Thursday, January 26, 2023

Nine things to know about euthanasia for mental illness in Canada.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

CTV news Medical Correspondent, Avis Favaro, has provided in-depth investigative reports into euthanasia (MAiD) in Canada. Favaro does not oppose euthanasia but she has reported on the controversial deaths. The reporting that we have seen by Favaro has opened the door to a real debate on the reality of Canada's euthanasia law.

The recent W5 report titled: 9 things to know about euthanasia for mental illness provides an interesting insight into the direction in Canada to allow people to die by euthanasia for mental illness. It is also worthwhile to watch some of the interview video's that are connected to the article. 

This is my commentary on Favaro's - 9 things to know about euthanasia for mental illness.

1. It is part of the changes to the MAiD law that began in 2021.

Favaro explains that Bill C-7 expanded Canada's euthanasia law to include people who are not terminally ill and it also legalized euthanasia for mental illness. Bill C-7 established a two year moratorium on euthanasia for mental illness to study the issue. Favaro provides links to the Interim report on euthanasia for mental illness and the report from an "expert panel" on euthanasia for mental illness.

Favaro doesn't state that the interim report and the "expert panel" report did not provide specific direction for responding to requests for euthanasia for mental illness. The "expert panel" suggested that the current rules concerning euthanasia for people who are not terminally ill will suffice for people with mental illness. Members of the "expert panel" who disagreed with the majority opinion resigned when they were not offered an opportunity to provide a different perspective.

2. No specific type of mental disorder is excluded from qualifying for a medically assisted death.

Favaro states that: Like physical illnesses, a person asking for MAiD must be found by assessors to have a "grievous and irremediable" medical condition -- meaning a serious and incurable illness, disease or disability in an advanced state of irreversible decline with intolerable suffering.

Euthanasia for mental illness is loosely defined and would be available to anyone who is approved to be living with a "grievous and irremediable" condition, terms that are completely subjective. There would be a 90 day waiting period.

3. Defining an "incurable" mental illness isn't always easy.

Favaro states that the "expert panel" suggested that with euthanasia for mental illness that the second assessor should be a psychiatrist who is an expert in the mental disorder that the requestor has.

Favaro wrote that it is difficult to determine that the mental illness is "incurable" In fact, it is impossible to determine that the mental illness is incurable. Experts testified that some people with mental illness will not be cured but it is impossible to know if any one person with a mental illness is incurable.

The expert panel suggested that the psychiatrist be an expert in the concerning condition, but it does not make this an obligation. Further to that, Canada has long waiting lists for psychiatric treatment. It would be very difficult, and in some cases nearly impossible, to have the second assessor be a psychiatrist who is an expert in that condition.

4. As with all forms of medically assisted death, the patient's doctor, psychiatrist, or family don't have to be part of the decision, and may not know about the MAiD until after the person has died.

Favaro is correct when she states, that based on privacy, an assessor can only contact the family, a family physician, or a treating psychiatrist if the requestor agrees. People with treatable conditions can be killed even though the assessor lacks information due to privacy.

5. Additional mental health treatments can be recommended before a MAiD approval, but the patient can also say no to any additional therapy.

Canada's law does not require that a person attempt effective medical treatment before being approved for death by euthanasia, therefore, people with treatable conditions are being killed by euthanasia.

The Netherlands requires people, who have requested euthanasia for mental illness, to attempt all effective treatments before being approved for death. This policy does not force them to attempt treatments, it only states that if someone wants to die by euthanasia they must be willing to attempt effective treatment.

6. People can have a medically assisted death even while they’re waiting for treatment.

Since Canada does not require a person to attempt effective treatment, a person can be approved to be killed, even though they are waiting for treatment.

This is particularly concerning for people who are approved for death based on a mental illness. The waiting lists for receiving psychiatric care are long. A person could be approved for death even though they have not received treatment for their condition. The same problem exists for people with disabilities and people with other chronic conditions.

7. Some doctors are calling it state-sanctioned suicide.

Many leading psychiatrists have testified that their patients with mental illness live with suicidal ideation. Killing a patient by lethal injection because they have suicidal ideation is like saying the treatment for suicidal ideation is death.

8. Some experts believe the number of MAiD deaths among those with mental disorders is likely to be low while others believe it will be high.

Data shows that a small number of euthanasia deaths in Belgium and the Netherlands, where euthanasia for mental illness is permitted are for mental illness. The data from 2021 Belgian euthanasia report indicates that of the 2700 reported euthanasia deaths, 45 were based on psychiatric conditions. The data from the 2021 Netherlands euthanasia report indicated that of the 7666 reported euthanasia deaths 115 were based on psychiatric conditions. Canada had more than 10,000 reported euthanasia deaths in 2021.

Favaro is correct when she states that Canada will likely permit euthanasia for mental illness without requiring the requester to attempt effective treatment. It is likely that Canada's percentage of euthanasia deaths for mental illness will be higher than the Netherlands and Belgium.

9. In the past mental illness hasn't prevented a person from accessing assisted dying.

It is true that Canadians with mental illness are dying by euthanasia based on also having a terminal or chronic medical condition. In the case of euthanasia for mental illness it is impossible to determine if a person with mental illness alone has an irremediable medical condition.

More articles on euthanasia for mental illness:

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