Canada is delaying plans that would allow people with mental illness to access medically assisted death amid concern from some doctors that the health system is not prepared to handle complicated cases.
As of March 2023, Canada It is expected to become one of the few countries in the world to allow physician-assisted dying for chronic mental disorders.
But on Thursday, Justice Minister David Lametti said the government would seek to delay expansion of Maid, following criticism from psychiatrists and doctors across the country.
“We are listening to what we are hearing and responding to, to make sure we move forward in a prudent manner. We know we need to get this right 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 minister for mental health and addictions, Carolyn Bennett, reiterated their belief that adequate due process guarantees existed.
When Canada first passed laws allowing medical assisted dying in 2016, only terminally ill patients were eligible for the procedure. But in 2019, a Quebec judge found the rule unconstitutional and pressured lawmakers to amend existing laws to include adults who did not 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 mentally ill patients as the sole cause of accessing assisted dying, giving them more time to study the subject. That study would have ended on March 17.
In recent weeks, psychiatrists have spoken out about the lack of preparation within the health system. media reports have also highlighted controversial casespolarizing the issue more and more.
Another delay would require new legislation, something parliament would have to take on board, and move quickly, when it returns at the end of January.
“We have started having informal discussions,” Lametti said. “We think there is widespread support.”
Madeline Li, a psychiatrist at Princess Margaret Cancer Care in Toronto, said she was relieved by the government’s decision to delay expansion.
“It makes me proud to be a Canadian, knowing that our government really meant it when it pledged to balance respect for autonomy with protection of the vulnerable,” Li said. “And I think this actually gives clinicians time to learn and reflect and think about how we can improve the safety of our cleaning practice… This gives us time to improve our overall quality of care.
Li hopes the additional time will help doctors develop a set of nationwide “best practice guidelines” to address what she sees as legislative gaps that provinces currently fill.
Acknowledging a “spectrum of opinion among psychiatrists,” Li feels the current rules give practitioners too much leeway: “I don’t think a maid’s decision should be influenced by an individual doctor’s values.”
Other experts see no justification for claims that there is no institutional willingness to include mental illness as a criterion.
“What does the ‘prep’ look like? What exactly does it mean? What needs to be done to be ‘ready’ and how will we know we’ve done it?” asked Mona Gupta, a psychiatrist at the University of Montreal and chair of the federal panel on maids and mental illness. “If you look at all kinds of complex, high-risk medical activities in our health care systems, where there are life and death issues, you could find, across the country, pockets of unpreparedness for all kinds of things. But that doesn’t mean we don’t.”
Gupta cautioned that the government’s decision further delayed active recognition of rights that the federal government had previously recognized 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 have a right to exercise, then it must be based on some compelling logic,” Gupta said, adding the term “Expansion” did not capture your view that the federal government made the decision to “prolong disenfranchisement” for people with chronic mental illness. “There must be specific benchmarks as to when this continued disenfranchisement will cease.”
Advocacy groups also criticized the federal government’s decision.
Dying With Dignity Canada said it was “disappointed” that the ban on accessing assisted dying was extended.
“The current exclusion of people 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 prolong painful suffering.”
Justice Minister Lametti has not indicated how long the government would seek a delay. To pass any legislation, the ruling Liberals would need the support of opposition parties.
