Canada must put the brakes on euthanasia for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Harvey Chochinov, the well known professor of psychiatrist from the University of Manitoba and the developer of dignity therapy, wrote an article that was published in the National Post on December 30, 2023 titled: Intensive compassionate caring - not MAiD - is the most effective way to address mental illness.

Chochinov is responding to the fact that Canada has approved the extension of euthanasia to people with mental illness alone, to begin on March 17, 2024. Chochinov is also referring to the government's Special Joint Committee on Medical Assistance in Dying which will release a report this month concerning euthanasia for mental illness alone.

Chochinov writes:

It’s time to put the brakes on Medical Assistance in Dying (MAID) in Canada for those whose sole underlying medical condition is mental illness.

The federal government has tasked the Special Joint Committee on Medical Assistance in Dying to determine if Canada is ready to extend MAID eligibility, starting in March 2024, to patients with mental illness alone. Despite those convinced it is time, and safe, to launch what amounts to ‘psychiatric euthanasia,’ the special committee must pay attention to a murmur of protest that has grown to a roar: Ottawa, we’ve got a problem.

Chochinov offers two key reasons why euthanasia should not be done to people with mental illness. His first key reason:

Current MAID eligibility requires a person have a grievous and irremediable medical condition. Unlike some cancers, and many neurodegenerative disorders, no mental disorder can be described as irremediable. To be sure, there are individuals whose mental affliction won’t improve, despite myriad treatments or psychosocial interventions. But there is currently no way to predict which patients won’t get better.

Studies of prognostic accuracy show psychiatrists are wrong half the time. I have cared for patients struggling with chronic suicidality; patients I worried might one day take their lives. I recall a woman with mind-numbing depression, who teetered precariously between life and death. One day, after years of countless drug trials, hospitalizations, electroconvulsive therapy, and various psychosocial interventions, she arrived for her appointment — three weeks into starting a new antidepressant — with a grin on her face.

“The door is purple” she declared. I told her the door had always been purple, to which she replied, “I know, but now I care.”

Before that moment, no one — not me, not her friends or family and not anyone on The Special Joint Committee on Medical Assistance in Dying, nor any MAID assessor — could have predicted her recovery.

Chochinov then states that Intensive, unwavering, compassionate care and caring — not MAID — offers the most effective way to address this kind of suffering.

Chochinov continues with his second key reason:

The other reason not to launch psychiatric euthanasia is our inability to determine suicidality from those requesting MAID whose sole underlying medical condition is mental illness. According to the Canadian Association for Suicide Prevention, someone not dying because of their condition, such as a mental disorder alone, seeking death is, by definition, suicidal. 

Similarly, the first item listed by the American Association of Suicidology differentiating physician hastened death and suicide is the patient must be dying. That certainly does not characterize patients who are mentally ill.

The euthanasia expansionists told the Special Joint Committee on Medical Assistance in Dying that “suicidality and having a reason to want to die are not at all the same.” Chochinov responds by stating:

We can say 'six' and ‘half-dozen' are not the same as many times as we like. If we repeat it frequently, consistently and without equivocation, it might even sound convincing, but that doesn't make it true.

Patients struggling with suicidality often have a reason to want to die, based on, for example, self-loathing, feeling a burden or becoming worn down pursuing care and support that could sustain them. In those instances, the line between MAID and suicide simply vanishes.

Chochinov states that proponents of euthanasia claim that it's discriminatory to  euthanasia for mental illness. Chochinov responds:

Avoiding discrimination does not mean everyone is treated the same, but rather, that everyone gets equal access to what they need to thrive.

Finally, Chochinov responds to the question of when euthanasia for mental illness can be launched by stating:

Time and again, committee members have asked witnesses when Canada’s psychiatric euthanasia program can be launched. I would suggest they behave like NASA. When a potentially catastrophic problem is identified before blast-off, space engineers don’t set an arbitrary new launch date, no more so than Health Canada announces a random release date of a new drug discovered to have unacceptable side-effects.

Chochinov concludes his article by stating:

Ottawa, we have a problem.

The federal government would be well advised to scrap this mission. But if it insists on moving forward, launch should proceed only when the problems are solved, and not a moment sooner.

Links to previous article by Dr Harvey Chochinov:

Patient centred care - Not death hastening (Link).