Euthanasia for mental illness. Killing people without a certain prognosis.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Canada expanded its (MAiD) euthanasia law by passing Bill C-7 in March 2021, Many people are unaware that one of the bill's provisions legalized euthanasia for people with mental illness alone. This means that a person who is not physically ill or dying but is living with mental illness can be killed by euthanasia.

At that time the federal government put a 2-year moratorium on euthanasia for mental illness to enable the government to establish protocols for this catagory of killing. I have stated that the two-year moratorium is unenforceable making euthanasia for mental illness legal already. 

Recently an acquaintance told me that her friend's mother (a person who I do not know) recently died by MAiD after living with chronic depression for more than twenty years. I certainly understand the suffering related to chronic depression but when did killing become a treatment for chronic depression?

A recent article by Sharon Kirkey titled: Canada will soon offer doctor-assisted death to the mentally ill. Who should be eligible? examines the issue by first interviewing Dutch research Psychiatrist Dr Sisco van Veen who says that mental illness cannot be identified like other diseases. van Veen states:

You can’t see depression on a scan. With the exception of dementia, where imaging can show structural brain changes, “in psychiatry, really all you have is the patient’s story, and what you see with your eyes and what you hear and what the family tells you,” van Veen says. Most mental disorders lack “prognostic predictability,” which makes determining when psychiatric suffering has become “irremediable,” essentially incurable, particularly challenging. Some say practically impossible...

... In the Netherlands, MAID for irremediable psychiatric suffering has been regulated by law since 2002, and a new study by van Veen and colleagues underscores just how complicated it can be. How do you define “grievous and irremediable” in psychiatry? Is it possible to conclude, with any certainty or confidence, that a mental illness has no prospect of ever improving? What has been done, what has been tried, and is it enough?

Kirkey outlines the government time-table on euthanasia for mental illness:

Sometime in April, an expert panel struck by the Liberal government to propose recommended protocols for MAID for mental illness will present its report to the government. A joint parliamentary committee studying the new MAID law has been given a mandate to report back by June 23. The expert panel’s chair declined an interview request, but her 12-member assembly has been tasked with setting out proposed parameters for how people with mental illness should be assessed for and — if found eligible — provided with MAID, not whether they should be eligible.

Kirkey speaks to Dr Sonu Gaind, a critic of euthanasia for mental illness.

For Dr. Sonu Gaind, a past president of the Canadian Psychiatric Association, the most fundamental safeguard has already been bypassed, because there is no scientific evidence, he says, that doctors can predict when a mental illness will be irremediable. Everything else goes out the window.

Gaind isn’t a conscientious objector to MAID. He’s the physician chair of the MAID team at Humber River Hospital in Toronto, where he’s chief of psychiatry. He works with cancer patients. He’s seen the positive, the value that MAID can bring. But unlike cancer, or progressive, neurodegenerative diseases like ALS, “we don’t understand the fundamental underlying biology causing most major mental illnesses.”

“We identify them through the clustering of various symptoms. We try to target treatments as best we can. But the reality is, we don’t understand what’s going on, on a fundamental biological level, unlike with the vast majority of these other predicable conditions.” Without understanding the biological underpinnings, what do you base your predictions on, he asks. He’s heard the argument that it’s difficult to make firm predictions about anything in medicine. But there’s a world of difference between the degree of uncertainty between advanced cancers and mental illnesses like depression, he argues.

“There’s no doubt that mental illnesses lead to grievous suffering, as grievous, even more grievous in some cases than other illnesses,” Gaind says. “It’s the irremediability part that our framework also requires and that scientifically cannot be met. That we cannot do. That’s the problem.”

Kirkey then reports, as I previously reported, that euthanasia for mental illness has already been happening in Canada. Kirkey writes:

Euthanasia for mental illness has, in fact, already occurred in Canada. Testifying before a Senate committee studying Bill C-7 last year, Vancouver psychiatrist Derryck Smith told the story of “E.F.”, a 58-year-old woman who suffered from severe conversion disorder, where a person’s paralysis, or blindness or other bizarre nervous system symptoms can’t be explained by any physical findings. She suffered from involuntary muscle spasms. Her eyelid muscles had spasmed shut, leaving her effectively blind. Her digestive system was a mess, she was in constant pain and needed to be carried or use a wheelchair. In May 2016, Alberta’s Court of Queen’s Bench allowed her an assisted death.

Smith took part in another case involving a 45-year-old Vancouver woman who had suffered from anorexia nervosa since she was 17. She’d endured a “gauntlet” of treatments, he said, had been certified several times under the Mental Health Act, involuntarily hospitalized and force fed by a tube in a manner that left her feeling “violated.” “At the time I assessed her, she had virtually no social life … no joy in her life.” Smyth determined the woman had capacity to agree to assisted death.

Gaind also explains how euthanasia for mental illness is far more prevalent for women than men.

“But when you expand it to sole mental illness conditions, the entire demographic shifts, and it’s people who have unresolved life suffering that also fuels their request,” Gaind says. A stark gender gap also emerges: when MAID is provided to the imminently dying, it’s a 50-50 gender split. As many men as women seek and get it. Experience in the Netherlands and other countries shows that twice as many women seek and receive MAID for mental illness.

Kirkey points out that, unlike the Netherlands, Canada's (MAiD) euthanasia law does not require people to try effective treatment before being approved for death. We don't know if Canada will require people who request euthanasia for mental illness alone to try effective treatment first.

Jocelyn Downie, Dalhousie University professor of law and medicine and Canada's leading pro-euthanasia academic as saying that, based on autonomy, we don't require Canadians to try effective treatments for other conditions. But Downie wants to ignore that fact that death by lethal injection is an irreversible decision with an immediate effect, whereas refusing treatment for cancer will result in a natural death. Downie also wants MAiD to be seen as a medical treatment decision that is equal to all other medical treatment decisions. Even if Downie accomplishes her goal, people in general will never and should never consider death by lethal injection as a medical treatment.

Sadly, Canada rushed into passing Bill C-7 in March 2021. Most Canadians have no idea that euthanasia for mental illness is permitted and previous opinion polls showed that most Canadians opposed euthanasia for mental illness alone.

I am expecting a report from the one-sided federal government appointed committee that was established to create rules for MAiD for mental illness alone. I am very concerned.