A special parliamentary committee is considering whether Canada is ready for the law on MAID for mental illness to take effect [March 17, 2024].
The EFC [Evangelical Fellowship of Canada] made a written submission on November 16 [below], describing the reasons Canada should not allow MAID for mental illness.
The committee’s report is due by January 31, 2024. Please pray for the committee to recommend at least a delay, if not a halt, to MAID for mental illness.
November 16, 2023
The Evangelical Fellowship of Canada (EFC) appreciates this opportunity to participate in the committee’s study of “the degree of preparedness attained for a safe and adequate application of MAID (in MD-SUMC [where a mental disorder is the sole underlying medical condition] situations).”
All Canadians can speak to readiness
• Free and healthy debate is a key element of a democracy. It has been suggested to this committee, however, that only proponents of MAID for mental illness can have sincere concerns and contributions into the assessment of whether Canada is prepared for the expansion. We caution that there is real danger in shutting down discourse and excluding Canadians on the basis of their views.
• The EFC is opposed to MAID, believing that it fundamentally devalues human life and normalizes suicide. We are very concerned that MAID for mental illness will disproportionately impact marginalized Canadians. If Parliament is going to go ahead with MAID for mental illness, it is essential that the strongest possible safeguards are in place to protect Canadians in moments of vulnerability before this expansion takes place.
• We urge the committee not to dismiss recommendations or arguments based on who is presenting them. Please consider and weigh all the evidence.
The limitations of the current law
• The law does not require treatment. It doesn’t require that a patient has tried all available treatments – or any treatment. It only requires that eligible patients be informed of treatment options and seriously consider them.
• Parliamentarians must look at what the law requires. If a particular safeguard seems essential, such as trying reasonable treatment, it should be enshrined in the law as a universal safeguard.
• We cannot assume that the percentage of Canadians with mental illness who access MAID will be as low as in Benelux countries when those countries have different safeguards. For example, in the Netherlands, while no patient is compelled to take treatment, a doctor may not end the life of a patient when there are means available to relieve their suffering. This will not be the case in Canada.
• The existing safeguards are very subjective. What is a grievous or serious illness? What is an advanced state of irreversible decline? Who decides? Parliamentarians must look at what the law allows rather than relying on how they expect health professionals will proceed. Assessing patients primarily on a case-by-case basis means there are no universal protections.
• There have been numerous reports of individuals in vulnerable situations choosing Track 2 MAID because of socioeconomic concerns. Canadians with mental illness already face stigma and discrimination. They may face similar pressures and challenges accessing care and support that may push them toward MAID.
• There is no clear guidance on how to distinguish suicidality from a request for MAID. This will be a subjective assessment, carried out unevenly in a fractured and overburdened health care system.
Other reasons Canada is not ready
• Data from the Benelux countries shows women with mental disorders are twice as likely to die by MAID than men. The reasons for this must be researched and addressed before MAID for mental illness is put in place.
• MAID for mental illness must not become an option – and particularly not the most accessible option – when mental health care may not be accessible or affordable, when treatment and support are not available. Canada’s health care systems have been described by the Prime Minister as “strained, if not broken right across the country in many, many ways.” Track 2 MAID must not be expanded on the basis of mental illness before addressing the existing issues many Canadians have accessing needed care.
o CAMH [Centre for Addiction and Mental Health] told this committee, “about 1/3 to 1/2 of Canadians with mental illness were not getting their mental health needs met before the COVID-19 pandemic exacerbated the mental health crisis and increased the burden on our mental health system.”
o One in 10 Canadians looking for counselling will wait more than four months for their first appointment. Wait times can be significantly longer for those needing specialized care.
o Only half of Canadians experiencing a major depressive episode receive ‘potentially adequate care.’
o One-third of Canadians aged 15 or older who report having a need for mental health care say those needs were not fully met.
• The law limits eligibility to those with a serious and irremediable medical condition. However, experts say that the trajectory of an individual person’s mental illness is difficult, if not impossible, to predict.
• Family doctors are the most common MAID providers. Mental illness is complex and doesn’t necessarily follow a predictable trajectory. Are family doctors equipped with the time, capacity or expertise to deal with this expansion?
• Statistics Canada reports a sharp increase in mental disorders over the last decade, particularly among many marginalized groups. It is unconscionable that in Canada it may become easier for a person with mental illness to access MAID than the care and supports they need to live.
There are no additional legislated safeguards for MD-SUMC. An Angus Reid Forum poll commissioned by the EFC this fall found very few Canadians (3%) believe no additional safeguards should be required for MAID for mental illness. A clear majority of those polled believe that if MAID for mental illness is put in place, it should be a last resort after all reasonable treatment options have been exhausted. If MAID for mental illness is to be allowed, the legislation must require:
• It be a last resort when all reasonable treatment options have been exhausted.
• Physicians must not be the ones to suggest MAID to their patients. Conversations about MAID be patient-initiated in order to protect patients from feeling pressured to request MAID in moments of vulnerability.
• Direct assessment of the patient by a psychiatrist.
• A minimum age of 25 years of age for eligibility to MAID MD-SUMC. The prefrontal cortex, responsible for judgment and decision-making, doesn’t fully mature until about age 25. There is no decision more grave than the decision to end one’s life.
We urge you to recommend a delay to MAID MD-SUMC, if not a halt.
The Christian Legal Fellowship also submitted a brief to the Special Joint Committee on MAID November 16. concluding, “CLF urges Parliament to reverse the proposed expansion of MAID MD-SUMC, and instead prioritize mental health supports that offer all Canadians the ability to live with dignity.”