending the latest assisted dying law, senators said they believed excluding people with mental disabilities from eligibility would amount to discrimination under the Charter.
Critics say there are currently no courts or laws that force the government on this issue.
Lemmens, along with many other law professors across the country, published an open letter earlier this year calling it “reckless” to suggest that courts would recognize such patients’ constitutional right to assisted dying. He said that.
“Indeed, for these reasons there is a strong case to the contrary that the Charter requires adequate and equal protection against premature death for all disabled persons,” the letter reads.
Lemmens wants the committee to recognize constitutional experts who say there is “no clear constitutional obligation” to expand further into mental illness in a report the Liberal Party says will inform its next steps. He said he was.
Still, some warn that future court challenges are inevitable.
Shelley Birenbaum of the Canadian Bar Association said people with mental illnesses have the same rights to “autonomy and self-determination” when it comes to their health as people with physical illnesses.
“The complete exclusion of all people suffering from mental illness as a sole underlying condition is likely to be constitutionally challenged as a violation of the equality, security and freedom guarantees in the Canadian Charter of Rights and Freedoms.” said the Toronto lawyer. He chaired the association’s end-of-life working group.
