What the future implications might be
Is it medically assisted death or is it disposal of people with mental illness and no resources? The Globe and Mail:
Canada will have one of the most liberal euthanasia laws in the world, joining only a few other countries that allow assisted dying for mental illness.
It will be the most controversial expansion of MAID since a Supreme Court ruling led the federal government to legalize euthanasia in 2016. At that time, MAID was only for patients with a foreseeable death, but Parliament – with Bill C-7 – removed that requirement in 2021.
The original version of the bill did not allow assisted death for patients with mental disorders as a sole condition because, the government said at the time, there were outstanding questions about how illnesses such as depression could be safely included, and what the future implications might be. The Senate disagreed, removing that exclusion before the bill passed, but with one caveat: Parliament would study the issue for two years before any of those patients could receive MAID.
With four months to go, there is still no consensus in the mental health community – and, in fact, doctors remain deeply divided. There are no finalized national standards, no transparent review process in place to watch for mistakes, and hospitals are still figuring out how they would implement the change.
Toronto’s Centre for Addiction and Mental Health (CAMH), Canada’s largest psychiatric teaching hospital, has said that assisted dying shouldn’t expand without more study. And the Canadian Mental Heath Association has raised serious concerns about expanding MAID without first increasing mental health care funding. In Quebec, after public consultations, a legislative committee has recommended against the province expanding MAID to mental illness at all.
I don’t know what I think about this. It’s very thorny. Is it just brutally disposing of people who don’t fit in well enough or aren’t useful enough? Or is it humanely helping people for whom living is a misery?
Expert dissension, a law without clarity, the arbitrary legislative finish line – all of this would be worrisome, even in normal times. But Bill C-7 passed before the full consequences of COVID-19 were known, before the pandemic ripped through the health care system and left it in tatters.
The law requires patients asking for MAID to be informed of possible treatment options that might alleviate their suffering. But this assumes those are readily available. Instead, wait times to see mental health clinicians have only increased.
Psychotherapy, a recommended treatment for most mental disorders, remains too expensive for many Canadians. In Toronto alone, an estimated 16,000 people are waiting for supportive housing for mental illness and addiction.
In Ontario, nearly 6,000 patients with the most severe mental disorders are on a years-long list for specialist community-based care.
So it becomes a resources issue, a money issue, which is surely a very bad reason to help people kill themselves. Then again there’s still the issue of people whose lives are nothing but misery.
The rising cost of rent and foodis also taking a particular toll on people with chronic mental illness, who are often already the poorest in society – and the very candidates who will qualify for assisted dying under the new law.
Assisted dying for people who can’t afford the rent…no that doesn’t sound good at all.
It sounds bloody awful, to be honest. It’s the ‘no co-morbidities part which has hitherto kept people alive long enough to survive the waiting list, get appropriate treatment, and go on to have a healthy life.
If you are suicidally miserable because you are in severe, intractable, possibly increasing pain from a condition which will imminently kill you, and want to die because facing further pain is pointless, then euthanasia is obviously a lot less cruel than making you wait for natural death.
However, if you are suicidally miserable solely due to a treatable mental illness or disorder, then it is the failure to treat which is immensely cruel, and killing you because you might appear to want that in the moment, because of under-funding of the resources which would restore your health, is abhorrent.
We’re seeing the same short-term thinking in the treatment of dysphoria in teens; the only difference is that the teens who undergo the appalling medical and surgical alternative to real treatment are still alive afterwards, and can sue for the abuse.
A dead person cannot sue; I don’t want to have to find out whether or not their bereaved families can.
tigger, I agree with that, though I might carve out a place for people who have a long-term mental illness that makes them chronically miserable all the time and there is no cure. If they don’t respond to treatment, you can try changing medications, changing therapists, etc, and see if that helps. But at some point, you’re faced with a patient as miserable as those with chronic terminal physical illness, and medical assistance is probably less painful than killing yourself.
I think, like Ophelia, I’m definitely torn on this issue. I am grateful that when I was depressed, unemployed, and had a seemingly unresponsive condition, I was not euthanized for my own sake. I eventually rebounded, and even though still battling depression and anxiety, can lead a normal, sort of happyish life.
are all…or most…severe mental ill eases “treatable” though? I honestly fear the jury is out on that??
[…] a comment by tigger_the_wing on What the future implications might […]
I agree with you, iknklast, that the situation can be very different for people with untreatable mental illness or disorders which are causing them extreme misery, which is why I specified treatable.
I fear, though, that untreated conditions may come to be regarded as untreatable, and thus lead to the euthanasia of sufferers, without providers making the (possibly more expensive and time-consuming) effort to try all available treatments first. Like you, I’m out the other side of a period of severe depression (many years now) and am so very grateful that a solution which works for me was eventually found, even though it was largely because of CBT and treatment for apparently unrelated conditions; mental health medications don’t work for me and have unacceptable side-effects.
Yes, we definitely need to have strict measures in place to determine someone is “untreatable”. I could have been pushed aside that way, but like you, CBT was a way through for me. I have problems with medications, too, and I know a lot of other people do.
Brian M., I think the jury is probably out on that, because some of it depends on what you mean by treated. Does a lightening of depression mean the same as a cure? Or does it require being happy all the time? (I would go with neither, myself, but use overall outcomes based on individual patients; that’s harder to write into a policy, though, so some people like the easy answer).
Too many people want “depressed” or “not-depressed” to be our standard, but unlike sex, depression really is a spectrum. Almost everyone will fall somewhere along it at some point in their life, often because of life circumstances that will possibly resolve or that the individual will learn how to cope with. So I think being very careful about prognosis and patient way of life (not necessarily the way of life society designates, but one that works for them) is essential.
But I think requiring co-morbidities for mental illness to be allowed euthanasia is putting yet another stigma on mental health, the idea that it isn’t “real” like other illnesses. I have had a number of various illnesses over the course of my life, at least three of which are chronic. They all come with some potential limitations on my activities. None of them has limited my activities to nearly the extent that the severe depression did for a decade. I lost a decade of my life to it, a decade I will never get back, and I was luckier than a lot of people who never come out the other side.
Is a shotgun or helium insufficient now? The government shouldn’t be in the business of helping unwell (in the head) people kill themselves nor any oathbound physician.