Ramona Coelho: Ottawa keeps mucking up MAID

Five years ago, Parliament made disastrous changes to Canada’s assisted dying law, including one that was almost an afterthought. The government’s original bill did not include expanding MAID for mental illness. The Senate added the expansion; the government — up against a court deadline that had already been extended four times — accepted it with a two-year delay. Within weeks, it was passed by the House under a closure motion.

Since then, that clock has governed the issue of MAID’s expansion, which has already been delayed twice.

This year, a parliamentary committee where I testified recommended pausing it indefinitely. Now, the government’s proposed approach is to cancel the expansion for mental illness, but let provinces decide whether to permit advance requests for MAID. While it’s a relief that government will no longer approve MAID for mental illness, it is unconscionable that they will add advance requests.

Last week, Bill C-218, a bill that would have excluded mental illness as a sole medical condition from MAID eligibility, was defeated in Parliament. According to a caucus briefing note, the government argued that the bill’s term, “mental disorder,” is too broad. This, despite the fact that the government’s own expert panel chose “mental disorder” because it is the term used in psychiatric diagnosis.  It is also the term used by the Special Joint Committee on Medical Assistance in Dying in the title of its June report. Some supporters of the bill, who want mental illness removed from MAID eligibility, even offered to change it to “mental illness.”

The government’s forthcoming bill should be judged on three things.

First, we need to scrutinize its language on MAID for mental illness. Conservative MP Tamara Jansen’s Bill C-218 would have permanently repealed the expansion but was voted down over a quibble about the term “mental disorder.” The Liberals now owe Canadians legislation that ensures the expansion will never happen. Justice Minister Sean Fraser has promised an indefinite exclusion of MAID for mental illness as a sole condition, but we have yet to see the legislation, and a pause is not a repeal. This is important, because it is not possible to reliably determine that a person with mental illness will not recover, and a reasoned request for MAID for mental illness cannot be distinguished from suicidality.

Second, will the forthcoming bill go far enough? Thomas Dillon died at 45 after a psychiatrist offered him MAID. He was assessed outside a Tim Hortons, with his mental illness and addictions largely untreated. Dillon was deemed eligible for MAID because he also had a bowel disease.

In cases I reviewed on Ontario’s MAID Death Review Committee, depression, trauma and isolation often drove requests that were approved, sometimes with no psychiatric expertise consulted, because there was also an accompanying physical diagnosis. Excluding mental illness as a “sole” condition is a good start, but the move still leaves other problems unaddressed. A better fix would be to repeal Track 2, the expansion to persons with disabilities who are not dying, entirely, as the United Nations Committee on the Rights of Persons with Disabilities has urged.

Third, the government bill will permit advance requests, leaving it up to provincial discretion. The current mental illness exclusion expires on March 17, 2027, so the bill has to pass before then. This last-minute addition mirrors the government’s 2021 mistake: carrying through a major expansion on a MAID bill that must pass by a fixed date.

Advance requests deserve their own debate, because the potential problems are serious. Consent given in advance cannot be fully informed; it often rests on fear of the future, not lived experience. My father had dementia, and his days held joy, laughter, love and dignity that neither he nor I could have foreseen. Ontario’s review of dementia cases found requests for MAID can be driven by fear of future decline, families raising MAID repeatedly on a patient’s behalf. It also found 86 per cent of these patients had not even received palliative care before MAID.

Canadians are not aware of the breadth of cases our MAID law allows. A National Institutes of Health-affiliated survey found that while 73.3 percent of Canadians support the MAID law in general, this support collapses once respondents are shown what the law actually permits. Only 19.2 per cent of respondents correctly knew that a terminal illness is not required for MAID eligibility, and only 20.7 per cent knew that a patient may refuse effective, recommended treatment and remain eligible. And 56 per cent of Canadians polled In an Angus Reid study this year did not know that there was a planned mental illness expansion.

Stopping MAID for mental illness is necessary. But if it is achieved via a bill that must pass by March 2027, with advance requests attached, Parliament will have learned nothing from the last five years. A death cannot be appealed. Debate has to come first.

National Post

Ramona Coelho, MDCM, CCFP, is a senior fellow at the Macdonald-Laurier Institute, an adjunct research professor of family medicine at the University of Western Ontario’s Schulich School of Medicine and Dentistry, and the co-editor of Unravelling MAiD in Canada: Euthanasia and Assisted Suicide as Medical Care.