Most Canadians don't support latest planned MAID expansion, survey finds

W5: The Death Debate, part one On March 17, 2023, people with mental illnesses will become eligible for Medical Assistance in Dying. W5's Avis Favaro investigates.

A recent survey suggests the majority of Canadians do not support the latest expansion that has been planned for medical assistance in dying in Canada, one which would open it up as an option for those with mental illnesses as a sole condition.

While six out of 10 Canadians support MAID in its current form, which allows those with a grievous and irremediable medical condition to apply for it, only three in ten Canadians support the idea of allowing patients to seek MAID purely based on mental illness, according to a new report by the Angus Reid Institute.

The report comes a week after the Trudeau Government introduced legislation to delay the expansion of MAID by a year, saying more time was needed to get it right.

“To be honest, we could have gone forward with the original date,” Justice Minister David Lametti said at a news conference last week. “But we want to be sure, we want to be safe, we want everybody to be on the same page.”

The expansion of MAID to allow mental illness as a sole condition has been a contentious concept.

Some mental health advocates say that having the option of MAID would allow individuals experiencing suffering to die with dignity.

But other psychiatrists and mental health advocates see the expansion of MAID to include those suffering from a mental illness as a potentially dangerous overreach, likening it to the government making suicide more accessible to a vulnerable population instead of putting in the work to provide the supports needed to improve their daily lives.

Still, others argue that the system simply isn’t ready to handle these changes, and that there aren’t clear enough guidelines delineated or training available to ensure MAID is only offered to those who truly require it.

The new report from Angus Reid is built on a survey conducted online among a representative sample of 1,816 Canadian adults at the end of January.

Canadians were questioned on some scenarios that have made headlines recently as the debate raged, with the vast majority agreeing that Canada should not be offering MAID to people purely on the basis of a lack of proper housing.

The majority of respondents (65 per cent) across the political spectrum agreed that potential patients should have to exhaust all treatment alternatives before MAID is available. Around 32 per cent of respondents were also concerned that the expansion of MAID laws could lead to less emphasis on improving palliative care.

SUPPORT FOR PREVIOUS MAID LAWS

In order to assess how Canadians’ opinions of MAID has changed, the survey asked participants about their support for the two previous variations of MAID.

When MAID was first introduced in 2016, those who applied needed to be able to prove that they were facing a foreseeable death due to an incurable illness or condition. In 2021, the laws were expanded to allow those facing serious, incurable illness or disability, who did not have a foreseeable death, to apply for MAID.

When survey participants were asked for their opinions on these two variations of the law, they were informed about existing safeguards for MAID, such as a 90-day waiting period between requesting and accessing MAID, as well as the assessment of two physicians, which both aimed to ensure these decisions were not spur of the moment.

More than half of respondents said they supported or strongly supported the 2016 version of MAID, with the next largest response being the 28 per cent who said they weren’t sure or couldn’t say.

Support was even higher for the 2021 criteria which removed the “foreseeable death” requirement, with 60 per cent of respondents saying they supported or strongly supported it, although the proportion which opposed or strongly opposed it increased from 2016’s 17 per cent to 28 per cent for the 2021 version.

Those from Quebec had the highest level of support for the 2021 version, with 78 per cent supporting it. It was the Superior Court of Quebec that originally ruled in 2019 that the provision requiring a “reasonable foreseeability of natural death” was unconstitutional.

CANADIANS MUCH LESS CERTAIN ABOUT NEW MENTAL HEALTH CHANGES TO MAID

In 2021, the government agreed to a future amendment to allow people to apply for MAID with a serious mental illness as their sole condition, but asked for a two-year extension to prepare for such a change to be implemented.

This deadline is coming up in March, unless the government receives the one year extension it has requested.

Angus Reid previously asked Canadians in a 2016 survey what they thought about mental illness as the sole condition for MAID, and in 2016, 78 per cent of Canadians were opposed.

That opposition has shrunk in the years since, but 51 per cent still oppose the idea of mental illness as a sole condition for MAID, according to the new survey.

Only 31 per cent said they support mental illness as a sole condition for MAID—a far cry from the 60 per cent who supported the 2021 updated version of the law which removed foreseeable death as a requirement.

Around 18 per cent of respondents said they weren’t sure about mental health as the sole condition.

When broken down by province, Saskatchewan has the highest percentage of those who oppose the idea, at 68 per cent, while Quebec has the lowest percentage of those who oppose the idea, at 43 per cent. Even in Quebec, those who oppose changing MAID laws to allow mental illness as the sole condition outnumber those who support it, although Quebec has the highest percentage of those who support it at 36 per cent.

Conservative voters have the strongest percentage who oppose the expansion, with 65 per cent stating their dislike compared to just 23 per cent who approved, while Liberal and NDP voters were more split. Of those surveyed, 42 per cent of those who identified as Liberal voters said they opposed the expansion, compared to 39 per cent who supported it. NDP voters were split by 40 per cent opposed, 36 per cent in support.

NDP voters and Bloc Quebecois voters had the highest percentage who reported they weren’t sure or couldn’t say, at 24 per cent and 26 per cent, respectively.

When asked if the increase in access to MAID since 2016 was a good or a bad thing, there was a lot of uncertainty among respondents, but the most common response was positive.

Around 43 per cent answered that it was a good thing because “people have more control over end-of-life decisions now.”

Around 25 per cent said it was a bad thing, and that MAID is “being overused/abused.”

A combined 31 per cent said it was neither good nor bad (20 per cent) or answered that they weren’t sure or couldn’t say (11 per cent).

HOMELESSNESS, CHRONIC PAIN AND A LACK OF ACCESS TO MEDICAL CARE: WHEN IS MAID APPROPRIATE?

The idea of choosing medically assisted death can be a difficult one for many Canadians to conceptualize. The nuances of different scenarios can make it hard to pinpoint when allowing MAID as an option is a compassionate way to give control back to individuals or when it is a sign of a government abdicating its responsibility to improve the lives of its citizens.

In order to get a better idea of how Canadians would judge individual scenarios, the survey presented ten situations to participants, some of which were drawn from real-life examples, that would allow them to empathize with those juggling these decisions.

Only one of the scenarios garnered a majority of support from respondents. When presented with the scenario of “a person suffers from debilitating chronic pain,” 64 per cent of those surveyed said they would support this person in seeking MAID. Men aged 55+ were most likely to support it in this scenario, with 70 per cent selecting that option.

The least popular scenario in terms of participants agreeing that MAID could be a solution, was “a person can’t find affordable housing.” Just nine per cent of participants said they would support the idea of a person in this situation seeking MAID.

The report noted that an Ontario man recently made news after he requested MAID not because he wanted to die, but because he thought it was a preferable alternative to being homeless.

A disabled Ontario woman also applied for MAID after seven years of applying for affordable housing in Toronto with no luck.

“No one should have to seek medical assistance in dying (MAID) because of a government’s refusal to act in the best interests of individuals experiencing homeless or disability,” Toronto-St. Paul's MPP Jill Andrew told CTV News Toronto in November.

Only 16 per cent of respondents supported MAID for a person with severe anxiety, 22 per cent supported MAID for a person with severe depression and 24 per cent supported MAID for a person who “has no hope for the future and finds no meaning in their life.”

Around 23 per cent of respondents said they would support a Canadian Armed Forces member seeking MAID due to suffering from PTSD.

An investigation was launched this fall after Veteran Affairs Canada discovered that an employee had offered MAID during discussions with four separate veterans. They confirmed in December that the employee was no longer working there.

"We expect all Veterans Affairs Canada employees to interact with veterans with care, compassion and respect, and the actions of this one employee is simply disgusting,” Veterans Affairs Minister Lawrence MacAulay said in November.

Only one in four respondents supported a person choosing medically assisted death if they couldn’t get access to other medical care.

Those aged 18-34 were more likely to support MAID across the board compared to other age groups.

Women aged 18-34 were much more likely to support the idea of MAID for a person who “feels their medical care needs are a burden to their family,” at 41 per cent, compared to women aged 35-54 (24 per cent) or aged 55+ (28 per cent).

Many people struggling with conditions such as depression and anxiety are also dealing with circumstances that exacerbate their mental health struggles, such as poverty or homelessness.

Those who urge caution when expanding MAID argue that before we expand it to include those experiencing mental illness as a sole condition, we need to expand social supports that could help tackle mental illness and the extenuating circumstances that make it worse.

That concern was echoed in the survey, with more than half of respondents answering that they were worried that MAID would become “a replacement for adequate social services in Canada.”

The largest group to express this concern was men aged 18-34, with 64 per cent stating they agreed with this fear.

MAID IN CANADA

The survey also touched upon how many Canadians have personal experience with MAID through a loved one.

Around 15 per cent of those surveyed said that either a close friend or family member had chosen to end their life through MAID.

Having a loved one who used MAID was more common among older Canadians, with 21 per cent of those aged 65+ stating they knew someone who died via MAID, but 11 per cent of those aged 18-34 still reported knowing someone who used MAID.

Around 42 per cent of all respondents said that when reflecting back, they could think of a close friend or family member who they believe would’ve chosen MAID if it had been available to them.