The Expert Panel on MAiD and Mental Illness has it wrong
By SEPHORA TANG AND DYLAN MCGUINTY MAY 23, 2022
The Expert Panel on MAiD and Mental Illness has it wrong on both MAiD and mental illness. At best, the panel is out of touch with reality and is blinded by its own biases. At worse, it is misleading the Canadian public on an issue of moral significance not seen since the de facto abolition of the death penalty in 1963.
On May 13, 2022, Canada’s Health Minister Jean-Yves Duclos and Justice Minister David Lametti tabled the final report of the Expert Panel on Medical Assistance in Dying (MAiD) and Mental Illness in Parliament, but Sephora Tang and Dylan McGuinty say the report falls short. The Hill Times photographs by Andrew Meade
On May 13, 2022, Canada’s ministers of health and justice tabled the final report of the Expert Panel on Medical Assistance in Dying (MAiD) and Mental Illness in Parliament. Tasked with giving the federal government recommendations to pass legislation that would provide MAiD to non-dying people suffering solely from mental illnesses such as depression, the panel wrote a report that was remarkable for its lack of substance, outdated evidence, and failure to provide meaningful guidance.
The panel’s purpose was “not to debate whether or not persons with a mental illness as their sole underlying medical condition should be eligible for MAiD,” but rather to review “protocols, guidance, and safeguards” to apply to requests for MAiD by persons who have a mental illness. In other words, the endorsement of assisted suicide as an intervention for mental illness was baked right into the report without discussion.
Astonishingly, despite increasing Canadian and international reports that demonstrate how the current MAiD regime in Canada fails the poor and marginalized, the panel’s authors concluded that the “existing MAiD eligibility criteria and safeguards” provide an “adequate structure” for MAiD where a mental disorder is the sole underlying medical condition. The report recommends subjective determinations by individual assessors on the irremediable nature of mental disorders, despite the clear lack of evidence that such determinations can be accurately predicted. The report also deems it to be an acceptable risk to wrongfully end a person’s life prematurely when they would have otherwise gotten better. The panel’s reckless position on what constitutes an acceptable risk contrasts starkly to the prudence that led Canada to prohibit capital punishment on the basis that risking even one wrongful death was too much risk for society to bear. The Panel fails to recommend even the most elementary methodology of determining how many or what types of interventions should be tried before determining that a mental disorder is incurable. Finally, the Panel compares the evaluation of eligibility for MAiD to evaluations for eligibility for long-term disability. However, in the case of an error in prognosis for a long-term disability application, the person is at least given the opportunity to recover; in the case of a MAiD application, an error that leads to eligibility for MAiD results in wrongful death.
The report is out of touch with the realities of the lived experience of those struggling financially. It seems to have been written from the back of a limousine speeding past Vancouver’s Downtown Eastside, or, sadly, your average seniors’ residence. While the report’s solution to the “structural vulnerabilities” due to poverty and inadequate housing is to simply “offer” housing and income supports, it reveals ignorance of practical reality. Demand for subsidized housing far exceeds supply even in Ottawa, with approximately 10,000 households on a wait list that can be five years or more, and income support for people living with disabilities has been frozen since 2018 at rates well below the poverty line. At the same time, the report suggests that a person need not attempt interventions to relieve suffering that are financially inaccessible. For those unable to afford treatments and services that are not covered by our publicly funded health-care system, death is offered and accepted by those who have no other financial option.
After highlighting the disproportionate ways in which Indigenous peoples are affected by poverty and lack of adequate housing and supports to live, the report insensitively calls upon “all levels of government” to ensure that Indigenous communities are afforded “equitable access” to MAiD, while failing to simultaneously advocate for their equalized access to supports in living. Thus, the report blindly supports the colonial mentality of offering harmful solutions to the victims of problems caused by systemic power structures. What is more, the systemic discrimination and ageism that is tastelessly baked into Bill C-7’s legislation is clearly seen where younger people with a mental illness would be afforded the “protection” of a 90-day assessment period, whereas a senior with the same diagnosis could be placed on the fast-track to death without even a 10-day reflection period. Is this the “autonomy” of “choice” that proponents of MAiD expansion are trying to convince Canadians to endorse?
The report cited evidence relied upon by the Superior Court of Quebec which concluded that there was no evidence that euthanasia and assisted suicide (EAS) outside the end-of-life context undermines suicide prevention or that it has increased suicide rates. However, in a study published by Oxford scholar David Jones in 2022, this conclusion was refuted by new evidence which demonstrates that, where EAS has been introduced, there has been an increase in suicide. Jones also found that in jurisdictions where EAS is permitted, there was no reduction in unregulated suicide, and in some cases, there was an increase in non-assisted suicide.
The Expert Panel on MAiD and Mental Illness has it wrong on both MAiD and mental illness. At best, the panel is out of touch with reality and is blinded by its own biases. At worse, it is misleading the Canadian public on an issue of moral significance not seen since the de facto abolition of the death penalty in 1963.
Dr. Sephora Tang is a psychiatrist and assistant professor with the University of Ottawa. She was an expert witness to the Senate’s Legal and Constitutional Affairs Committee study of Bill C-7 on Medical Assistance in Dying, and is co-author of the MAiD to MAD declaration. Dylan McGuinty Jr., MA, JD, is an Ottawa lawyer who assists people and families with end-of-life and estate planning.