Revised March 21, 2021
Background: As a result of the 2019 Truchon decision in a
lower court in Quebec, a revised Medical Assistance in Dying (MAID) law (Bill
C-7) is now being considered by our federal parliament. The proposed
legislation removes the “death being reasonably foreseeable” requirement and is
opening the door for physician assisted suicide for people who are not
terminally ill.
Some persons with mental illness, by virtue of brain disease that often
includes symptoms of hopelessness and suicidal thinking, have long been recognized
as potentially vulnerable to suicide inducement and, until now, have rightfully
been excluded from eligibility for MAID. Suicide prevention is recognized as a
critical mental health service necessary to preserve life. The Senate recently
proposed an amendment that will eliminate this broad protection and allow
state-sanctioned suicide for these vulnerable people, starting in 18 months.
The Liberals are proposing adding just 6 more months to that time frame. The
reality is that neither time frame can produce non-existent clinical evidence
in support of the naïve legal position that doctors can magically predict
irremediability for mental illness.
Myth: Deciding who will
get MAID for mental illness will not be a guessing game.
Fact: The expert panel being constituted by the Liberal
government can’t manufacture evidence that doesn’t exist in the universe. No
one can know what is unknowable. Everyone can state over and over that some
people with mental illness must have irremediable mental illness. But no one
can identify precisely who these people are. Not you. Not any experienced
psychiatrist. Unless they guess. Or unless they mean by irremediable that
someone hasn’t gotten better when their suffering is considered at a certain
point in time (as would be true of everyone at given points). What point in
time? During the year they are waiting for psychiatry services? During the 5
years they are waiting for sub-specialty psychiatry care? During the endless
amount of time they are waiting for non-existent intensive case management? Or
a place to live? During the time they are waiting for the standard treatment
that the government hasn’t funded? During the time disease induced hopelessness
has kept them from seeking help? During the time their disease has impaired
their insight into the fact they need help? Start the timer!
How many die by suicide while waiting for months or
years for any mental health services?
How many die by suicide after being discharged
prematurely from in-patient psychiatry?
How many die by suicide because they are unwilling to
go to the ER and be treated with disrespect and disdain again?
How many die by suicide because they are labelled a
“drug seeking problem”?
How many die by suicide after being sent home from the
Emergency Room?
How many die by suicide because of suffering wrought
by abject loneliness?
How many die by suicide because of the suffering
wrought by poverty?
How many die by suicide because of stigmatization and
social rejection?
How many die by suicide because of homelessness?
How many die by suicide because their families can no
longer cope with their symptoms?
How many die by suicide because they saw a story about
suicide in the media?
How many die by suicide because of inexperienced
doctors?
How many die by suicide because of misdiagnosis?
How many die by suicide because their doctor doesn’t
seek advice from sub-specialist colleagues?
How many die by suicide because they live in a rural
community and have inadequate treatment?
How many die by suicide because of the psychiatrist
shortage? (over 200 positions unfilled at hospitals in Ontario)
How many die by suicide because of poor treatment by
their own doctor who has internalized the same stigmatization and judgement of
other Canadians?
How many die by suicide because they feel their life
just doesn’t matter to anyone?
How many will refuse treatment because MAID will be a
faster, easier, doctor-supported alternative to healing?
How many will die by MAID who could live a good, long
life instead?
You don’t know
the answer to these questions? Neither do I. Neither will the members of the
expert panel being set up to give our country the “MAID for Mental Illness
How-to Manual”. But that won’t stop them from writing the rules for the
guessing game as though they do. Let’s play the odds they will say. If you have
suffered a long time and tried some treatments that is good enough. It won’t
matter whether it was provided in time to prevent brain damage from your
degenerative disease, or the right treatment even, or whether your suffering
was because of poverty or loneliness or homelessness, or whether you kept
refusing treatment offered. It won’t matter because wrong guesses won’t be
exposed from the grave.
“Canada, the
Guessing Game Capital of the World”
Myth: The Justice
Minister/Attorney General of Canada didn’t mislead Canadians.
Fact: One of the most extraordinary things about the last
few months in the flow of events that led to the House of Commons passing Bill
C-7 (by a vote of 180-149) on March 11, 2021 was that an Attorney General of
Canada, David Lametti, sworn to uphold the laws of the land, and his
Parliamentary Secretary, MP Arif Virani, repeatedly made statements that were
clearly misleading. And then other Liberals repeated them over and over in their
written and verbal “talking points”.
In November,
parliament and the small group of Canadians that were even aware of what was
happening (what with a pandemic on our minds) were told three things:
- MAID
for mental illness is excluded from
Bill C-7 - The exclusion of mental illness is
consistent with the Charter. - There
is no consensus among expert mental
health clinicians or organizations on whether MAID should be offered for mental
illness.
In February, when
examining the bill, the Senate made up completely new legislation and added
MAID for mental illness to begin in 18 months. The bill went back to the House
of Commons where the Liberals accepted the new legislation (and said 24 months
to implementation instead of 18.) They said a year to study ways to implement
it (implementation being a foregone conclusion) and then the second year to
operationalize it.
What is
remarkable, as all other political parties except the Bloc decried, is that:
- The
Senate made new law. It did not simply reflect on, or make suggestions on, the
existing law. This is not the Senate’s legislative role. This is the unelected
tail wagging the elected dog. - The
Liberals allowed this new law without any of the standard House of Commons
parliamentary committee work that studies new law, without any public
consultation process on the new law, and without first listening to Canadian
experts and mental health organizations. - Then
the Liberals and Bloc rammed this through the House of Commons with a closure
motion that shut down debate and allowed for only a few hours of discussion.
The only reasonable interpretation is that they feared further dissent in their
own ranks (7 Liberals did not support the bill, which took real courage given a
party apparatus that expects conformity) and they feared being exposed for what
they had done. They were enacting new law without proper consultation with
anyone. The few weeks between the February 2021 Senate amendment and the March
11, 2021 passage of the bill gave no time for consultation nor was it even considered.
And
so, in contrast to just a few months ago, the Attorney General of Canada is now
saying:
- MAID for mental illness is included in Bill C-7
- The inclusion
of mental illness is consistent with the Charter. - There is consensus
among expert mental health clinicians or organizations on whether MAID should
be offered for mental illness. - The government has already consulted widely and had
hundreds of hours of testimony and input.
When did this
magical consensus appear? When did the specific consultations on this new law
occur? In fact they didn’t. The
testimony heard previously was never in relation to the new law. It couldn’t
have been because the new law didn’t exist! The previous testimony was from
hundreds of disability organizations. Their testimony was ignored. For mental
illness the Liberals just skipped a step and didn’t even have to pretend they
listened.
The Prime
Minister has said over and over during COVID that the government follows the
advice of experts and the science. They didn’t in this case. They didn’t even
ask us.
A couple of years
ago the Canadian Council of Academies advised against MAID for mental illness.
CAMH, CMHA, and myriad mental health organizations are already on record as
being against it. On March 11, when a Conservative MP in the House of Commons
said he held a letter with 129 organizations objecting, and he asked MP Arif
Virani (Minister of Justice spokesperson) to name even one organization that
supported the new law, MP Virani was at an obvious loss and then suggested
maybe a Quebec psychiatrist group (who by their own admission report their
psychiatrists are extremely split) and that Dying with Dignity is in support.
Dying with Dignity! A suicide lobby group is what this government offers as
support for legislation that facilitates suicide! Utterly shameful!
Will the
government stack the expert panel it is creating as it follows through on the
charade of safeguards? It would seem it has to, because an otherwise balanced
group of experts that understands clinical realities and the science would
recommend that the law cannot be implemented because mental illness can never
meet the Bill C-7 legal test of irremediability.
Every Canadian
with a disability and every Canadian touched by a personal experience with
mental illness should remember this moment at the ballot box. I wonder if the
Liberals and Bloc have registered just how many tens of millions of Canadians
that actually is?
Myth: Members of Parliament are doing their duty
as legislators by complying with the Charter of Rights.
Fact: That is only part of their duty. If the
Charter said slavery or eugenics or forced sterilization were the law of the
land (all of which have been the case on Canadian soil) MPs duty in the present
day would clearly not be to blindly comply with a particular Charter
interpretation but rather ensure justice and equality for all. The Charter is a
living document subject to judicial interpretation and embodied in just
legislation made by just legislators. A presumed and untested interpretation of
the Charter mustn’t lead to the abrogation of legislative duty, thoroughness,
reflection, and ultimate responsibility to protect all citizens. MPs marching
in lockstep in response to Truchon, the Senate amendment, and claims to
certainty about the primacy of a particular charter interpretation are all
examples of the tail wagging the dog and the dog letting it.
Myth: The 24 month
“sunset clause” is a reasonable way to ensure that MAID for mental illness goes
ahead safely.
Fact: This
should properly be called the “delayed implementation clause”. Approving the 24
month sunset clause is absolutely tantamount in this present moment to saying
we already know it must be allowed even though we don’t have any present
evidence that it should be allowed. The legal argument must follow from
clinical evidence, and not vice versa. Pretending doctors can do something they
can’t in order to bolster a legal position is the false manufacturing of
evidence. If evidence in support of clear clinical prognostication
existed for these particular brain diseases it would have already come forth
through the Canadian Council of Academies exhaustive review, and it would have
been loudly confirmed by MAID expansionists. Yet, not one of them actually said
we can predict irremediability in any particular patient. They keep saying,
like a mantra, that “people with irremediable mental illness deserve MAID”.
But they have no data, and no clinical evidence-based means, to identify who
these individuals might actually be. Extensive clinical experience tells us
that such patients are rare or may not exist except insofar as there are
patients who refuse potentially effective treatments and the myriad options for
the relief of suffering (the case of EF is a case in point). What ethical
doctor would use guesswork when the outcome is certain death? Unfortunately,
there are inexperienced psychiatrists, and there will be psychiatrists who are
confident with guesswork because no one will ever know if they were wrong. Do
we really want legislation that suborns incompetent professional practice?
It comes down to this: Let’s
agree there are people with irremediable mental illness. Who are they? Your
untrained guess is as good as any psychiatrist. That should worry you.
Myth: It must be a doctor who performs the
assisted death procedure because it is a medical act.
Fact: If it is a medical act why is it viewed and
operationalized in the United States and Switzerland as a social freedom or
autonomous act of citizenship? In those countries it is not a health care
intervention, treatment procedure, or part of the medicalized tableau it has
become in Canada. In those countries people take the poison pill on their own
time, in their own location of choice, and with whomever they wish. In those
countries you have to meet certain criteria (e.g. terminally ill) to get the
poison pill from your doctor, but after that you are on your own. If you can complete
your suicide without a doctor is it still a medical act?
In the US it is illegal to
inject the poison to cause death (the person has to take it in pill form) but
in Canada that is the preferred method used by 97% of “MAID providers” to date.
If the person is in hospital, very near death, can’t swallow, already has an IV
line in, I get the practical logic of it. But if you have mental illness and
can do it yourself whenever you want, absent medical involvement, what does
that tell us about the act itself?
MAID providers say you need
someone who can start an IV line…that makes it medical! So anyone who draws
blood in a lab can also do it? So anyone addicted to IV morphine or heroin or
crack can also do it? So anyone who has a one hour how-to training session can
also do it? So any Dying with Dignity volunteer who wants to get good at it can
do it? Like getting my Red Cross Death-Aid certificate?
MAID providers say over and
over that an IV method causes death faster. I am not sure why 3 hours is better
than 7 hours at that point. “Easier on people watching”, they say. Do they
really believe that a few hours will in any way assuage the agony of a
physically healthy loved one choosing suicide? They also say the person might
throw up the pill…again they are talking about people on the cusp of death who
are severely physically ill…not a relevant consideration in people with mental
illness who are physically able to swallow. Besides, if you throw up, take
another pill. The do-it yourself kits can have two pills and a checklist for
documents to sign attesting it was uncoerced suicide.
MAID providers say how
supportive and comforting and essential the doctor’s and nurse’s presence are.
But, again, this is in the context of terminal illness. In the suicide context?
Do they help by providing false moral absolution for the person and exoneration
for themselves and family members? Do people really believe the psychological
dynamics are this simplistic? The Swiss experience confirms substantial
traumatization for a lot of loved ones. In a non-terminal context these are not
the sweet goodbyes that MAID expansionists fantasize they are.
Myth: “Reasonably forseeable death” should not be a necessary
condition for MAID.
Fact: The MAID law from 2016 (Bill C-14) provides access to MAID
for people who have a “grievous and irremediable medical condition.”
The term is specified under the law as having the following components: 1) “a
serious and incurable illness, disease or disability”; 2) “an advanced state of
irreversible decline of capabilities”; 3) which causes “unbearable physical or
psychological suffering that cannot be relieved under conditions that the person considers acceptable”
and; 4) “the person’s natural death has become reasonably foreseeable, taking
into account all medical circumstances, and not requiring a specific prognosis
as to how long they have left to live.”
All these conditions have needed to be fulfilled for
MAID to proceed, and thereby limited MAID to the context of terminal illness.
Ethicists speak of necessary and sufficient conditions for a course of action
to be justifiable. By removing the “death being reasonably forseeable”
criterion, the judge in Truchon made a unilateral determination that terminal
illness was not a necessary condition for MAID and made the other conditions
jointly sufficient. What logic supports making just that particular necessary
condition unnecessary? Some would argue that it is not just necessary but also
has primacy of importance in any weighting of the four conditions. “If you are
dying, what does it matter if you die a few weeks earlier?” “If you are dying
soon, that will stop the suffering.” “What does it matter if your disease is
remediable (not curable but your suffering can be reduced) if you are going to
die in a few weeks anyway?”
On one interpretation, the
logic in Truchon is akin to saying that every Canadian should have access to
chemotherapy even if you don’t have cancer, or that every Canadian should have
access to a wheelchair even if you have no problem walking. Having a
terminal illness with very little time left to live is in fact a particular
physical state that entails multiple ethical, conceptual, and pragmatic
considerations that are both particular and unique to it. The current MAID
debate and the 50 years of medical ethics literature on euthanasia attest to
the different moral and empirical status of the near death context.
Myth: MAID for terminal
illness is the same as MAID for mental illness.
Fact: Terminal
illness means sure death and no hope. Mental illness means no death and
sustaining hope. Profoundly different states of being. Saying the two are the
same for purposes of assisted death is twisting logic in the service of
ideology.
With the “reasonably
forseeable death” criterion removed in Bill C-7, the use of the
“irremediability” criterion is being changed in practice from definitely irremediable to possibly irremediable. Is “possibly”
good enough when what is at stake is not 6 months but 60 years?
Some people extrapolate
from the “beautiful stories about warm goodbyes” with MAID for terminal illness
to a claim that the same will hold true outside the terminal context. On
the contrary, the Swiss, Belgian and Dutch experience shows the non-terminal
context is fraught with distress (families don’t support the death, families
will not participate, families initiate legal action, families still have hope
of recovery, families feel abandoned, family members are traumatized –
including PTSD).
Myth: There is no distinction between physical
and mental Illness when it comes to MAID.
Fact: There are brain diseases that are in the clearly
defined domain of psychiatric disorders. Physiologically there is of course a
continuum…we have one whole body. And suffering is suffering. However,
diagnostically and categorically there is not one continuum. There are 3
treatment categories: physical illness, mental illness, and mixed illness.
Mixed illness includes dementias (e.g. Alzheimers) and certain
neurological disorders (e.g Huntington’s) that can meet criteria for terminal
disorders.
Clear mental illness is distinguished by the brain diseases that cause
psychiatric symptoms: suicidal thinking, abnormal mood, impaired cognition,
psychosis, hopelessness…a very specific list of symptoms and symptom clusters.
They are not terminal conditions.
Here is another way of telling the difference. With physical illnesses I
know when treatment attempts are exhausted, and I make that determination in a
medical milieu free of societal stigma. With mental illness:
- Treatment is commonly not available because of stigma
- Treatment is often not begun because of the impact of stigma on the
person - Treatment is often derailed because of the impact of stigma
- Treatment attempts are never exhausted because the treatment arsenal is
substantial and healing can take years - It is impossible to predict which patient may yet recover or have
reduced suffering
Myth: The Senate supported an 18 month “sunset
clause” because they wisely weighed all of the evidence they heard.
Fact: The preponderance of recent Senate Committee evidence
did not support moving forward with MAID for mental illness (hence the
Committee’s very thoughtful report). A key issue is the question of
establishing whether some mental illnesses can meet the legal test of
irremediability. Either there is adequate data to support determinations of
irremediability or there is not. If it existed it would have been presented. It
does not exist, so it could not be presented. The Committee heard and seemingly
understood this. However, in ignoring the Committee report, the majority of
members in the full Senate gave unjustified weight to supposition, fallacious
reasoning, and/or a political agenda. Furthermore, they are trying to pre-empt the
mandated (and COVID delayed) legislative review of Bill C-14; they did not weigh
the clear recommendation of the Canadian Council of Academies that advised
against proceeding with MAID for mental illness due to lack of data and the
limits of clinical prognostication; they did not respect the informed pleas of
myriad disability and mental health organizations representing the most
vulnerable of citizens; they ignored the grave concerns of Indigenous peoples
and the United Nations; and they are trying to bind parliament to a course of
action of their own desire with no request for a reference to the Supreme
Court.
New information or better reasoning will not
miraculously appear in the next 18 months. The Senate has made us an outlier in
the world. This is not about social progress, or recognition of a changing
world and citizen values. The Senate is ignoring the evidence and sound reasoning
put before it. Martin Luther King said his task was to help people see the injustice
before their very eyes. I expected better from the senators. I needed better. I
can tell you today the names of my patients who will die because of their
actions….patients who are gradually healing but plan to stop trying.
Every Canadian citizen already has the right
to kill him or herself. MAID for mental illness does not add any new legal
liberty and there is no legal “right to death” in our charter.
Of the 100% of
Canadians who attempt suicide, only 23% try again, and only 7% complete
suicide. MAID
for mental illness only serves to make suicide easier. Why does the Senate want
suicide to be easier? The Senate has failed in its duty to protect.
Myth: “Bill C-7 must be passed right away because suffering
Canadians need relief through MAID as fast as possible!”
Fact: If this is true,
then it is also true that universal palliative care must be available as fast
as possible, and that universal disability supports must be available as fast
as possible, and that universal mental health care must be available as fast as
possible, because it is the absence of these that is making some people suffer
so much that they want to die rather than live. Why do some people with the
power to rectify longstanding discrimination wear a cloak of virtue to hide
their disfigured sense of decency?
We can all agree
that terrible suffering must be responded to with haste and compassion. Why is
it, though, that the many decades of extreme suffering of persons with
disabilities and mental illness did not garner this same politically urgent
response? Why the focus on MAID and the political pretense that Bill C-7 is the
most urgent and best solution? Why was Truchon not appealed to the Supreme
Court?
If it weren’t for
the COVID pandemic and winter weather Parliament Hill would see the largest
protest of Canadians in wheelchairs ever assembled. If it weren’t for poverty
and marginalization and the fact most Canadians are unaware of this shocking
push for state sanctioned suicide, those protesters would be joined by millions
more.
Who do you stand
with Liberal Party? You proclaim loudly that you stand with Indigenous peoples
but they are telling you this bill that pretends to equality is colonialism in
sheep’s clothing. They are saying that this law will kill them in a medical
system that is already unabashedly racist. It is another imposition of colonial
values being used to crush Indigenous spirituality and mock respect for the
sacredness of life.
Who do you stand
with NDP Party? You say with the poor and vulnerable…are you pretending not to
hear? The disability organizations are shouting loudly into your face.
Who do you stand
with Conservative Party? The mentally ill need your help and protection, not
the false mercy of state killing.
This “othering”,
this heartless stigmatization, this inability to bridge the gulf of ableism,
this lack of understanding at the deepest level of our shared humanity, is
obvious to those watching from across the gulf… from our wheelchairs and
homeless shelters…from our homes that look so placid to passersby but are in
reality places of secret sorrow and struggle and hopelessness. What utter
tragedy that people in power spouting sham slogans don’t even know what they
don’t know. Blind with eyes wide
open.
Myth: People deserve death
with dignity and MAID provides that.
Fact: This debate has distorted
what dignity means. Dignity means deserving of honour or respect. What MAID
advocates mean by loss of dignity is loss of control, loss of superficial
appearance, and self-critical judgement. They have, tragically, subverted the
most dignified acts of all: unfailing love and deep respect for each other in
all life circumstances. Bathing my dying grandmother, whispered conversations
on the threshold of separation, silent reflection and presence through a long
night waiting for a last breath…these are the moments of greatest dignity.
Dignity is found within
our relationships. It is about whether someone looks at you and treats you with
respect rather than with subtle disdain or prejudice, or makes you feel like
you are bothering them. Dignity is not about the means of death. Dying with
dignity means dying in a milieu of care, love, kindness and respect. Anyone who
says all of these things are not present in a natural death setting simply does
not understand what dignity is.
Myth: Bill C-7 is not discriminatory.
Fact: Canadian disability organizations, mental health
organizations, Indigenous organizations, religious organizations, and the
United Nations all say Bill C-7 is absolutely discriminatory because it singles
out vulnerable Canadians and offers them the inducement of physician assisted
death without offering adequate disability supports or treatment to help them
live full lives free of the suffering caused by poor health care, poverty, and
stigma.
It singles out persons with disabilities and
mental illness as a specific group of people who are not terminally ill but
deserve access to MAID because they have enough suffering to warrant it. Sheer
presumption and ignorance. Let’s understand what discrimination is. It is
pretending that all Canadians are equal in all ways. We must be equal before
the law but we are all dealt different hands by fate and endure practical
inequalities of many sorts. The obvious reality is that some of us face
profound life challenges (disease, disability, stigma, discrimination,
misfortune, poverty, isolation) and require laws that preserve our legal
equality within the circumstances of our personal disadvantage. A law that
offers death to one group and support and treatment to all others is the
paradigm of discrimination.
Bill C-7 pretends to equality by singing a
siren song of rights. It says all people with mental illness deserve respect,
equal access to MAID, and freedom of choice, all the while ignoring, or even
making a mockery of, the particular life realities of living with severe mental
illness. This law proclaims that I should consider death instead of recovery. Vulnerable patients need
protection from legislators and doctors who want to make it easier for them to
die while simultaneously being denied access to universal mental health care.
That is the true discrimination.
Myth: Not allowing people with mental illness to
access MAID is discriminatory.
Fact: This is a simplistic “equity of access” argument
that claims unjustifiable priority over “equality of care” and “health rights”’
and “right to life” arguments. On its
own, it has face value and appeals to our sense of fairness. Understood properly,
from the informed and wider vantage point of the real contexts of suffering, it
is tragically narrow in focus. It is a defense of simplistic playground rules
in a complex world of systemic ableism. It is like saying that everyone in the
sandbox deserves toys to play with while ignoring the kids with amputations or
in wheelchairs who can’t get into the sandbox.
Myth: MAID is not suicide.
Fact: The Canadian government defines suicide
simply and clearly as, “the intentional action of ending
one’s life”. MAID
is suicide. The
American Association of Suicidology does not support the claim that MAID is not
suicide, except in the context of terminal illness. Those
who claim suicideis impulsive and
violent, while MAID is well thought out, peaceful, and dignified, are
arbitrarily redefining what suicide is. Social engineering always begins with
language engineering. Suicide is taking steps to cause your own death, whatever
the steps. 75% of people plan their suicide, and many are completed with care
and consideration of the impact on first responders and others. The
characterization of all suicides as compelled, impulsive, and violent is
factually wrong and perpetuates media stereotypes.
What is clear is that
suicide is a raw agony for loved ones. The trappings of medical comfort and the
mutual pretense of moral exoneration that the staging of the MAID event
promises cannot diminish this sorrow. In fact, it can serve to inflame the
wound through the betrayal by both medicine and state.
Myth:
MAID doesn’t make patients want suicide.
Fact:
Offering MAID interferes with recovery. Clinical relationships are already
being profoundly undermined. Some mental health patients are now saying, “Why
try to recover when MAID is coming soon and I will be able to choose death?”
Some patients keep asking for MAID while they are actually getting better but
can’t recognize it yet. A colleague said offering MAID to someone with suicidal
thinking is like offering a lethal dose of fentanyl to a person addicted to
heroin…it makes no clinical sense at all.
Most suicidal thinking
is ambivalent. We must not have legislation that will lead people to death who
otherwise would have healed or coped. Offering an easy path to suicide is an ethically indefensible
inducement. You can’t offer a sanitized gun in a white coat.
Opportunity begets action.
Some say MAID is
morally acceptable because the law and a doctor says it is…and it comes with
all the idealized trappings of medical comfort along with the relief of guilt
that often comes with suicide. And we
know that there is a profound power imbalance that means the very offering of
MAID by a doctor carries the message of hopelessness and the clear implication
of a recommended course of action…choose death.
Myth: Psychiatrists can predict which people will
not recover from their mental illnesses.
Fact: Determining
whether a particular psychiatric disease is irremediable is absolutely impossible.
We
can’t know what is unknowable. People recover after 2
years and after 15 years. People can have improved symptom control and reduced
suffering when they get skilled care and treatment. Shared suffering is reduced
suffering. Inadequate care causes remediable illnesses to appear irremediable.
Myth: There is good mental health care for all
the sickest people in Canada.
Fact: Only
1 in 3 people get help. TMS for treatment-resistant depression is now 90%
effective and only funded in 4 provinces. Wait times for all services can be
years. Rural Canadians have poor access.
As we speak, 6000 of
the sickest people in Ontario are waiting up to 5 years to get specialty psychiatric
care. These are degenerative diseases. It is like being diagnosed with a
growing brain tumor and having to wait years for chemo while you get sicker and
sicker. This is systemic stigmatization and discrimination.
Death versus no
treatment is not an autonomous choice.
Myth: MAID for mental illness enhances personal
autonomy.
Fact: All suicide is tragic. When considering suicide
people weigh the various means at their disposal. For example, many choose to
overdose; others may choose a method that they feel is most acceptable and
accessible. Having MAID as an additional option does not actually enhance your
autonomy because you can already complete your own suicide plan.
The MAID autonomy claim is analogous to this
scenario: I can change the oil on my own car. I may have to check out a YouTube
video and buy some tools, and I may get dirty, but as a decisionally capable
person I can do it. If the government orders a mechanic to do it for me, my
autonomy has not been enhanced. It has simply been made easier to get to the
same endpoint. MAID advocates confuse autonomy with facilitation.
MAID advocates claim that not providing such
facilitation “compels” people to kill themselves in violent and horrible ways.
Who or what is doing the compelling? Many people do kill themselves in very
thoughtful and peaceful ways and to claim otherwise is simply to betray
ignorance of what actually goes on in the world.
From
a suicide prevention perspective, suicide shouldn’t be easy. We have two clear examples
(gas in England, poison in Sri Lanka) that show unequivocally that ease of
opportunity matters. We know this to be true for farmers with guns and doctors with
pills. And soon, thanks to this law, patients with doctors.
Inducement,
temptation, bolstering a power imbalance, false moral exoneration, and
encouragement to die are not enhancements of autonomy.
Myth: Trying to protect people with mental
illness from MAID is discriminating against them by saying they aren’t capable
of making their own treatment decisions.
Fact: Everyone agrees that most people living with
mental illness are perfectly capable of making their own treatment decisions.
Everyone agrees that there are some people who by virtue of illness (e.g.
psychosis, depression induced suicidal thinking) can’t make their own reasoned
decisions. Where matters are complicated is with people who fall in the middle,
people whose decisional capacity is uncertain and who therefore may not be able
to provide fully informed consent to an offer of death.Research shows that if 100
psychiatrists assess a person with uncertain decisional capacity, 35 will have
one opinion, and 65 will have another. Different
psychiatrists have different skill sets and levels of experience. They also
have biases like everyone else. As in the Benelux countries, if legalized here,
there will be psychiatrists who become the super suicide helpers. Patients will
doctor shop until dead.
Myth: We already assess decisional capacity for
MAID for physical and mental illness together, so we must be able to do it for
mental illness alone.
Fact: What this facile and specious claim (what logic
professors call a “categorical fallacy”) tries to gloss over is that all
current assessments in Canada are done only with people who are terminally ill.
Terminal illness is, in fact, the current legislative condition that allows
MAID to be offered. No such necessary condition exists, or has been formulated,
for mental illness alone. If the necessary condition posited by MAID advocates for
mental illness alone is a subjective claim of “unbearable suffering” then, in
fact, the door will be opened to any Canadian seeking MAID for any reason (e.g.
grief, tired of life, divorce, abject loneliness) as long as they have some
concomitant medical condition that they subjectively and unilaterally validate
as distressing enough.
Myth: People who have suffered a lot want MAID.
Fact: No, they want relief of suffering. But they have
come to believe that nothing but death will work. Unfortunately, prolonged
suffering severely constricts a person’s decision horizon and they stop trying
even when good options for healing or reduced suffering are presented to them.
In animal research this is called, “learned hopelessness”.
Ethicists speak of “first and second order
desires”. As an example, my first order desire may be to smoke the cigarette I
have in my hand, but my second order desire…my more authentic desire…is to stop
smoking because I want to preserve my health. With MAID, a person’s first order
desire is the immediate relief of suffering, but their second order desire is
to heal, to live, and to have a meaningful life.
Myth: MAID is a form of treatment for mental
illness.
Fact: Killing someone is never medical treatment. It is a
means of eliminating suffering while eliminating the sufferer as well.
Myth: If MAID is legal it must be ethical.
Fact: Just because the law says something is legally
allowed doesn’t make it ethically acceptable. Laws have allowed slavery,
apartheid, eugenics, forced sterilization, systemic racism, sexism, ableism, and
ageism. This law joins a long parade.
Myth: This is about ethics not
data.
Fact: It is about both. Evidence-based medicine
relies on data. Applied medical ethics uses data to inform the ethical
analysis. Unlike most physical diseases, we absolutely lack any prognostic data
that can tell us which particular patients with mental illness are likely to
get better and which aren’t. There are so many treatment options in psychiatry
(along with the passage of time, natural adaptation, learned coping, the
alleviation of poverty and loneliness, and the comfort of meaningful
relationships)
that no studies have been designed that fully capture the complexity of
individually unique healing trajectories. For example, having a baby and no
longer being suicidal because of a newfound purpose in life are not the types
of things commonly studied when looking at diseases. It doesn’t mean we can’t
do some form of research, however imperfectly, but we haven’t yet. Proceeding
headlong into expanding MAID without such data to inform our ethical and social
policy thinking is presumption and fantasy trumping data and reality.
Myth: If a doctor says assisted suicide is
morally acceptable then it is.
Fact: What makes any doctor more of a moral expert than
your own conscience and learned values. Doctors have been elevated to new age
priests but they only have the exact same claim to moral expertise as every
other Canadian. A doctor, with all the attendant medical trappings and the halo
of perceived goodness, provides false moral absolution and exoneration for a
person choosing suicide and using the doctor as the sanitized gun. It is a
dance of mutual pretense that does not withstand the scrutiny of ethical
analysis. It is a suicide protocol masked by euphemism, false mercy, dissembling,
willful casuistry, or naïve self-delusion about the righteousness of one’s path
and purpose.
Myth: MAID is consistent with each doctor’s professional obligation
to practice according to established standards of care.
Fact: MAID for mental illness makes the doctor a
consumer controlled tool of death rather than an expert supporting healing and
reducing suffering. Of grave concern is the effort of some legislators to allow
MAID for mental illness without any statutory requirement that all standard or
reasonable treatments have been tried before the patient is killed. The law as it
stands says it is completely up to the person to decide if they are suffering
unbearably and they can refuse standard treatments that might help them heal or
cope. To allow people to choose death over and above proffered treatments for
their illness is an unprecedented undermining of basic medical ethics and a
physician’s duty to use their clinical skill and judgment to practice in accord
with established standards of care. A doctor cannot support offering death when
treatment is untried or incomplete.
Against such an unheard of legislative backdrop, what safeguards can
possibly work?
Myth: A doctor helping a patient complete suicide is
not a moral issue in a secular and pluralistic society.
Fact: Continuing religious,
social, and ethical reflection would not support this claim. Beliefs and prohibitions about suicide and
doctors killing their patients have been held and argued for thousands of years
but in our secularized and pluralistic society the media, politicians, and
academia often relegate them to the sidelines in the forum of public debate.
The disparagement of religious/faith-based perspectives is ironic given that
70% of Canadians report holding faith- or spiritual-based values. Many publicly
mask what they privately hold.
All
arguments for human dignity and mutual respect are primarily rooted in the
religious narratives that historically shaped Canadian law and values. MAID
advocates who dismiss objections to their position as being held by “religious
people who can’t tell me or society what to do” have profoundly misunderstood
and devalued the breadth of serious ethical analysis that underpins traditional
religious stances and attendant social structures. I wish I didn’t feel a need
to state the obvious, but bigotry is not ethically defensible, nor is it
morally acceptable in a pluralistic society.
Conscience
rights are actually rooted in what informs our conscience: deep moral
intuitions born of faith in something. Many good ethical arguments against physician
assisted suicide are rooted not in faith-based or deontological claims but in
relational, utilitarian, virtue, and professional ethics. There are many lenses
through which we can find common ground and we must have a thoughtful and open
discussion of what assisted suicide means for us as ethical (religious or
non-religious) persons jointly forging caring societies.
Myth: A psychiatrist killing patients does not
violate medical professional ethics.
Fact: The World Medical Association condemns MAID
as an extreme violation of medical ethics. The American Psychiatric Association
unequivocally condemns MAID for mental illness as an extreme ethical violation.
The Canadian Mental Health Association condemns MAID for mental illness. In
fact, the long list of medical professional associations that condemn this
practice the world over shines a bright light on Canada as an extreme moral
outlier if it proceeds down this road. This social juncture is disturbingly
reminiscent of the claim to “progressive thinking” that many psychiatrists used
to defend eugenics and forced sterilization within my lifetime. It absolutely
matters that the world community finds what we are considering morally
abhorrent.
Myth: The majority of members of the Canadian Psychiatric
Association support MAID for mental illness.
Fact: The Canadian Psychiatric
Association has most recently adopted a position of neutrality which supports
nothing and everything, and undermines its own credibility by bowing to
politics over professional ethics and data. Only
41% of the approximately 5000 Canadian psychiatrists are members of the
Canadian Psychiatric Association.
In 2016, the CPA
surveyed its membership and 75% of the 500 respondents objected to MAID for
mental illness. Without any further survey, or broad or expert consultation,
the CPA leadership released a position statement in 2020 that was developed by
the 7 member Professional Standards and Practice Committee. It said the CPA
supported MAID for mental illness because it was discriminatory to deny any
citizen with mental illness equal access to a service other Canadians had
available to them. It did not address the ethical or professional duty issues,
nor did it consider the lack of evidence for irremediability of psychiatric
disorders, nor did it reflect the opinion of the majority of psychiatrists as
expressed in 2016, nor did it provide any balanced or considered statement
rooted in the clinical expertise of its membership. The CPA openly acknowledged
to members it had not even considered whether psychiatric conditions were
irremediable, and if so, how that should be assessed. Its leadership chose to
make a political statement rather than a statement rooted in a serious
consideration of medical ethics, evidence, and the impact of suicide inducement
on vulnerable Canadians.
In 2020 the CPA leadership surveyed its members again
with what many members have described as a “loaded survey”. They reportedly had
only a 23% response rate. The full results of the 10 question survey have still
not been released to the membership or the public. Some CPA members report
starting the survey but then refusing to complete it because they felt it was
so biased. To borrow Noam Chomsky’s phrase, it seemed to be “manufacturing
consent”. Any expressed support for the position that a patient should be
considered eligible for MAID does nothing to clarify the issues of inadequate
data, irremediability, or professional ethics and duty. And asking whether members support
“safeguards” (which of course members would if the practice became legally
allowable) doesn’t mean they want it legally allowable in the first place.
The 2020 position statement was quietly modified in
2021 with a very different neutral position which can
be found on the CPA website: “There are compelling legal, clinical,
ethical, moral and philosophical questions that make this issue particularly
challenging. At this time, the CPA has
not taken a position on whether MAiD should be available in situations where
mental illness is the sole underlying medical condition.” Despite this
very different position being posted on the CPA website, the CPA leadership has
not prominently announced this neutral stance to policy makers, media and the
public, nor did it testify to the significant change at parliamentary
hearings. Instead the CPA has let
mistaken public perception of its position stand uncorrected. Very recent media reports reflect this,
including reporting in the national media citing support for MAID for mental
illness on grounds that, “The Canadian Psychiatric Association has denounced
the exclusion (of mental illness from MAID) as discriminatory, stigmatizing and
unconstitutional.” I will note,
psychiatrists are neither judges nor constitutional lawyers.
Attempts by several CPA members to have the issue
of MAID and mental illness considered and discussed at the 2020 annual general
meeting were thwarted by an arcane procedural objection by the CPA leadership.
Despite multiple members requesting a month and a half before the AGM that MAID
be added to the agenda, they were told they were too late (of note, at that
juncture, the agenda had not been set, and notice for the AGM only went out two
weeks later).
A working group was
struck to develop a new ‘discussion paper’ on MAID in 2020, many months after
the CPA had already released the aforementioned position statement. Some CPA
members expressed concern that the new working group membership was weighted
with psychiatrists already well known to support MAID for mental illness
(including those who had served as expert witnesses for groups advocating for
expansion of MAID for mental illness). Of note, membership did not seem to include
or welcome experts who have publicly expressed caution regarding the expansion
of MAID.
Instead of truly
engaging members in response to criticisms, a past president of the CPA (who
publicly challenged the actions of the CPA and criticized the lack of
engagement in developing the CPA Position Statement, and the lack of evidence
and consultation informing CPA’s position) has been repeatedly accused by CPA
leadership of ‘misrepresenting’ issues.
Nearly one full year
since the CPA released its Position Statement on MAID without member input, the
CPA has still never asked members whether they agree with the 2020 Position
Statement or with the CPA’s positioning of the organization in the media on a
critical clinical and social issue. Many colleagues are now telling me that
they are struggling with whether to resign from the CPA or to enter into a battle
with a leadership so far removed from respecting the views of its own
membership.
Myth: Most psychiatrists support MAID for Mental
Illness.
Fact: Psychiatrists are split over MAID for mental
illness. We have little data to establish the degree of the split, but enough
data to be certain there is a split. Anyone who claims there is an emerging
consensus based on the silence of the majority is simply speculating.
Psychiatrists have critical experience and expertise but haven’t been asked any
clear questions that reflect complex clinical realities or legislative options. What can be said, as per public statements, is that
psychiatrists on both sides of the issue do agree on
this: “You can’t predict the course of illness for any individual patient”.
- In a 2016 survey, 500 of
5000 Canadian psychiatrists responded. 75% objected to MAID for mental illness. - In a recent Quebec survey,
263 of 1300 psychiatrists responded. 36% objected to MAID for mental illness in
all circumstances, and 42% said we need at least ten years of treatment before
we can consider that further treatment may not produce added benefit. - Some
psychiatrists say this split is about differences in personal values only.
Others say it is about professional ethics which should apply to all psychiatrists.
A very long list of medical
professional associations around the world agree with the latter. - Some say
this is an ethical debate that should be decided by values. Others point out
that values are informed by data and that we need to use our scientific and
evidence-based methods, however imperfectly, to see what the data shows.
Applied ethics uses data. The current data does not support determinations of “irremediability”
for mental illnesses (we can’t predict who will or won’t get better over the
long term). - A few psychiatrists have
claimed, “MAID is not suicide”. Others say, “Outside of a terminal context, we can’t
practically or conceptually distinguish those seeking MAID for mental illness
from those who are suicidal because of their mental illness”. This
latter position is supported by a large body of research and conceptual work
from the Canadian and American suicidology associations, and myriad health
professional associations. - A few psychiatrists have
said that if someone has subjectively suffered “long enough” we must respect
their choice to die and help them to die. Different psychiatrists will have very broad
interpretations of when patients have suffered ‘enough’ or had adequate
treatment. Others say because it is impossible to predict when suffering may be
relieved through treatment, or improved
coping, that we have a professional duty to
keep trying.
Highlighting these differences shows the split, but the analysis of the
values, life stories, clinical experience and acumen, and variance of
interpretation of the exact same data are what tell the story. It is
complicated. What is not complicated is this. If MAID is allowed for mental
illness, we know with 100% certainty that we will make fatal
mistakes, and that we will take the lives of patients who would have gotten
better…we just won’t know which. The hundreds of people who will die by MAID who would
have gotten better are not statistics. If it is your partner, or son, or
daughter, do you want a psychiatrist who supports MAID and is legally
sanctioned to kill?
Myth: Safeguards will prevent abuses.
Fact: The population of Canada is roughly 37 million
people. 50% of all Canadians have, or have had, a mental illness by the age of
40 (19 million people). 44% of Canadians over age 20 have a chronic illness (16
million people). 7 million Canadians have disabilities. Let’s very
conservatively estimate that 27 of the 37 million non-terminally ill people in
Canada are about to potentially or eventually qualify for MAID when Bill C-7
passes. And there are 92,000 MDs and 6000 NPs, all of whom can induce and complete
assisted suicide. How, with those numbers, is it possible to administer and
monitor any practical safeguards? Does parliament really intend to swing the
door that far open on a so-called “treatment of last resort”?
Some doctors in the Netherlands have
stated that if you don’t want physician assisted suicide, you should have
your wish written down and make sure your loved ones know, because otherwise it
will be assumed you want it. This presumption is a complete and unethical inversion
of the long established informed consent protocol: patients are expected to
opt-out of doctor assisted death rather than opt-in with clear consent.
Research
from Belgium and the Netherlands shows over 30% of doctor caused death (I
use the word “caused” not “assisted” because the patients didn’t ask for
assistance) went ahead without the consent of the patient (Smets et al,
BMJ 2010). 47% of cases of physician
caused/assisted death were not reported, despite the legal requirement to do so
(this information comes from anonymous surveys of doctors). The reason for
non-reporting was most often because consent was not obtained. One such case
involved a nun. The treating team felt her lack of request for a physician
assisted death was because of her religious values being in the way and
so, as an “act of mercy”, they killed her anyway. She didn’t see it
coming. About a third of patients don’t. It starts with a sedative in your
orange juice and you never wake up.
In Belgium and Netherlands, the requirement
that all treatments be tried before causing death was circumvented by doctors
who simply chose not to do so, without repercussion. Judges and monitoring
bodies simply also ignored the legislated process safeguards. Patients
doctor-shopped to find doctors to approve their request for death; one
particularly infamous psychiatrist on a public crusade to relieve suffering has
become a super suicide helper. To people who say that won’t happen in Canada
because we will set up a better and wiser monitoring system, I ask, how is the
state going to effectively monitor what goes on behind millions of examining
room doors shielded by confidentiality laws?
This
is proactive social engineering rather than a response to citizen need, desire
or request. Dr. Scott Kim (bioethicist/psychiatrist) makes an important point
that the change in Canadian law will bring about a new reality where safeguards
fall away in a self-fulfilling manner. It will become the moral norm and
expectation that an assisted death be chosen without “medical obstruction”:
“The
hope that we can protect psychiatric patients sufficiently by imposing a strict
system of safeguards is based on a perspective prior to legalization of
psychiatric PAD (physician assisted death). But we fail to note that the
legalization itself will likely change the social and practice context of how
the safeguards are applied. The very act of legalizing psychiatric PAD provides
strong support for it as a social good; this then becomes the context for
capacity determinations and the idea of a strict capacity threshold will begin
to seem unnecessary, even obstructive. This is not a claim about a slippery
slope of abuses and errors; the point is that the very norm of what an abuse or
an error means will be recalibrated to the new reality, an apparently
reassuring reality with no evidence of abuses and errors.” (Kim S., 2016)
Furthermore, any requirement for X number of
years of treatment, or Y number of reasonable treatment trials, or Z number of
psychiatric consultations, falters and fails against the backdrop of the
unassailable legal principle of the absolute right of treatment refusal, and
the Bill C-14 entrenched principle of a subjective claim of unbearable
suffering being sufficient. Limiting eligibility over time is impossible in this
legal framework. This means that, in practice, proposed safeguards will not be sustainably
enforceable.
If we knew there was a clear finish line when
treatment in a particular case could be proven to have failed, a safeguard
charade wouldn’t matter as much. But there are no such finish lines for mental
illnesses. Hence, we can only establish speedbumps but not change any
determined person’s ultimate demand for assisted suicide.
A law, that under the weight of its own legal
precedent, cannot set any sustainable limit on accessibility to what is
supposed to be a rare outcome of last resort is both naïve and dangerous. It
means the state has absolutely failed in its duty to protect its citizens.
Validating
assisted suicide removes barriers, makes it the norm, and perversely makes
caution appear obstructionist.
Myth: Maid for mental illness will have no
unintended consequences.
Fact: Today, my patient (in
whom psychotic symptoms resolved with medication over the past year) refused my
suggestion for psychotherapy as a next step. She said she wants MAID and that
“it will soon be legal”, and she doesn’t want psychotherapy because “it might
make her change her mind about wanting MAID”. My reason for wanting her to
begin psychotherapy is because she has been sick for so long that she now
expects to always be sick, and being a “patient in need” has become her
established means of eliciting support and care from others. My team can help
her move to a healthier position in life where she can better meet her emotional
needs. Disturbingly, MAID is, in clinical lingo, “a sick role reinforcement”
par excellence. We have to believe we can heal in order to take steps to heal.
MAID proffered by a powerful and trusted physician says, “stop hoping”.
In the short term:
- Children who lack
life experience and judgement will be allowed to choose this “medical
procedure” because it has been falsely labelled as such, rather than what it
really is. It is literally an existential choice that should require some
expectation of maturity and mastery of life’s challenges. Killing a child
absent the opportunity to recover and develop resilience is a gross violation
of both parental and state duties to protect. Shockingly, it is already
happening in Europe. A twelve year old was allowed to “choose” doctor assisted
death. - More and more
healers will abandon their professed vow and become agents of death but retain
the now subverted honorific of “Doctor”.
Assisted death will become first line “medical treatment” for the
disabled and mentally ill, being offered by hospitals to save money and
indoctrinated young doctors blind to their own complicity in a state killing
apparatus. Families relieved of their “burden” will be grateful and the media
will be full of stories reinforcing the new compassion narrative. Very much
like Germany of the 1930’s. - MAID will mean
taking mental illness less seriously. We currently fight stigmatization and
want mental illness out in the open and talked about. But with an assisted
suicide solution to suffering we move backwards. What will sustain the
professional mobilization to research “treatment resistant illness” when it all
becomes less urgent. There will be less felt responsibility by some
psychiatrists to keep trying no matter what. People will die because MAID also
relieves the burden on each psychiatrist to do everything possible, only the
patient won’t know that they gave up because their psychiatrist gave up first.
In the long term:
- A new profession of
assisted death specialists will emerge. We already have doctors reporting they
are personally doing hundreds of MAID “procedures” a year (of note, you don’t
need medical training to administer poison). These are the salespeople and
emotional advocates who can’t understand why others don’t share their view of
the romanticized and sanitized theatres of death. Unfortunately, these medical
theatrics seduce and distract from a human reality only understood in the
living (and dying) of it. - We will extinguish the
human ecology of suffering. It will no longer to be a human goal to build
strength of spirit and character by rising up through suffering. Finding solutions to living with suffering
will simply matter less. We will take lives early to interrupt suffering. It
will be snuffed out earlier and earlier so we don’t have to see it, make sense
of it, or imagine how we might endure it. Of course you never know what life
brings until you get there, but we will normalize exiting the mortal coil
before the journey is over. (I will note that our imaginations are almost
always worse than any reality.) Suffering will become the great enemy rather
than the great teacher. Would
Terry Fox have run his Marathon of Hope if MAID had been pressed upon him at
his most vulnerable? - Families and loved
ones will be emotional casualties. One of the most beautiful senses of
accomplishment in life comes from “doing all I could” and “helping, loving, and
comforting to the very end”. They will be denied the choice to support the
person they love through a natural death because of the forced sacrifice on the
medical altar. Self-sacrifice and love will be falsely twisted into
characterizations of selfishness. - Each person will be
made to feel guilty for wanting to use up medical resources, being a burden on
their family, and not doing “the right thing”. Medical suicide will become the
“normal and expected” path to death. It will be modelled generationally and
encouraged through systematic propaganda by a state intent on saving money and
eliminating those on the fringe. - At some point in the future we won’t
even have the memory of what it is like now…to be able to hope that more
treatment and support could make life better someday. Benjy Freedman, a
Montreal bioethicist, may have been prescient in 1994 when he wrote (in
response to the Sue Rodrigues case): “…arguments can be made with respect to
two other conditions stated by the dissenting Justices: that the request for
euthanasia or assisted suicide be firm and unwavering, and that it be provided
by a fully informed person of undoubted competence. These conditions are not
self-interpreting. They are, moreover, in large degree, social constructions,
often understood as relative to accepted or expected choices. What the slippery
slope reminds us is that social expectations change over time, under pressure
of the previous choice. At present, for example, asking to be killed is an odd
choice and might trigger searching questions about competence. Over time,
however, this rigour might well give way. It is not hard to envision a time when
quite the reverse obtains, when an ill person who fails to ask to be killed is
judged to be “in denial” and for that reason in need of therapy.”
Myth: Governments are not motivated to support
MAID in order to save money.
Fact: Killing certain
citizens saves money. It takes care of the “problem” of the aging population.
Palliative care is expensive. MAID pushes the marginalized beyond the final
margin once and for all. How else do you
explain the purpose of the recent parliamentary cost
analysis of implementing the new law? The government funded study said $150
million would be saved in the first year. If MAID is an essential “Charter
right” that must be offered no matter what, why was cost considered? Afterall,
it is patently obvious that killing terminally ill people, and disabled people,
and mentally ill people, and socially disadvantaged people, sooner than
otherwise, saves money. The social engineering agenda appears to be fostering an
ethos where people nobly kill themselves so that they are not a burden on
others. Additionally, doctors killing such persons is framed as a great act of
compassion rather than the commodification of death in a secular age. This is
ableism wearing a mask of virtuous hypocrisy.
Conclusion: We cannot know which mental illnesses are
irremediable for any given patient. We simply do not have the data necessary to
make definitive clinical determinations, despite what some may falsely claim.
Most Canadians are
unaware of this artificially pressured legislative push. And only about 10% of
psychiatrists have weighed in. Some
of my psychiatrist colleagues are shocked to hear death could be offered
without the requirement that at least standard treatments have been tried. They
have absolutely no doubt that patients who would have gotten better will die if
mental illness is not excluded in Bill C-7. And any proposed procedural
safeguards will falter and fail under the weight of individual physicians
acting to normalize assisted suicide as a “standard practice” rather than as an
option of absolute last resort.
Canada offers MAID but
notuniversalpalliative care, disability supports, or mental health care. Do we
congratulate ourselves for our compassion in giving people an easier way to
die, while depriving them of the resources they need to live? How can Bill C-7 be justified while Canadians’ health rights are
ignored and unprotected? Is this what free choice
looks like in Canada?
John Maher MD FRCPC
Psychiatrist, Canadian
Mental Health Association
President, Ontario
Association of ACT & FACT
Editor-in-Chief, Journal of
Ethics in Mental Health
APR
2021
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