Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition
In her Special to the National Post, Coelho is responding to Canada's federal parliament defeating Bill C-218, the bill that would have prevented euthanasia for mental illness, as a sole criteria, and the announcement, by the federal government, to expand euthanasia to approval by advanced directive.
Coelho comments on Canada's expansion of euthanasia in 2021:
Five years ago, Parliament made disastrous changes to Canada's assisted dying law, including one that was almost an afterthought. The government's original bill did not include expanding MAID for mental illness. The Senate added the expansion; the government — up against a court deadline that had already been extended four times — accepted it with a two-year delay. Within weeks, it was passed by the House under a closure motion.
Euthanasia for mental illness has been delayed until March 2027 and now it has been recommended that euthanasia for mental illness be indefinitely delayed, Coelho writes:
This year, a parliamentary committee where I testified recommended pausing it indefinitely. Now, the government's proposed approach is to cancel the expansion for mental illness, but let provinces decide whether to permit advance requests for MAID. While it's a relief that government will no longer approve MAID for mental illness, it is unconscionable that they will add advance requests.Bill C-218 that would have excluded mental illness as a sole medical condition that was defeated in parliament on October 7 while on the same day, the government announced that they will introduce their own bill to exclude euthanasia for mental illness. Coelho argues that the government's bill should be judged based on three criteria.
First, we need to scrutinize its language on MAID for mental illness. Conservative MP Tamara Jansen's Bill C-218 would have permanently repealed the expansion but was voted down over a quibble about the term "mental disorder." The Liberals now owe Canadians legislation that ensures the expansion will never happen. Justice Minister Sean Fraser has promised an indefinite exclusion of MAID for mental illness as a sole condition, but we have yet to see the legislation, and a pause is not a repeal. This is important, because it is not possible to reliably determine that a person with mental illness will not recover, and a reasoned request for MAID for mental illness cannot be distinguished from suicidality.
Second, will the forthcoming bill go far enough? Thomas Dillon died at 45 after a psychiatrist offered him MAID. He was assessed outside a Tim Hortons, with his mental illness and addictions largely untreated. Dillon was deemed eligible for MAID because he also had a bowel disease.
In cases I reviewed on Ontario's MAID Death Review Committee, depression, trauma and isolation often drove requests that were approved, sometimes with no psychiatric expertise consulted, because there was also an accompanying physical diagnosis. Excluding mental illness as a "sole" condition is a good start, but the move still leaves other problems unaddressed. A better fix would be to repeal Track 2, the expansion to persons with disabilities who are not dying, entirely, as the United Nations Committee on the Rights of Persons with Disabilities has urged.
Third, the government bill will permit advance requests, leaving it up to provincial discretion. The current mental illness exclusion expires on March 17, 2027, so the bill has to pass before then. This last-minute addition mirrors the government's 2021 mistake: carrying through a major expansion on a MAID bill that must pass by a fixed date.
Coelho then comments on the expansion of euthanasia to include advanced requests:
Advance requests deserve their own debate, because the potential problems are serious. Consent given in advance cannot be fully informed; it often rests on fear of the future, not lived experience. My father had dementia, and his days held joy, laughter, love and dignity that neither he nor I could have foreseen. Ontario's review of dementia cases found requests for MAID can be driven by fear of future decline, families raising MAID repeatedly on a patient's behalf. It also found 86 per cent of these patients had not even received palliative care before MAID.
Coelho shows how Canadians do not know what teh euthanasia law permits:
Canadians are not aware of the breadth of cases our MAID law allows. A National Institutes of Health-affiliated survey found that while 73.3 percent of Canadians support the MAID law in general, this support collapses once respondents are shown what the law actually permits. Only 19.2 per cent of respondents correctly knew that a terminal illness is not required for MAID eligibility, and only 20.7 per cent knew that a patient may refuse effective, recommended treatment and remain eligible. And 56 per cent of Canadians polled In an Angus Reid study this year did not know that there was a planned mental illness expansion.
Coelho challenges parliament to stop mucking up the euthanasia debate.
Stopping MAID for mental illness is necessary. But if it is achieved via a bill that must pass by March 2027, with advance requests attached, Parliament will have learned nothing from the last five years. A death cannot be appealed. Debate has to come first.
Some previous articles by Dr Ramona Coelho:
- The euthanasia committee got it right on mental illness.
- Parliament must go further (Read).
- Euthanasia can allow structural coercive forces to push people toward death (Read).
- How euthanasia is rewriting the ethics of medicine (Read).
- Disabled Canadians should never feel compelled to die (Read).
- How euthanasia fails Canada's most vulnerable (Read).










.jpg)




