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OTTAWA — Ottawa’s changes to its medically assisted suicide framework are being viewed by some as one step forward and one step backwards.
While many advocates applauded the government’s decision to permanently bar mental illness being the sole qualification for Medical Assistance in Dying (MAID), new rules that would open the door towards “advance requests” are causing concern.
One of those raising the alarm is disability rights advocacy group Inclusion Canada, which said that while they back the permanent exclusion of mental illness, they still hold severe reservations about advance requests.
“We thought we were dealing with one issue, which was MAID for mental illness, and now all of a sudden we’ve got advance requests,” Inclusion Canada CEO Krista Carr told the Toronto Sun on Wednesday.
“We shouldn’t be expanding an already flawed system even further.”
Government promised new MAID legislation earlier this month
On Tuesday, Justice Minister Sean Fraser announced legislation had been tabled in the House of Commons to alter Canada’s MAID framework to permanently prevent extending doctor-assisted death to people whose sole underlying condition is mental illness.
This came after Fraser announced on Oct. 7 that the rules would soon be changing to accommodate the mental health exclusion, a move made on the same day the House was to vote on a Tory private member’s bill that would permanently stop the expansion.
But with the tabling of Bill C-41 — the Medical Assistance in Dying Safeguards Act came new provisions allowing patients diagnosed with terminal illnesses to file “advance requests” on MAID while they’re still of sound mind.
Patients seeking MAID in Canada are assigned to one of two pathways: Track 1 for those with terminal illnesses or whose natural death is reasonably foreseeable, and Track 2 for those whose death is not a reasonable outcome in the foreseeable future.
In June, a joint House-Senate committee called for Criminal Code amendments to “indefinitely exclude persons whose sole underlying medical condition is a mental illness from eligibility for medical assistance in dying.”
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Advance requests addition raising concerns
In 2021, Canada removed requirements that death must be “reasonably foreseeable” for MAID approval — setting the stage for extending therapeutic suicide to those whose sole underlying medical condition is mental illness.
That expansion was delayed twice, most recently by February 2024 legislation that pushed the deadline to March 17, 2027.
Carr said permitting mental illness to be a sole qualifier for MAID was a last-minute amendment by the Senate — and fears the addition of advance requests is another hasty addition.
“The government accepted it without study, or rigor, or consultation, or anything — and look where we are today,” she said of the Senate’s additions to Canada’s MAID framework.
“Why are we (dropping the mental illness qualifier?) We’re doing it because we have now studied it, we have had thorough consultation, we have heard from experts, we have done our due diligence, and we realize it’s not a good idea.”
University of Toronto Law Professor Trudo Lemmens told the Sun that this week’s changes moves MAID “further away from an exceptional practice that requires the clearest and most unequivocal consent,” and took aim at provisions in the bill that allow providers to treat “involuntary words, sounds or gestures made in response to contact” as something other than refusal.
“We already see that some MAID providers take a very flexible approach to determining when MAID is appropriate,” he said.
“Any further discretion we give them risks being abused.”
The Netherlands, the other nation that currently allows dementia patients to provide advance requests for MAID, still struggles with the practice.
Tory MP Tamara Jansen, who sponsored the bill defeated earlier this month that would have excluded mental illness, echoed those concerns.
“Mental illness and advance requests are separate issues, one has been extensively studied and has broad consensus, the other does not,” she wrote on social media.
“With the March 17 deadline approaching, the Liberals are holding Parliament ransom.”
bpassifiume@postmedia.com
X: @bryanpassifiume