Paul Tuns:
On June 17, the tenth anniversary of the legalization of euthanasia in Canada, Parliament’s Special Joint Committee on Medical Assistance (AMAD) issued an 88-page report recommending the federal government “indefinitely exclude” people whose sole underlying condition is a mental illness from the country’s Medical Assistance in Dying regime.
In 2021, Parliament expanded Canada’s euthanasia law to include people suffering from non-terminal but irremediable illnesses. A provision for allowing people whose sole condition for requesting so-called Medical Assistance in Dying was delayed until March 17, 2023. Parliament has since twice delayed enacting that provision although if it does not act on either the recommendation or pass Tamara Jansen’s private member’s bill, C-218 which would permanently exclude those suffering solely from mental illness. MAiD for mental illness will now be implemented in March 2027.
The report – published after the committee heard testimony from 44 witnesses from March through May and received 33 written briefs – considered four possible recommendations: repeal the provision allowing euthanasia for mental illness, introduce legislation to further delay its implementation, introduce legislation to permanently prohibit euthanasia for mental illness, or, refer the matter to the Supreme Court of Canada to rule on the constitutionality of the exclusion.
The majority of the 16-member committee supported the recommendation “That the Government of Canada amend the Criminal Code to indefinitely exclude persons whose sole underlying medical condition Is a mental illness from eligibility for medical assistance in dying.” The three members of the committee from the Senate and the Bloc Quebecois both dissented from the report with separate opinions. Both dissents encouraged the government to refer the issue to the Supreme Court of Canada.
The report, which rehearsed the arguments made by both sides of the debate during hearings, leaned heavily on the experts who said that “there is still no clear agreement among clinicians on the approach to assessing eligibility” and noting two primary issues: determining irremediability and distinguishing between a request to be euthanized and suicidal intent. The committee determined that there is no medical consensus on these matters and it was thus risky to go forward with expanding euthanasia to those suffering solely from mental illness. The committee acknowledged that some expert witnesses “testified that it would not be possible – either at this moment or at any future time – to reliably determine irremediability in mental illness. Some psychiatrists testified that diagnoses of mental illness can change with new information, for example from depression to bipolar disorder, further complicating making clinical decisions.
The report also acknowledged that “a recurring theme” from the testimony was “the pressing need for increased and more equitable access to adequate treatment,” and seemed sympathetic to the argument that physicians “have an obligation to provide access to mental health treatment before providing access to MAiD.” (Canadian euthanasia law does not require patients seek treatment for their health issues before requesting Medical Assistance in Dying.)
The committee’s majority also took seriously warnings that “expanding MAiD may lead to the ‘so-called suicide contagion effect’ … (which would) undermine suicide prevention efforts.”
The report also acknowledged that some witnesses “expressed concerns, notably around possible non-compliance and the perceived lack of safeguards needed to achieve the right balance between ensuring access or autonomy and protecting potentially vulnerable populations.” These witnesses included women, people with disabilities, and aboriginal Canadians. The report acknowledged concerns over the lack of “oversight and discipline” when MAiD regulations are ignored in practice. Some witnesses raised the issue of “the effectiveness of the legal framework in sanctioning misconduct.” It specifically mentioned Euthanasia Prevention Coalition executive director Alex Schadenberg’s call for Parliament “to examine how Canada’s euthanasia is actually functioning” and whether there are “abuses of the law.”
Senators Rosemary Moodie, Pamela Wallin, and Kristopher Wells issued a dissenting opinion complaining about the committee’s process, claiming that it was rigged against expansion due to a “highly irregular and flawed process,” paying special attention to the number of witnesses opposed to permitting euthanasia at the present time for those suffering solely from mental illness. They would have liked to hear from more patients with “lived experience” with mental illness who sought to end their suffering through euthanasia, a complaint also made by the pro-euthanasia lobby organization Dying with Dignity.
Liberal MP and committee co-chair Marcus Powlowski said that the committee was fair in its hearings and followed normal procedures for determining witnesses.
Dying with Dignity and other advocates of expanding euthanasia claim that excluding mental illness as sole criteria for MAiD is unconstitutional because it discriminates against those suffering solely from mental illness compared to those with a physical illness or condition. Powlowski addressed that concern in a supplementary opinion to the report, arguing, “I think the courts ought to conclude, as did our committee, that not allowing MAiD for mental illness, until such time as some fundamental concerns are addressed, is a reasonable limitation.”
In May, Prime Minister Mark Carney said he would wait for the committee report before deciding on how to procced on the issue, a position reiterated by Justice Minister Sean Fraser. A spokesman for Fraser told the Epoch Times the government is “committed to getting this right” and that it would take “time” to carefully review the full report.
Conservative MP Tamara Jansen, a member of the committee, praised the two main findings of the report – the inability to determine when mental illness is irremediable and the inability to distinguish between a request for euthanasia and suicidality – as well as its conclusion to indefinitely delay expansion. She said the obvious response to the report was for Parliament to pass her private member’s bill, C-218. “There is no reason for the government not to support Bill C-218 at second reading,” she said.
The EPC’s Alex Schadenberg agrees. He said, “The best way to prevent euthanasia for mental illness is for parliament to pass Bill C-218.”
In its “supplementary opinion” to the report, the Conservative MPs and senator serving on the committee, made further recommendations such as stronger monitoring of Medical Assistance in Dying and improved public reporting, national standards for oversight, new guidelines and training for practitioners, and further review of whether current safeguards are working.
Rebecca Vachon, health program director at Cardus, a think tank, welcomed the report’s conclusion. “We call on the federal government to support legislation that will enact this recommendation into law, thereby protecting Canadians who live with mental illnesses.” Vachon said, “Parliamentary committees should continue to investigate MAiD in a transparent and publicly accountable way, particularly with regard to the impacts MAiD has had on vulnerable Canadians, as has been continually attested to by disability advocacy organizations and demonstrated through reviews of data.
Schadenberg said the Euthanasia Prevention Coalition is “pleased that the AMAD Committee is recommending that euthanasia for mental illness, as the sole criteria, not be implemented” and the EPC “now calls on the AMAD Committee to do an in-depth complete review of Canada’s euthanasia law, especially now that it has been operating for 10 years.
He warned: ”It is great news that the AMAD Committee has decided that Canada should not implement euthanasia for mental illness, but the battle is not over;” there is currently an Ontario lawsuit seeking an emergency decision that would approve the euthanasia of Claire Brosseau, who is seeking “death by lethal poison based on mental illness alone.” Schadenberg said, “Even though the parliamentary committee is recommending that euthanasia for mental illness be indefinitely excluded from the law, a judge may legislate from the bench that Brosseau, and in turn others, can be killed by euthanasia based on mental illness alone.”
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