Plan to exclude mental illnesses from assisted-dying criteria prompts legal, moral questions

TORONTO — A proposed change to the federal assisted-dying law would explicitly state that medically assisted death could not be obtained for a patient with mental health concerns, angering some psychiatrists.

However, other psychiatrists are concerned that allowing assisted death on grounds of mental illness equates to allowing them to kill their patients – something they see as very dissimilar to relieving the suffering of patients with terminal physical conditions.

Bill C-7, the first significant modification to the assisted-dying law since it came into effect in 2016, is currently sitting with the House of Commons justice committee.

In addition to removing the requirement that a recipient’s death must be reasonably foreseeable, the bill would explicitly ban access to assisted death in cases where the patient’s only underlying medical conditions are classified as mental illnesses.

The Canadian Press reports that “a small number of Canadians suffering solely from severe, irremediable mental disorders have received assisted deaths” since 2016. If C-7 is passed in its current state, Canadians in the same situation would no longer legally have that option.

CONSTITUTIONALITY CONCERNS

The government has argued that the law was not meant to permit medically assisted death for those with only mental illnesses, and that C-7 codifies that intention.

This has drawn criticism from the Canadian Psychiatric Association, which described it as unconstitutional in a submission to the justice committee, arguing that Section 15 of the Charter of Rights and Freedoms guarantees laws will treat Canadians equally regardless of physical or mental disabilities.

“Explicitly stating that mental illness is not an illness, disease or disability is inaccurate, stigmatizing, arbitrary and discriminatory,” the organization’s brief reads.

The Justice Department has said that C-7 “has the potential” to violate Charter rights but that those violations are justifiable because of “the inherent risks and complexity” of making assisted death a legal option for those with only mental illnesses.

Some psychiatrists echo the association’s concerns, arguing that explicitly excluding those with solely mental illnesses from accessing assisted death stigmatizes them and their suffering.

Dr. Derryck Smith, a Vancouver-based psychiatrist, told The Canadian Press that he has been involved in two cases where medical assistance in dying was accessed by patients who were suffering only from severe mental disorders, including one woman who he said was living with a severe eating disorder and planned to starve herself to death.

He said he finds it “unbelievable” that the government is now looking to deny assisted dying in cases similar to that one.

‘NOT OUR JOB TO KILL’

Other psychiatrists, however, say they cannot see any basis for granting assisted death to their patients, arguing that there is a difference between mental illness and physical conditions where no relief is possible.

“We are in the business, professionally and ethically, of helping people find purpose, find meaning, find hope, find reasons to live,” Dr. John Maher, a Calgary-based psychiatrist, told CTV News in an interview in January.

“It’s not our job to kill patients.”

Maher said he believes that “some relief of suffering” is possible for all psychiatric patients.

“If you’re talking about people who are living with mental illness, they’re not dying, they’re not terminally ill, and they have conditions which are treatable,” he said.

A survey of 528 Canadian psychiatrists found in 2017 that while more than 70 per cent supported medical assistance in death in principle, less than 30 per cent supported it for solely mental illnesses.

Bill C-7 must be passed by Dec. 18 in order for the government to comply with a deadline imposed by Quebec’s courts that has already been extended twice.

Conservative Leader Erin O’Toole and a majority of his MPs opposed C-7 at second reading, with O’Toole saying he wanted to see “reasonable safeguards to protect the vulnerable” before he could support the bill.

Parliamentary Budget Officer Yves Giroux estimated last month that the changes proposed by C-7 could result in 1,200 more Canadians accessing medically assisted death next year.

With files from CTV News’ Medical Correspondent Avis Favaro and The Canadian Press

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