Outcry grows against mental illness as grounds for medically-provided euthanasia

Expanding medically-provided euthanasia / assisted suicide to individuals with mental illness continues to be debated, even as the government approves a one-year delay. (Pixabay photo)

By Terry O’Neill, The B.C. Catholic

[Vancouver – Canadian Catholic News] – In a little more than three months, federal law will permit Canadians who are mentally ill to access the country’s already permissive assisted-suicide regime on the sole grounds that they are suffering from a mental disorder.

They will not have to show that their illness is a fatal one, nor that their death is imminent, but only that they find their mental disorder to be so unbearable that they should be allowed to have themselves put to death.

As the March 2023 deadline for expansion of assisted-suicide eligibility draws ever closer, Catholics from across the country are raising their voices in opposition. In Vancouver, for example, Archbishop J. Michael Miller recently described the law as “morally depraved.”

Any hope that the federal government would reverse course appeared to be dashed in late October by the Liberal government’s health minister, Jean-Yves Duclos.

Duclos released a little-noticed statement on Oct. 20, 2022 that not only appeared to ignore the Special Joint Senate-Commons Committee on MAiD (medical assistance in dying)  request for more time to study the issue, but also embraced the recommendations of a government-appointed “expert panel” which reported in May that the government did not need to undertake any new legislative protections before opening assisted suicide to the mentally ill.

Federal Health Minister Jean-Yves Duclos says the Liberal government is working to implement recommendations to allow euthanasia on the sole grounds of mental illness. (Twitter image, The B.C. Catholic – CCN)

But at least two panel members, Jeffrey Kirby and Ellen Cohen, resigned before the panel released its report to protest its failure to recommend adequate safeguards.

Kirby, a retired professor in the department of bioethics at Dalhousie University, told The Toronto Star that he believes “more people will end up being approved for MAiD and having MAiD performed than is warranted” because of that failure.

Similarly, Cohen, who worked for 30 years in the field of mental health, wrote in an essay that she felt the panel’s recommendations did not contain sufficient safeguards. “I could not legitimize the process and I also could not condone the conclusions of the panel,” she said.

Deepened concern

While the Catholic Church opposes all forms of assisted suicide, the looming expansion of eligibility requirements has sparked renewed and deepened concern.

“Next March, unless the government is forced to change its mind, persons suffering solely from mental illness will become eligible for euthanasia,” Archbishop Miller said in his homily at the White Mass for health-care professionals Oct. 29.

“In six years, Canada has gone from totally banning euthanasia to one of the most permissive euthanasia regimes in the world,” Archbishop Miller said. “And even more access could be coming, including allowing ‘mature minors’ to request it.”

“The only way now to minimize the damage to human dignity caused by such morally depraved laws is to work to ensure that palliative care is affordable and accessible to every Canadian,” he said.

Every diocese in Ontario has now joined the pro-palliative-care “No Options, No Choice” initiative, which the Christian Medical and Dental Association of Canada launched in October. The initiative seeks to persuade provincial governments to spend more on palliative care, mental-health treatments, and social and housing supports to ensure that Canadians don’t choose Medical Assistance in Dying [MAiD] out of despair and frustration.

Lives can still be saved

“Am I saying this is going to eliminate MAiD altogether? Probably not,” Deacon Larry Worthern, executive director of the association, said in an interview with The Catholic Register. “But how many lives will be saved in the interim?”

Also in Ontario, the Saint Elizabeth Health Care foundation, with funding from ShareLife and support from the Catholic Charities arm of the Archdiocese of Toronto, opened a special “HopeLine” service on Nov. 11 to provide information about access to palliative care.

The Canadian Conference of Catholic Bishops formally told the joint parliamentary committee in May that it opposed assisted suicide and the expansion of eligibility to the mentally ill.

“The legal expansion of eligibility for MAiD will only serve to erode the respect for the essential dignity of the human person and the common good of society, which must be committed to protecting and safeguarding vulnerable individuals and those without a voice,” said the submission, signed by CCCB president Bishop Raymond Poisson.

While the committee heard many similar presentations from individuals and organizations opposed to allowing the mentally ill access to assisted suicide, the majority of its senators and members of Parliament reported in June that they supported the expert panel’s finding that sufficient policies were already in place, or were being developed, to enable the practice to proceed. At the same time, the committee asked for more time to conclude its own study of the issue.

Warnings not being heeded

A minority of the committee members issued a dissenting report, charging that legislation of this nature needs to be guided by science, and not ideology. “We have been warned by several experts that if MAID MD-SUMC [Medical Assistance in Dying where Mental Disorder is the Sole Underlying Medical Condition] is implemented as planned, it will facilitate the deaths of Canadians who could have gotten better, robbing them of the opportunity they may have had to live a fulfilling life,” the dissenters said.

Among the problems they cited was the difficulty of determining whether a patient’s desire for suicide is a symptom of their illness, or whether it is a distinct phenomenon known as suicidal ideation, or having suicidal thoughts.

“I think what is happening is that the government is throwing people with suicidal ideation under the bus,” Alex Schadenberg, executive director of the Euthanasia Prevention Coalition, said in an interview with The B.C. Catholic. “So when a symptom of your condition is suicidal ideation, and they are offering you euthanasia, obviously, there’s a big problem here. What they really need is treatment, not death.”

(Pixabay photo)

MP Michael Cooper (CPC St. Albert–Edmonton) told The B.C. Catholic that he and the other two MPs who signed the dissenting committee report said it is extremely difficult to determine whether someone suffering from a mental disorder is irremediably ill. By law, however, for someone to be eligible for assisted suicide, a person must have a “grievous and irremediable medical condition.”

“The train has left the station, there’s no question,” Cooper said. “The government has set in motion this significant expansion without study, without consultation, without safeguards, and (despite) evidence from experts that, in cases of mental illness, it’s not possible or at least very difficult to determine irremediability.”

Process was a failure

MP Michael Cooper (Submitted photo, The B.C. Catholic – CCN)

Cooper said the May expert-panel report offered no safeguards or practice standards. “So in that regard, the expert panel failed to produce a report on the very issues that they were tasked to producing recommendations on,” Cooper said.

“Their only safeguard was to say that these decisions, in respect to eligibility [where the sole ground was mental disorder] can be decided on a case-by-case basis. In other words, these decisions are going to be made on the basis of guesses and hunches.”

Cooper said that even in the unlikely event that the special joint committee’s final report in February recommends additional legislative safeguards, Parliament will have no time to enact them before the March implementation date.

“The Liberal government has created an untenable situation,” he said.

Ottawa psychiatrist Dr. Sephora Tang was one of the originators of the physician-led MAiD to MAD initiative in 2020 to inform the public about the dangerous expansion of euthanasia eligibility. Dr. Tang said told The B.C. Catholic that the regulations expected to be in place in March will fall far short of needed protections.

She said the inadequacies start with federal legislation that lets physicians make subjective determinations of when mental illness qualifies for euthanasia and without minimum standards of treatment before ending a patient’s life.

Wrongful deaths inevitable

Dr. Sephora Tang (Submitted photo, The B.C. Catholic – CCN)

“When you apply this inadequate framework to people who are suicidal as a symptom of a mental disorder and who are unable to receive or who decline treatment, even for reasons of poverty or inaccessibility due to long wait lists, you get state-sanctioned and -facilitated suicide for people who under different circumstances would have gotten better and lived to see a better day.”

Doctors who were previously expected to prevent suicide will be asked instead to facilitate it, she said. “In a health-care system as fractured as our own, with many people struggling simply to survive, Canada’s expanding laws on euthanasia and assisted suicide will lead to many wrongful deaths in a terribly conceived social experiment.”

Dr. Tang said it is not too late for the government to put on the brakes “before the MAiD train crashes. Parliament has the power to change course if they have the will and the leadership to travel down another track.”

But will they? she asks. “The fates of many lives are perched precariously on political thrones. If things proceed to March 2023 with no changes, as the government to date seems poised to do, the government will have taken away the last legal tool that I and my fellow psychiatrists rely upon to keep our patients alive long enough to recover from their illness.

“Our work in caring for patients which has already been extraordinarily difficult with limited resources will become harder still.”

She said it may be that Canadians don’t fully grasp the significance of the negative consequences the expanded MAiD law will have on society. “But one day,” she said, “I think we will begin to realize and grieve how terribly our country has erred in its approach, but not before many more lives have been lost to a destructive ideology.”

How MAiD became MAD

Critics have long used the deceptive euphemism “MAiD” (Medical Assistance in Dying) for what is legally permitted homicide – the killing of one person by another.

Now, since the March 2021 passage of Bill C-7, which allows the assisted suicide of persons who are not actually dying, it is clear that continued use of an expression describing someone as “dying” is also factually incorrect. More-honest alternatives do exist.

Some Canadian doctors noted this in 2020 when, concerned about the expansion of eligibility criteria, they said in a public declaration that a better description of the then-looming law would be “Medically Assisted Death.” They dubbed their lobbying effort the “MAiD to MAD” project.

The doctors warned that the law would make Canada “the world leader” in administering death. “We watch in utter dismay and horror at how the nature of our medical profession has been so quickly destroyed by the creation of misguided laws,” they declared.

The federal government is now beginning to employ another bewildering acronym connected with the scheduled March 2023 allowance of mental illness as a sole criterion for accessing assisted suicide: “MAiD MD-SUMC,” short for “Medical Assistance in Dying where Mental Disorder is the Sole Underlying Medical Condition.”

Matthew Marquardt, a lawyer who is executive director of Toronto-based Catholic Conscience, suggests a more truthful description: “SAD” for “socially assisted death.”

“I settled several years ago on the term … because I am unwilling to accept complicity in helping to ‘sell’ voluntary or acquiescent suicide to vulnerable people, particularly through the use of sunny, euphemistic terms like ‘MAiD,’” Marquardt said in an interview with The B.C. Catholic.

“The friendly packaging of socially promoted suicide using cute terms like ‘MAiD’ smacks very strongly to me of an insidious plan to reduce the public-health and welfare ‘burden’ by offering cheaper and quicker means of emptying hospital and palliative-care beds, rather than accepting our loving Creator’s invitation to accompany those on their journey back to him.”

He urged Canadians not to accept assisted suicide as a fait accompli. “The Church teaches, and has always taught, that we have a personal responsibility to do what we can to improve the conduct of our societies,” Marquardt said.

“Instead of resorting to poison needles, we can look after our aging parents in our homes, especially if we pursue social policies that encourage the use of multi-generation homes, as many cultures do. We can also simply sit with friends, praying with them or simply being present to them, and support home visitation groups by parishes and others.”

Timeline of a slippery slope to death

June 2016: Euthanasia (Medical Assistance in Dying) becomes legal in Canada for persons whose natural death is reasonably foreseeable. Critics warn of a slippery slope that will lead to ever more permissive regulations.

March 2021: Bill C-7 becomes law, removing the eligibility criterion of a reasonably foreseeable natural death and permitting assisted suicide when mental illness is the sole underlying medical condition, effective March 2023. The law also allows eligible persons whose natural death is reasonably foreseeable and who have a set date to receive MAiD to waive final consent if they are at risk of losing capacity in the interim.

May 2022: A report from a Liberal-hand-picked “expert panel” finds only that some practices and standards surrounding the mental-illness criterion need to be refined and that “no new legal safeguards are required.”

June 2022: Parliament’s Special Joint [Senate-Commons] Committee on MAiD tables an interim report on the mental-illness criterion, supporting the expert panel but also asking the federal government for more time to complete its own review because “there is still work to be done on this complex issue.” Three members of the committee issue a dissenting report calling on the government to halt and reconsider the expansion of MAiD.

October 2022: The Quebec College of Physicians recommends to the Special Joint Committee that MAID regulations be expanded to allow infanticide for severely ill newborns.

October 2022: Federal Health Minister Jean-Yves Duclos sends a letter to the joint committee explaining that the Liberal government is working with the provinces and territories “to support the implementation of the panel’s recommendations” and that he expects sufficient “practice standards and training modules” to be in place by March 2023 to allow the expansion of MAiD eligibility, on the sole grounds of mental illness, to proceed. He does not specifically reply to the Committee’s request for more time.

February 2023: Scheduled completion date for the work of the Special Joint Committee, which is also looking into calls to extend MAiD to “mature minors.” Even if it calls for stricter legislative controls, insufficient time would remain for such amendments to be enacted before the scheduled March 2023 expansion of eligibility for MAiD.

March 2023: Medical staff will be allowed to facilitate the deaths of persons through “Medical Assistance in Dying where Mental Disorder is the Sole Underlying Medical Condition” (MAID MD-SUMC).