If the current timetable is maintained, medical assistance in dying (MAID) will be expanded in March to include people whose sole underlying condition is a mental disorder.
At present, MAID can be offered to people who suffer such disorders, but only if they also have physical ailments deemed either terminal, or grievous and irremediable, such as chronic pain.
The inclusion of standalone mental disorders follows, in part, from a 2019 Quebec Superior Court ruling that the original statute was too restrictive. But psychiatrists across the country, including the heads of psychiatry at all 17 of the country’s medical schools, are alarmed.
They fear that as currently drafted, the new legislation is too vague, giving no guidance as to what counts as “irremediable.”
Dr. Jitender Sareen, head of psychiatry at the University of Manitoba, points out that “if a person wants MAID solely for mental health conditions, we don’t have the clear standards around definitions of who’s eligible. How many assessments and what kinds of assessment would they actually need?
As well, they’re concerned that with the country’s health-care system swamped by the COVID outbreak, this is no time to introduce a controversial and far-reaching change.
At a minimum, their preference would be to delay implementation, to allow time for more precise guidelines to be worked out.
A further difficulty is that as things stand, there is considerable uncertainty as to who may offer MAID. Health Canada says physicians and nurse practitioners can provide this service, with the assistance of pharmacists and pharmacy technicians/assistants. “Other health care providers” may also help out.
This is casting the net far too wide. Only fully trained physicians should be giving this life-ending procedure.
Adding to the potential for confusion, there are already concerns in the physician community about when MAID should be offered, even in the case of terminal illness. Quite a few doctors want nothing to do with what they perceive to be a professionally risky procedure.
These concerns came to a head two weeks ago, when a female veteran and former Paralympian told a parliamentary committee that in response to her requests for a wheelchair ramp at her home, a Veterans Affairs caseworker offered her MAID.
Retired Cpl. Christine Gauthier testified that during the phone call, in which she described her problems with mobility, she was told: “Well, you know that we can assist you with assisted dying now if you’d like.”
A spokesperson for Veterans Affairs minister Lawrence MacAulay said he is taking the issue “very seriously,” and added that an inquiry is underway. If ministerial accountability meant anything, MacAulay should have offered his resignation over this shameful episode.
Yet there is another side to this. If properly defined and regulated, there is a strong moral case for MAID. Despite the best efforts of medicine, there are circumstances, terminal cancer for example, where some patients may suffer excruciating pain.
Likewise, elderly people in the last stages of Alzheimer’s might very well prefer to end life on their own terms, rather than suffer the loss of dignity the disease threatens.
It comes down to this: Complex new public policy ventures rarely unfold exactly as planned. There is usually a period of trial and error.
But in this case, while there may be room for trial, there is no room for error. The consequences of getting it wrong are too damaging to consider.
So let Parliament bow to the advice of leading psychiatrists, and delay the extension of MAID until proper guidelines have been worked out.
>>> To comment on this article, write a letter to the editor: [email protected]
