Canadian report is negative to the concept of euthanasia for psychiatric reasons alone.

Alex Schadenberg
Executive Director - Euthanasia Prevention Coalition

The long-awaited reports from the Council of Canadian Academies (CCA) concerning the possible extension of euthanasia to children (mature minors), to incompetent people who made an "advanced request," and to people for psychological conditions alone was released on December 12.

The Euthanasia Prevention Coalition opposes euthanasia but for the purpose of this article we will only comment on the issue within the report.

Canada legalized euthanasia in June 2016 in response to the Supreme Court of Canada Carter decision in February 2015 that struck down Canada's laws protecting people from euthanasia and assisted suicide.

Euthanasia and assisted suicide are now referred to as Medical Aid in Dying (MAiD) in Canada.

• Link to the CCA summary of the three reports.
• Link to the report: Medical Assistance in Dying Where A Mental Disorder is the Sole Underlying Medical Condition.

Canada's euthanasia law requires that a person experience: physical or psychological suffering that is intolerable to them and cannot be relieved under conditions that they consider acceptable. The law also requires that a person's natural death has become reasonably foreseeable. Therefore a person who is psychologically suffering can qualify for euthanasia, as long as their natural death is reasonably foreseeable.

• Link to the article: Is euthanasia psychiatric treatment.

The CCA report does not offer recommendations for changing the law but it clearly underlines the problems with euthanasia for psychological suffering. 

The report leans toward opposing the extension of euthanasia to people with psychological conditions alone. The report makes many strong statements concerning the problem with euthanasia for psychological reasons. For instance, the report states:

A particular challenge for some people who request MAID MD-SUMC is that their desire to die could be a symptom of their mental disorder. Suicidal ideation is a common symptom of some mental disorders, and some mental disorders can distort a person’s thoughts and emotions, leading to a desire to die, hopelessness, and a negative view of the future, even when a person retains decision-making capacity. It may be difficult for a clinician to distinguish between a capable person who is making an autonomous decision for MAID and a person whose pathological desire to die is a symptom of their mental disorder that impairs their decision-making. 

Most mental disorders lack the prognostic predictability of the physical conditions that currently motivate MAID requests in Canada. There is less certainty about how a person’s mental disorder will evolve over time and whether treatments and/or social interventions will be effective in relieving their suffering and improving their quality of life when compared to the physical conditions that currently motivate MAID requests. 

Having a mental disorder is one of the most strongly associated risk factors for suicide. Systematic reviews and meta-analyses have found that up to 90% of those who die by suicide may have had a diagnosable psychiatric disorder (as determined by a retrospective psychological autopsy). Furthermore, there is some evidence that some people who have sought psychiatric euthanasia and assisted suicide (psychiatric EAS) in jurisdictions that permit it share certain characteristics with people who attempt suicide.

The report acknowledges that based on the permissive language in Canada's euthanasia law, if the law were extended to allow euthanasia for psychological conditions alone, Canada would have the most permissive euthanasia law in the world. The report states:

MAID law in Canada explicitly defines intolerable suffering in subjective terms. While a healthcare practitioner must “be of the opinion that” these conditions are met, if a patient truly believes their suffering is intolerable, and believes that existing means to relieve their suffering are not acceptable to them, they thereby meet the criteria for intolerable suffering set out in the legislation. 

No other country permits MAID MD-SUMC where one of the eligibility criteria is based on an individual’s personal assessment of what conditions for relief of their intolerable suffering they consider acceptable. If Canada were to expand MAID MD-SUMC using this criterion, it could become the most permissive jurisdiction in the world with respect to how relief of suffering is evaluated.

Tine Nys (center) with her sisters

Considering the recent announcement that three Belgian doctors are facing prosecution in the euthanasia death of Tine Nys. According to the Brussels Times:

The case concerns a 38-year-old woman, Tine Nys, who was euthanised in April 2010 at her request, as she suffered from psychological problems. 

According to the patient’s family, Nys was not ill enough to meet the requirements of the euthanasia law as it was at that time. In addition, the procedure was carried out in an “amateurish” fashion, relatives said. A sister of the dead woman made a complaint, and the circumstances of the case were investigated by the Ghent prosecutor’s office. 

According to the family, Nys had a psychiatric past, but at the time of her request for euthanasia had not been in an institution for 15 years. She had, however, experienced a recent break in a relationship.

Considering the fact that Canada's euthanasia law is completely subjective as to whether a person's suffering is considered "intolerable" the extension of euthanasia to people with psychological conditions alone would be a disaster. It would be impossible to determine whether a person is suffering intolerably or experiencing suicidal ideation and seeking an "assisted death."

Clearly Canada has gone too far already. Canada needs to add clear definitions to its euthanasia law rather than extending euthanasia.