By: Hannah Baillie, General Member, Young Canadians Roundtable on Health
In June 2016, the Canadian government updated its criminal code to allow doctors and nurses to provide Medical Assistance in Dying (MAiD) to individuals who meet specific criteria. The bill, C-14, called upon the Council of Canadian Academies (CCA) to study whether MAiD would be appropriate for sensitive cases, such as in minors, advance requests, and for individuals experiencing mental illness as their primary condition. The government set a deadline of March 2023 to expand MAiD to individuals suffering from mental illnesses; however, this deadline has been pushed back. Experts and legislators agree that more time is needed to determine whether it is safe and appropriate to use MAiD within this population.
Who can receive MAiD?
Bill C-14 provides the following eligibility criteria for MAiD:
1. Be eligible for health insurance in Canada
2. Be at least 18 years old and capable of making health care decisions
3. Have a grievous and irremediable medical condition
4. Make a voluntary request free from external pressure
5. Give informed consent after being informed of all other available treatments and care.
Individuals must follow a strict process for requesting, being assessed for, and receiving MAiD. They must be evaluated by two different healthcare providers to ensure they meet the criteria outlined above.
Mental illnesses currently do not qualify as a “grievous and irremediable medical condition.” The opposition called on the government to delay the rollout of MAiD for mental health in order to disseminate resources to healthcare providers and review a report published by the Special Joint Committee on MAiD. They have not yet set another tentative rollout date.
Are there any countries that allow MAiD for mental illness?
Yes, there are a handful of countries around the world who currently allow MAiD for individuals with mental illnesses. These countries include: the Netherlands, Belgium, Luxembourg, Switzerland, Spain, and Colombia.
In Switzerland, there are currently six organizations who provide MAiD to individuals with mental illnesses. The law allows for individuals to receive assisted suicide when patients commit the act themselves and those assisting them derive no personal benefit from their death. Similar to Canada, implementing this legislation caused heated debate in the Swiss Parliament. However, even as early as 2012, Swiss politicians rejected the idea of strengthening controls on MAiD for mental illnesses. This has led to an influx of international travellers entering the country in order to access MAiD for mental health reasons.
What are people saying about MAiD for mental health in Canada?
Individual opinions on whether or not MAiD is appropriate for those with mental illnesses rightfully vary; it is an incredibly sensitive topic. However, a few national mental health organizations have published their stance on the debate. The Centre for Addiction and Mental Health (CAMH) states: “CAMH has publicly expressed concern with the federal government’s intention to extend MAiD eligibility to people whose sole medical condition is mental illness at this time. There is a lack of consensus on the issue, and we have requested that the government extend the temporary prohibition on MAiD for people whose sole medical condition is mental illness until further discussion and consultation takes place, particularly with people with lived experience of mental illness and their families.”.
Similarly, the Canadian Mental Health Association (CMHA) states: “CMHA's position on medical assistance in dying in Canada is that people with a mental health problem or illness should be assisted to live and thrive. CMHA believes that every person living with mental health and addictions issues must be actively supported in their journey of recovery.”
The Association of Chairs of Psychiatry in Canada stated: “Further time is required to increase awareness of this change and establish guidelines and standards to which clinicians, patients and the public can turn to for more education and information.”
What will happen moving forward?
Experts and legislators must develop and agree upon standards for psychiatric evaluation to determine whether MAiD for mental illness is appropriate, and whether an individual’s mental illness is “grievous and irremediable.” So far, discussion around treatment types, attempts, outcomes, severity, and duration of mental illnesses have been tabled. Given the sensitivity of the topic and its potential impact on Canadians’ lives, it is possible that the debate around MAiD eligibility for those with mental illness will take a long time to produce definitive results. In all likelihood, there will be additional safeguard measures to ensure the proper use of MAiD within this population.
Want to learn more about MAiD for mental illness?
Check out the following resources:
Policy Advice for Medical Assistance in Dying and Mental Illness -- CAMH
A Public Consultation on Medical Assistance in Dying (MAID)