Ottawa to delay again expansion of medically assisted death for patients with mental illnesses

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The federal government is delaying for the second time plans to expand medical assistance in dying to people whose only medical condition is a mental illness, just weeks before such provisions were set to take effect.

Canada is not yet ready to go ahead with this move, Health Minister Mark Holland acknowledged on Monday, echoing the conclusions of a joint parliamentary committee, which had released a highly anticipated report shortly beforehand.

“The system needs to be ready,” Mr. Holland said. “We need to get it right.”

The committee heard “significant testimony” from stakeholders about whether the country’s medical system is adequately prepared for the controversial expansion of MAID.

“Many practitioners remain concerned, particularly regarding the challenges of assessing irremediability,” the report read. Some witnesses told the committee about the difficulty in distinguishing requests for medical assistance in dying from suicidal thoughts.

MAID provisions for individuals with mental illnesses were previously set to kick in back in March, 2023, but Ottawa had delayed that to March of this year. It reconvened a special joint committee of MPs and senators to verify that there could be “a safe and adequate application” of the planned expansion.

Mr. Holland said Monday the government agrees with the committee’s findings that more time is needed. He did not say, however, how much more time. Mr. Holland promised to bring forward legislation soon that will set out a new timeline. At present, provisions to allow MAID for mental illness are to take effect on March 17.

Provinces have also expressed concerns about readiness, Mr. Holland said, adding that Alberta, Saskatchewan, Manitoba and Quebec said they were not ready to proceed.

In the committee’s report, a majority of members said that medical assistance in dying in this area should not be made available in Canada until the Health and Justice Ministers are satisfied “based on recommendations from their respective departments and in consultation with their provincial and territorial counterparts and with Indigenous peoples, that it can be safely and adequately provided.”

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They also recommended that the special committee be re-established one year before the date on which the law will permit medical assistance in dying for individuals whose sole underlying reason is a mental disorder “to verify the degree of preparedness.”

A dissenting report was filed by some members of the committee: Senators Stan Kutcher, Marie-Françoise Mégie and Pamela Wallin.

The senators released a statement saying that despite the fact that the majority of witnesses testified that readiness had been achieved, the majority report says that the Canadian medical system is not ready and recommends an extension.

“However, the committee did not undertake a study of the ‘Canadian medical system,’” the senators said. “Our mandate was to determine if the federal government’s tasks for readiness had been completed. We believe they have.”

Canadians with mental disorders should receive appropriate health care on a case-by-case basis, the senators added, saying this is a right afforded to all other Canadians who meet criteria for access to MAID.

“It also stigmatizes individuals with mental disorders, promoting the myth that individuals with mental disorders are incapable of making informed decisions about their end-of-life choices,” the senators said.

Helen Long, chief executive of Dying With Dignity Canada, said Monday there is a lack of clarity at this stage on what the committee’s recommendation will mean, adding that her organization will continue to educate Canadians on end-of-life choice.

“For the people across the country who live with treatment-resistant mental disorders who have patiently waited for this change in Canada’s MAID law, Dying With Dignity Canada is disheartened and shares the frustration of the continued exclusion, stigmatization and discrimination based on diagnosis – a clear breach of the Charter of Rights and Freedoms,” Ms. Long said.

Conservative MP Michael Cooper, who was a member of the committee, said Monday that it is good the government is “finally listening, or appears to be finally listening to what experts have been telling this government” about concerns that MAID for mental illness isn’t safe and can’t be implemented at this time.

“Given the issues that have been identified from the standpoint of moving ahead, anything less than an indefinite pause is insufficient,” Mr. Cooper said.

NDP MP Alistair MacGregor, one of the vice-chairs of the special committee, said in an interview prior to the tabling of the committee’s report that the panel heard a wide range of perspectives about extending MAID laws.

He said those professionals, such as psychologists and psychiatrists, expressed discomfort with the way Canada’s laws are going on MAID.

“That was quite remarkable,” Mr. MacGregor said.

Jocelyn Downie, a professor emeritus at Dalhousie’s Faculties of Law and Medicine who has long studied MAID, told The Globe and Mail on Monday, before the release of the committee’s report, that the metrics for readiness had been met.

She also said if another exemption were to be granted, the consequence would be that “people who would meet the robust eligibility criteria and procedural safeguards who have been waiting for the exclusion to be lifted will be left in a state of enduring, intolerable and unrelievable suffering.”

David Lametti, who previously served as justice minister and recently announced that he was leaving federal politics, said last week that MAID in this area would only apply to a very small number of people and he “wouldn’t be afraid personally of moving forward with it.”

Mr. Lametti was in the justice portfolio when Bill C-7 was passed, which expanded access to MAID to individuals whose sole underlying medical condition is mental illness.

With a report from The Canadian Press