I strongly encourage you to reject MAID offered for mental disorders

This chain of letters begins with a letter to Mario Simard Bloc Québécois’ Member of Parliament for Jonquière. Mario Simard then responses to Odile Marcotte and then Odile Marcottee responds to Mario Simard. This letter chain was originally written in French and then translated to English.

Dear monsieur Simard,

I am writing to you regarding Bill C-218 and would be very grateful if you would acknowledge receipt of this letter. I have known suicidal individuals and people suffering from mental illness, and I am deeply troubled by the idea that the government could encourage them, in any way, to resort to medical assistance in dying (MAID).

There are very good reasons why the implementation of MAID for mental disorders without other medical conditions has been postponed twice. In Quebec, it was even rejected. The opinions of healthcare professionals reflect deep divisions on this issue. While a majority of the population still supports MAID in general, only a minority of that population supports it in these specific cases.

It is crucial to emphasize that MAID for mental disorders is not a logical extension of current practice. On the contrary, it contradicts the fundamental principles of that practice. Indeed, the two essential criteria for eligibility for medical assistance in dying (as currently practiced) are (a) the irremediable nature of the patient's condition and (b) the patient's free and informed consent.

However, the irremediable nature of a mental or psychological disorder cannot be determined in the same way as for a physical illness. Scientific knowledge of mental disorders is not currently as advanced as that of physical illnesses. Psychiatrists are unable to predict which of their patients with similar mental disorders will see their condition improve; nor can they say how long it will take.

Many people who have experienced long periods of acute mental distress are convinced that they would no longer be alive today if MAID had been available while they were being treated for their illness.

Furthermore, the very nature of psychiatric symptoms often prevents patients from exercising their freedom of choice, making the ethical practice of MAID almost impossible.

Here is what the Canadian Association for Suicide Prevention (CASP) says on this subject:

“With regard to patients’ ability to provide consent to medical assistance in dying, the very nature of mental illness can impair decision-making capacity. Those suffering from acute mental illness are routinely encouraged to avoid making major decisions. The decision to prematurely end one’s life is of enormous and grave importance and should not be made by someone suffering from mental illness.”

A particular difficulty arises from the practical impossibility of reliably distinguishing between the rational (desired) motivation underlying a typical MAID request, on the one hand, and the expression of pathological suicidal desires that appear rational, on the other. This is again the perspective of the ACPS.

"For people at the end of life, there may be little or no overlap between medical assistance in dying and suicide in the traditional sense of the term. However, the risks of overlap increase sharply for people with chronic, but non-terminal, conditions, and particularly for those with mental disorders."

The constitutional rationale that compelled the Parliament of Canada to create an exception to the Criminal Code allowing for MAID is based on a trade-off between "justice" for those frustrated by prohibition, on the one hand, and the state's responsibility to protect those made vulnerable by the introduction of MAID, on the other. According to the Carter decision, an outright ban on MAID is unreasonable, and such a trade-off is necessary.

However, for the reasons stated above, the number of potentially vulnerable individuals will increase dramatically if Parliament decides to extend access to MAID to those suffering from mental illness but not other medical conditions.

Furthermore, in accordance with the medical perspective of Quebec's law on end-of-life care, the National Assembly of Quebec determined that medical assistance in dying could not constitute legitimate medical care solely for individuals with mental illness. This was the conclusion of a special committee's work, and this conclusion, undoubtedly shared by the majority of Quebecers, was subsequently ratified by the National Assembly in the new version of the law on end-of-life care.

I have just outlined the reasons why the practice of MAID for purely psychiatric purposes has been met with such a lukewarm reception and its introduction has been delayed for so long. In short, this introduction will lead to the unnecessary deaths of people whose conditions are by no means irreversible, in many cases, and whose requests do not stem from a genuine choice but from the symptoms of the illness itself. I strongly encourage you to seize this opportunity, not to inadvertently broaden the eligibility criteria for medical assistance in dying, but to set firm limits by definitively rejecting MAID offered for mental disorders in the absence of other medical conditions. 

 

Please vote YES on Bill C-218.

Odile Marcotte
Retired Professor Department of Computer Science, UQAM

Bonjour, Mme Marcotte,

 

Thank you very much for your letter and for the sensitivity with which you express your concerns. The issues surrounding medical assistance in dying, particularly when mental health is involved, raise profound and legitimate questions, and I wish to acknowledge the sincerity and importance of your initiative. Allow me to outline, with all due respect to your position, the Bloc Québécois’ perspective on Bill C-218. 

 

First, this bill is effectively unnecessary, since Parliament has already passed Bill C-62, which maintains the exclusion of mental illness as the sole condition for eligibility for MAID until March 17, 2027. Before any changes are made, a Joint Committee must thoroughly analyze the issue and determine whether legislative amendments are necessary. Therefore, no decision can be made until this rigorous work is completed. 

 

Second, we believe it is not the Conservatives’ place to unilaterally decide on such a complex and sensitive issue. Their moral or religious opposition to MAID cannot justify restricting the fundamental rights of Quebecers. Everyone remains free to choose not to use MAID, but it would be unfair to impose this position on the entire population. 

 

Furthermore, the preamble to Bill C-218 wrongly pits access to MAID against mental health care.

 

It is entirely possible (and necessary) to strengthen mental health services while respecting the rights of people experiencing severe and incurable suffering. This is why the Bloc Québécois continues to call for increased health transfers so that the provinces can provide adequate and accessible services. 

 

Finally, this bill does not address the demands of the Quebec government. The National Assembly wants the Criminal Code amended to allow advance MAID requests in provinces that have adopted a clear legislative framework, such as Quebec. A bill along these lines, such as the one proposed by Senator Wallin, would have received our support. Unfortunately, this is not the case with Bill C-218. I want to assure you that the Bloc Québécois remains deeply committed to protecting vulnerable people, respecting individual autonomy, and defending Quebec's democratic choices. Your letter demonstrates a genuine concern for human dignity, and I sincerely thank you for it. Please accept my sincere regards. 

Mario Simard Member of Parliament for Jonquière

Response from Odile Marcotte.

Dear monsieur Simard, 

Thank you for your reply, as I know you are very busy. I would like to make a few brief comments on it. 

You mention the rigorous work that the Special Joint Senate and House of Commons committee on Medical Assistance in Dying will undertake. I have been following the debate on Medical Assistance in Dying (which was initially called euthanasia) since its inception, and I am convinced that there is just as much rigor on one side (the one opposing the expansion of MAID) as on the other. Rigor cannot resolve this issue, since it is philosophical (and not merely moral and religious, as you seem to think) conceptions that are at odds. 

The question is whether suicide should be part of the care provided by the public health service. It is naive to think that healthcare for people with mental illness will not be affected by extending MAID to their cases, firstly because MAID is less expensive than such care, and secondly because the perspective of healthcare professionals will inevitably be altered by this extension. 

Thank you for reminding me that I am free not to use MAID, but I note that your party demonstrates little critical thinking in the face of propaganda from the College of Physicians and the Quebec Association for the Right to Die with Dignity. The respect shown by these organizations for differing opinions is entirely theoretical, since all palliative care homes in Quebec are now obligated to provide MAID to those who request it, regardless of the distress this obligation will cause to terminally ill individuals whose loved ones have committed suicide and who wish to end their lives in peace. 

Sincerely, Odile Marcotte