Re: Eligibility of Persons Whose Sole Underlying Medical Condition is a Mental Illness
The following is a longer version of my testimony to Special Joint Committee on MAiD. Due to time restrictions I had to edit severely. However the session is an hour long and I had hoped some of the Committee members would use their time to ask me questions. Only one did.
Thank you for the opportunity to provide some brief comments. One of the hats I wear is that I sit as a care partner on the Providence Health Care Psychiatry Lived Experience Research Advisory Committee and I am always struck by the urgency accorded expansion of MAID for mental illness versus that of providing funding for comprehensive mental health care, supports, livable income and housing for those with mental illness.
Injustice can often be measured in time.
Today, I am speaking as co-founder of the Disability Filibuster.
As policy makers I am certain you are aware that neither people nor policies are islands unto themselves. And yet MAID is discussed as if it exists inside a vacuum, free of influence from, or consequence to, society.
In what little time I have I will address a couple of persistent myths that constantly derail and impede rather than build understanding.
Myth One: The reason people oppose expanding MAiD criteria to include mental illness as a sole underlying condition is because they believe mental illness is less real than physical illness and they treat it as less significant and less worthy of support.
False: The division between physical and mental illness is one asserted and maintained by the medical model and the Canadian state. Due to the exclusion of essential elements of mental health care from Canada’s publicly funded and arguably misnamed universal health care system, Canada has a two-tier mental health care system. The average provincial and territorial mental health care funding lags behind that of many peer countries. Proportionally, Canada’s public spending on mental illness is lower than its occurrence among all illnesses. People with mental illness face particular threats to their civil rights. A BC study found that for nearly a third of people with mental illness, their first contact with mental health care involved the police. A situation that the Canadian Mental Health Association attributes to the lack of community services, the limited scope of crisis services, a reduction in hospital beds so that even short stays are only available to those in the most acute crisis. A CMHA fact sheet states: “Police officers are, by default, becoming the first point of access to mental health services for persons with mental illness, earning them the nickname ‘psychiatrists in blue.’” They go on to explain that one of the consequences of this is that “public also receives reinforcement for the false perception that mental illness is a crime rather than an illness, and that persons with mental illness are a public danger – a common and erroneous belief which hurts both persons with mental illness and the public.”
Stigma requires power. Without power, stigma is just someone’s bad opinion.
I hope this isn’t too idiomatic a reference, but in terms of the claims asserted by the myth, the call is coming from inside your house, not ours.
As disabled people we understand disability as one large tent. Power divides and builds hierarchies. Justice unites through shared struggle and common goals.
There are differences and these do matter. Where physical disability can be met with a benevolent though also hostile othering that infantalizes, assumes helplessness, denies access and views our bodies with disgust, people with mental illness confront staggeringly pervasive, dehumanizing and isolating stigma and dangerous stereotypes while being simultaneously blamed for their illness and having its existence doubted.
The experience of oppression is not the same but the cause of it is.
And please remember that the majority of disabled people have more than one disability and a combination of both physical and mental illness is not uncommon. So when someone projects this myth onto one of us they are often accusing and pretending to defend the exact same person.
Myth Two: Failing to expand MAID is discrimination.
False: This and other assertions made by proponents of MAiD’s expansion reflect a profound lack of understanding of disability rights, history and what the causes, consequences and solutions to the discrimination and injustice disabled people experience actually are.
This myth exists as part of the hyper-individualization of human rights by neoliberalism. Instead of human rights as integral component for building a better society, your body becomes a container of assets that you manage. Universal human vulnerability is denied and instead treated as a deviance from ‘normal’ so that whatever social institutions and policies do exist, do not reflect the necessary conditions for broad resilience. Disability and illness are interpreted through the lens of self-ownership, (an extension of private property rights) and personal responsibility. That the neoliberal state is generously offering to aid you into the grave – for free – is not a pivot, it’s an unmasking of any pretence left covering Canada’s allegiance to the dictum of Margaret Thatcher: “there is no such thing as a society.”
In a zero-sum society where the state’s responsibility for social welfare of its citizens is eroded, it was almost inevitable that human rights would become a competitive race to the bottom. A throne of nails and a poison drip awaits the victor.
The urge to distinguish oneself as ‘free’ while yoked to neoliberal and eugenic logic leads to absurdly invoking the Charter to demand something simply because someone else has it - even if what that person has is killing them and those around them. MAID is particularly exploitative as it uses the same hierarchy of deservingness as the charity model to suggest you can reverse your way out of pity and ableist oppression, assert your freedom and prove your equality by asking the state to kill you. Surely this committee and the Canadian state is capable of a more sophisticated understanding of discrimination and human rights.
In a forthcoming chapter entitled, The Case Against Legalizing Assisted Death for Psychiatric Disorders,” Trudo Lemmens and Scott Kim demonstrate why parity arguments logically lead to absolute autonomy (death on demand for anyone).
“..the parity argument is difficult to restrain. For instance, it is not clear whether one canThis aligns with disability analysis that for years has asked “Why Us?” The actual discrimination exists at the level of deciding that our suffering - and only our suffering - makes us killable. Humans suffer in a myriad of ways and among the worst is feeling helpless while someone you care for is suffering. And those feelings also happen when you are the person who others might be feeling powerless to help. It makes me wonder how much unprocessed grief and feelings of powerlessness lead to a misguided desire to add meaning and purpose by participating in the construction of MAiD. Once you unravel and disentangle your thoughts and definitions of words like dignity from ableism, you are left with the realization that ableism is the only thing defining the perimeters of MAiD.
draw a principled line around ‘medical and psychiatric suffering’ so that all other suffering is excluded, if all that matters is some formal criterion of equal treatment. What is unique about medically based suffering (both somatic and mental) that suggests a clear, principled line around it (Braun, 2023; Davis & Mathison, 2020; Kim, 2023)? That is, one could apply the parity principle to whether persons suffering from non-medical causes are being discriminated against. There is a perennial debate in the Netherlands about extending legal EAS [euthanasia, assisted suicide] to, for example, elderly persons who do not have irremediable medical suffering, but who are ‘tired of life’ and would like EAS. What principle would exclude suffering from abject poverty? The logical destination of the parity argument seems to be a pure autonomy-based EAS system.”[i]
Disability analysis has evolved from its early focus on individual rights, independence and integration into existing systems. Breaking free of the medical and charity model and the explosion of knowledge that followed the freeing of many, (though not all), from institutions, led to the realization that the tools we were using were pre-coded to build ableism not dismantle it. As Jean-Sebastian Beaudry, Canada Research Chair in Health, Inclusion and Policy at McGill Law School explains, “Disability justice…requires the dismantling of the multifaceted ableist ideology that pervades the very tools used to achieve justice, and disguises policy shortcomings as unavoidable economic or biological necessities.” [ii]
MAiD is built discrimination, not a remedy to it. The Canadian state decided no dignity is possible for someone who is disabled and, as consolation prize, branded a lethal injection from a state-sanctioned provider “dignified” declaring, “There’s your human rights!”. Conveniently, this aligns with the commodification of human rights. A new revenue stream was created for some but, overall, killing us is vastly cheaper than building the necessary infrastructure and policy to make a dignified life plausible.
The reasoning behind this myth is akin to suggesting that ugly laws were discriminatory not because they banned visibly disabled people from public space but because they didn’t ban all disabled people from public space.
Those presenting the astroturf-autonomy of “access” to death to an actual-autonomy-deprived population are certainly making a choice to do so. But why?
At least one study found that support for euthanasia on the basis of mental illness was positively correlated with stigma towards people with mental illness. Not only the opposite of what one would expect if the myth were true but suggests that those spreading this myth may be projecting their own beliefs onto us.
The co-opting or, at best, outdated and incorrect understanding of disability rights invoked in the name of support for MAiD is made possible by the absence of disabled knowledge and understanding. The mythmaking - or some would call it misinformation – reflects broader epistemic injustice that has remained largely unchallenged and become more entrenched and fictitious as a result of MAID.
MAiD is discrimination not a solution to it. It must be repealed not expanded.
[i] Scott Kim & Trudo Lemmens, The Case Against Legalizing Assisted Death for Psychiatric Disorders
(Forthcoming in Matthé Scholten, Kelso Cratsley, and Tania Gerkel, eds., Mental Health Ethics:
Current Controversies and Emerging Debates (Oxford University Press))
[ii] Jonas-Sebastien Beaudry Ableism’s new clothes: Achievements and challenges for disability rights in Canada
University of Toronto Law Journal 2024 74:1, 1-40
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