'Weighing our options': Ottawa open to further pause to expand assisted dying rules

OTTAWA -

The federal government is considering whether to pause its original plan tobroaden the rules that govern medically assisted dying so they include patients whose only underlying condition is a mental disorder.

"We're weighing our options," Justice Minister Arif Virani said Wednesday.

It would be the second time the federal Liberals have hit pause on the plan. The first came in February, when the government decided to impose a one-year delay amid widespread public and political concern.

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That decision established a new deadline of March 2024 -- one that now appears in jeopardy. Cabinet will consider the input of a joint parliamentary committee, as well as medical experts and other stakeholders, Virani said.

"We'll evaluate all of that comprehensively to make a decision whether we move ahead on March 17, or whether we pause," he told The Canadian Press in a wide-ranging interview.

Both options are "on the table," he added.

Back in February, Virani's predecessor David Lametti said the government could have pressed ahead with its schedule, but opted instead to give medical professionals more time to prepare for the change.

"We strongly believe," Lametti said at the time, that an extension would "provide sufficient time to ensure our health-care system protects those who may be vulnerable and support autonomy and freedom of choice."

Conservative MP Ed Fast sees Virani's comments as a shift.

"It's the first time I've seen a glimmer of hope come from the Liberal government that they're prepared to reconsider their decision to move ahead."

Earlier this year, Fast's private member's bill, which would have amended the Criminal Code to expressly prohibit the use of a mental disorder as a basis for choosing medical help to end one's life, came to a vote in the House of Commons

While it was defeated with the majority of Liberal and Bloc Quebecois MPs opposing it, eight Liberal MPs broke ranks. Twenty-four NDP MPs also voted for the private member's bill, with none opposed.

Alistair MacGregor, one of the New Democrats who voted in its favour, says another delay is needed at least "until there are better supports in place," and there is a better understanding of how Canadians will be affected.

Fast says he hoped his bill "forced the government to go back to the drawing board and consider what their own members had to say."

Federal Conservative Leader Pierre Poilievre has already committed to scrapping the expansion plans if he forms the next government, and supported that bill.

Fast said he would prefer that the Liberal government do away with the expansion altogether, rather than consider another delay. What ought to happen, he said, is a national debate.

"I would certainly welcome an indefinite pause that would allow Canadians to have the full public discussion that has still not been had on the issue."

However, the CEO of Dying with Dignity Canada -- an advocacy group that has fought for more access to assisted death -- says she is worried about the government "stringing people along and disappointing them" with another possible delay.

"There are people who have been waiting for years just to hear, 'Can I be assessed?' Not even, 'Am I eligible?' But: 'Can I be assessed? And what do I do next?"' Helen Long said Friday.

"For those people, we're concerned about an announcement like this sending them into crisis."

Medical assistance in dying was effectively legalized in Canada in 2016. Three years later, the Superior Court of Quebec declared the original criteria -- adults with a "reasonable foreseeability of natural death" -- unconstitutional.

Senators, too, argued that excluding those with a qualifying mental disorder was a violation of their rights. Prime Minister Justin Trudeau's government ultimately agreed to expand eligibility in 2021.

That ushered in a two-year sunset clause that was set to expire last March, before the Liberals moved to delay it by an extra year.

Virani says the idea is either to let the provision sunset on March 17 "or to pause it further."

"Those are the two options that we're looking at."

A small handful of countries in Europe already allow adults whose sole medical condition is a mental disorder to seek medical assistance in dying. Whether Canada should follow suit is a question that has sparked fierce debate.

Speaking at a housing announcement in Vancouver, B.C., Prime Minister Justin Trudeau said his government needs to ensure it is balancing "the desire to protect vulnerable people" with respecting "people's rights to make their own choices."

He said his government has acted "very, very careful over the years" on the issue.

Supporters say expanding the regime provides choice for those who are suffering and have no other options; denying it violates their rights. Some disability advocates, however, say proper mental-health supports are a better option.

Other organizations, like the Centre for Addiction and Mental Health, note there is no clear medical consensus on what constitutes a "grievous and irremediable" mental illness, or on how to distinguish that from suicidality.

The centre was pleased to hear the government was open to another delay, Dr. Tarek Rajji, who chairs its medical advisory committee, said in a statement.

"At this time, the health care system is not ready," Rajji said.

The Canadian Mental Health Association also released a statement supporting a delay beyond March, saying the recent consultations done by provinces have been "significantly expedited" to meet the current timelines.

Virani says the first step will be to evaluate what a special joint committee of MPs and senators studying the matter will recommend. The committee was reconvened to study whether the system was prepared for such an expansion.

Members of the committee have adopted the report but have until the end of January to present it to the House of Commons, co-chair Rene Arseneault, a Liberal MP from Quebec, said in a statement.

"Canadians should be following what that committee recommends, because we're very keen on ensuring that the system is ready," Virani said.

"That will inform what we do on March 17, whether we move ahead with mental illness as a sole underlying condition -- or not."

Fast, who sits on the committee, said listening to the witnesses who testified showed him "there was no consensus in Canada at this point in time that we're ready for this."

Konia Trouton, the president of the Canadian Association of MAiD Assessors and Providers, says the organization will continue to provide clinicians with the professional support they need.

"As an organization representing the professionals who do this work, (we) think the clinicians are ready."

Long also said the federal government has done what it needs to do to ensure the health system is prepared, in terms of steps like developing a national curriculum.

The fact Virani made his comments before the committee submitted its report is "disappointing," she said.

"It's important not to conflate people who don't support this option with (the question of): 'Are we ready?"' she added.

"Those are two different things."

Virani said the decision to seek medical assistance to end one's life is a "fundamental personal choice."

The government, he said, is "very actively listening" to those voices that say Canada is not ready for an expansion into mental illness.

This report by The Canadian Press was first published Dec. 15, 2023.

-- With files from Nicole Ireland in Toronto.