Senate amendment raises debate over medically assisted death for those with mental illness

Power Play: Lametti on MAID access Justice Minister David Lametti discusses the amendments proposed by the Senate to improve access and inclusion to medically assisted death.

TORONTO — In the Canadian Senate this week, senators voted on the future of medically assisted death (MAID) in Canada, weighing an amendment that could open it up to those suffering solely from mental illnesses.

Senators voted Tuesday to amend Bill C-7, which would, among other things, explicitly prohibit those suffering only from mental illness from accessing MAID. The amendment put an 18-month time limit on the mental illness exclusion, during which time Parliament must figure out how to properly expand medically assisted death to those who suffer from mental illnesses.

"Our bodies and our minds belong to us, not to the Crown,” Senator Paula Simons said in the Senate. “If we cannot be sovereign over our own lives and our own souls, then we are enslaved indeed.”

The topic is highly controversial, pitting questions of equality and the right to determine one’s own future against fears that vulnerable people could be hurt by expanding access.

For John Scully, expanding access to MAID would only be a positive change, one he has been waiting for.

“It is a question of human rights, and we deserve to be treated as equals,” Scully told CTV News. “Physically ill patients and mentally ill patients, we are just the same. And we deserve the same rights and this certainly goes for MAID for the mentally ill.”

Scully is a former journalist who has suffered from deep depression and PTSD that have defied treatment. His experiences have made him a proponent of those struggling with mental illness being able to have access to MAID.

“We deserve to […] die with dignity, with peace and surrounded with family, not take the route that I've taken twice, which is attempted suicide, which shocks the hell out of the families and loved ones,” he said.

He said it would make a “huge difference” if people in similar situations to his own knew they could have access to MAID, saying it could actually cut down on suicides.

“I would not think about […] suicide again,” he said. “It gives me peace and assurance that if I wanted to kill myself or wanted a way out of the suffering from mental illness, it would be there.”

However, others are sounding the alarm bell over the sunset clause.

Senator Denise Batters, whose husband David Batters died by suicide, asked the government to reject the senate proposal of a sunset clause, saying it could herald a dangerous future.

“This very innocuous sounding sunset clause, put in this legislation […] all that really means is that 18 months from now, after the bill passes, then people who are mentally-ill in Canada, [could] potentially be put to death by the state by [being] eligible for assisted suicide,” she said.

She said that the purpose of excluding those with mental health struggles from access to MAID “is actually quite a major part of protecting people.”

She believes the government should be focusing instead on fixing gaps in mental health care.

Some 4,600 Canadians die by suicide each year.

Although the 18 month time limit would allow the government the space to refine guidelines and protocols for expanding MAID to those suffering solely from mental illness, the proposed law currently would allow those struggling with mental health to access a medical death even if they haven't tried other treatments.

John Maher, a psychiatrist based in Barrie, Ont. with experience working with patients with personality disorders, told CTV News that he’s concerned there isn’t enough data currently to support MAID for mental illness.

“Some people with mental illness recover after a few months, some people after many, many years,” he said. “And so to offer MAID to anyone at a point in time when you don't know if they're going to get better, is really discriminatory.

“It's not what psychiatrists do,” he added. “We help people find purpose and meaning we help them cope with their suffering.”

He claims that the topic is being couched in terms of fairness when it shouldn’t be.

“What they're saying with this legislation is everybody, every Canadian citizen, should be entitled to MAID, but not every Canadian citizen is able to make a choice when they're suffering from a brain disease that impairs their thinking or their judgment,” he said.

However, many psychiatrists disagree with his perspective.

Senator Stan Kutcher, a psychiatrist who proposed the sunset clause on the mental illness exclusion, argued in the Senate that excluding those suffering solely from mental illness from accessing MAID is unconstitutional and stigmatizes them.

He said the exclusion wrongfully suggests those with mental illness lack the capacity to decide when their struggle has become too much.

"Intolerable suffering is a subjective, personal experience. It cannot be negated or delegitimized by anyone else's valuation of that suffering," Kutcher told the Senate.

The Canadian Psychiatric Association, although it has not taken a stance on whether or not MAID should be available when mental illness is the sole underlying medical condition, described Bill C-7’s framing of mental illness as not an actual illness as “unconstitutional” in the fall.

“Explicitly stating that mental illness is not an illness, disease or disability is inaccurate, stigmatizing, arbitrary and discriminatory,” they stated in a brief to the House of Commons Standing Committee on Justice and Human Rights. “It suggests that those with mental disorders do not suffer from a recognized illness, disease or disability and/or that they would recover if they simply adhered to therapy and tried harder.”

In Scully’s eyes, suggesting that people with mental illnesses are all incapable of making their own decisions is “sheer ignorance.

“I think that’s utter nonsense,” he said. “I’m articulate, I can write, I can think, I can talk. I have cognitive assurance. And to say that we are not capable of making a decision shows to me one of the great flaws in […] psychiatry and psychology.”

The future of this bill is very much up in the air, as it still needs to return to the House of Commons with this new amendment, where the government will decide what amendments to accept or reject.

There could be a delay or a referral to court for another extension, but one thing is certain — this is a topic that is not going away.

Resources are available in communities across Canada for anyone struggling with anxiety, depression or other mental health concerns.