Dr Laurence Normand-Rivest: Let us offer healing to the suffering

Presentation at the EPC Press Conference on October 7 in support of Bill C-218

Dr Laurence Normand-Rivest

My name is Laurence Normand-Rivest and I have been a family doctor for 13 years in Montreal, caring mainly for geriatric patients in clinic, long term facilities and providing palliative care at home for patients at the end of life. I also work 15 hours per week at the walk-in of my clinic where I meet patients of all ages and backgrounds.

I support Bill 218 to undo Bill C-39 coming into effect on March 17th 2027 that would allow those suffering solely from psychiatric illnesses to ask for MAID.

We should ask ourselves if homicide is an adequate answer to suicidal ideation. Have Canadians become lobbyists of suicide?

In 2016, Bill C14 defined MAID as assisted suicide provided by a doctor to a patient suffering from a terminal and grievous and irremediable condition in the context of a relationship between the patient and his doctor. Many safeguards have been removed since the introduction of the law, especially the initial delay of reflection of 10 days removed in 2021 with the introduction of Bill C7, which allows a patient in shock because of bad news to ask to be killed immediately. Bill C7 also expanded MAID for the people suffering from a serious illness when death is not foreseeable. With Bill C-39, patients wouldn’t need to have any physical illness to ask for assisted suicide.

Les idées suicidaires sont un symptôme de la dépression. Statistiques Canada estime que plus d’un Canadien sur 10 souffrira d’un épisode de dépression majeure dans sa vie. Des centaines de patients m’ont consultée au sans rendez-vous à cause de symptômes dépressifs. Je leur dis qu’ils peuvent prendre des rendez-vous de suivi avec moi et que je ne les lâcherai pas tant qu’ils ne seront pas guéris. La période initiale de détresse et d’idéation suicidaire, pouvant parfois durer des mois voire des années, est réversible pour la plupart des patients. J’ai même un patient qui avait été déclaré inapte au travail pour dépression chronique qui après dix ans, est redevenu assez fonctionnel pour réintégrer le travail qu’il aimait tant. Il est très réducteur de notre part de juger qu’une condition psychologique est irrémédiable, et plusieurs comorbidités physiques, comme des douleurs chroniques, nécessitent l’attention de plusieurs médecins spécialistes et de professionnels, ainsi que l’aide de ressources communautaires, avant de permettre au patient de sortir des bas-fonds de sa dépression.

English translation: 

(Suicidal thoughts are a symptom of depression. Statistics Canada estimates that more than one in ten Canadians will experience an episode of major depression in their lifetime. Hundreds of patients have consulted me at the walk-in clinic due to depressive symptoms. I tell them they can schedule follow-up appointments with me and that I will not abandon them until they have recovered. For most patients, the initial period of distress and suicidal ideation—which can sometimes last for months or even years—is reversible. I even have a patient who had been declared unfit for work due to chronic depression but, after ten years, became functional enough to return to the job he loved so much. It is overly simplistic to deem a psychological condition irreversible; furthermore, various physical comorbidities—such as chronic pain—require the attention of multiple medical specialists and professionals, as well as support from community resources, to help the patient emerge from the depths of depression.)

In 2023, Health Canada published the norms of practice of MAID, stating that patients should be informed of all the therapeutical options available to alleviate suffering. If the patients qualify for it, Health Canada stated that they should be informed of the possibility of MAID.

Why have we placed assisted suicide at the same level as healthcare? Have we designed suicide as a remedy to patients because of our incapacity to provide proper care to all? Roger Foley, a 51 year old man suffering from cerebellar ataxia hospitalized in London since 2016, has been offered MAID several times because our healthcare system couldn’t provide the homecare he was asking for.

I am very concerned for our patients who are psychologically in distress and wondering to whom they will turn to. We know that access to healthcare is often very difficult, especially for the most vulnerable, who are isolated, and prone to despair. AP News reported that patients have qualified for euthanasia because of isolation, poverty and obesity. In Montreal, I have heard of colleagues in my department administering MAID to a homecare patient who had chronic mobility issues but no grievous or irremediable condition, because he had asked for it a few days before Christmas in order not to be alone. Can MAID be a solution to the plague of loneliness? Have we thought of the despair of those suffering the loss of the deceased? How many victims will there be of our culture of death?

J’ai été responsable du service d’hébergement dans le CIUSSS Centre-Sud de Montréal pendant quelques années, et j’ai travaillé dans 8 CHSLD dans les CIUSSS du Sud et du Nord de Montréal, dont 2 unités où un grand nombre de patients souffrent de maladies psychiatriques chroniques. J’ai aussi parmi ma clientèle âgée au bureau et à domicile plusieurs patients souffrant de schizophrénie, de trouble bipolaire réfractaire ou de dépression chronique, dont plusieurs personnes invalides. Parmi eux, nombreux sont ceux qui trouvent une grande joie dans la simplicité du quotidien, et qui sont eux-mêmes des soignants par leur empathie qui apporte tant de consolation pour les personnes qu’ils rencontrent. La vulnérabilité ouvre le cœur à la souffrance de l’autre et nous permet d’y faire face.

English Translation: 

(I was in charge of the residential care department at the CIUSSS Centre-Sud de Montréal for several years and worked in eight long-term care facilities (CHSLDs) across the CIUSSS networks of southern and northern Montreal, including two units housing large numbers of patients with chronic psychiatric conditions. My caseload—both in the clinic and during home visits—also includes many elderly patients suffering from schizophrenia, treatment-resistant bipolar disorder, or chronic depression, including several individuals living with disabilities. Many of them find great joy in the simplicity of everyday life and act as caregivers themselves through an empathy that brings profound comfort to the people they meet. Vulnerability opens the heart to the suffering of others and enables us to face it.)

We know that suicidal thoughts are symptoms of an underlying depressed mood and that depression can be treated. Let us offer healing to the suffering, be present and faithful in our support, and not eliminate them.

Senator Denise Batters speech in the Senate opposing euthanasia for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Senator Denise Batters has been one of the most clear and effective voices in Canada's Senate opposing euthanasia for mental illness. Bill C-7, that passed on March 17, 2021, legalized euthanasia for mental illness alone, but with a two year moratorium for implementation. 

The attached video is the speech by Senator Batters, in the Senate, concerning Bill C-39, a bill to delay the implementation of euthanasia for mental illness, for one year, until March 17, 2024. Dr Batters husband, Dave Batters, was a Member of Parliament when he died by suicide on June 29, 2009.

Senator Denise Batters

Senator Batters states in her speech.

• Euthanasia for mental illness alone is abhorrent.
• Bill C-7 (passed in March 2021) which eliminated the requirement that people must be terminally ill to die by euthanasia, has led to the slippery slope with veterans with PTSD dying by euthanasia and disabled and impoverished Canadians are deciding to end their lives by euthanasia.
• The parliamentary committee on MAiD has recommended to expand euthanasia to children.
• Psychiatrists are warning that euthanasia should not be extended to people with mental illness, in response the government is delaying the implementation to gain time to sell Canadians on the concept.
• A recent Angus Reid survey found that only 31% of Canadians support euthanasia for mental illness.
• Batters' very first social media post and article was entitled: Help the mentally ill, don't kill them.
• Originally Bill C-7 excluded euthanasia for mental illness. The Senate passed an amendment to the bill to require euthanasia for mental illness and the government accepted the amendment but with a two-year moratorium for implementation.
• During the Bill C-7 debate, euthanasia for mental illness was never studied by a committee of the Parliament or Senate.
• The parliamentary committee on MAiD studied further of expansion of euthanasia, to minors and by advanced consent.
• Mental illness is not irremediable, one of the criteria required in the law.
• Recovery from mental illness is possible, but cannot be predicted.
• Dr John Maher, a respected psychiatrist who specializes in difficult cases, calls euthanasia for mental illness - facilitated suicide.
• Advocates of euthanasia for mental illness have changed their argument from it being an irremediable medical condition to an inaccessible medical condition.
• One psychiatrist has stated that she would consider a long waiting list for psychiatric treatment as it being an irremediable medical condition.
• There are problems with access to Canada's healthcare system. The answer is to fix that system, not to confirm a mentally ill persons feeling of hopeless and offer them the lethal means to suicide.
• As a compassionate society we have the obligation to hold hope for mentally ill Canadians when they don't hold hope for themselves.

False claims by the government concerning euthanasia for mental illness.

• Justice Minister David Lametti claims that euthanasia for mental illness has been mandated by the courts. This is not true. The Carter and Truchon cases did not rule on the constitutionality of euthanasia for mental illness alone.
• The government and euthanasia lobby falsely claim that euthanasia for physical or psychological suffering are equivalent. A mental illness is not terminal. Death is not a reasonably foreseeable outcome. Mental illness is not irremediable and it is unpredictable.
• Suicidality can be a symptom of mental illness.
• To recognize the difference between physical and mental illness is not discriminatory but a simple acknowledgement of fact.
• Canadians with mental illness do not have full access to treatment and support options.
• This is not equality for people with mental illness but a complete dereliction of our duty.
• The gaps in our treatment of mental illness are leading to people seeking death.
• I am livid that the government is offering death rather than treatment.

Recommendations:

• We should be using the year of delay for implementing euthanasia for mental illness to actually provide an in-depth study into whether we should be implementing euthanasia for mental illness.
• Justice Minister Lametti has stated that the delay is to allow everyone to internalize the standards and allow universities to prepare teaching material. This is bunk.

Conclusion:

• The tide is turning and the government has actually delayed euthanasia for mental illness to give them more time to do a sell job to Canadians.
• The government is delaying euthanasia for mental illness because psychiatrists and professionals are against it. Canadians are not ready for it either.
• The rest of the world is looking at Canada's euthanasia law with shock as we have become the most permissive country in the world.
• Since everyone is uncomfortable with it, it is probably an indication that we are doing something wrong. We need to stop this runaway train before it's too late.
• The one year delay to euthanasia for mental illness is a start, but it is only a start. This government needs to completely re-evaluate extending euthanasia for mental illness. They have gone too far with this ideological experiment and are headed straight for the abyss.
• The law has gone too far for psychiatrists, too far for Canadians and it is hurting people who desperately need us to preserve hope, people with mental illness.

We must not let people with mental illness down.

Article: Senator Denise Batters: Help the mentally ill, Don't kill them (Link).

Canada's Senate only has one week in parliament to pass Bill C-39 and delay euthanasia for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Toronto Sun reporter Catherine Lévesque stated that on February 15, the House of Commons unanimously passed Bill C-39, the bill that would delay the implementation of euthanasia for mental illness until March 17, 2024. But Canada's Senate only has one week to also pass C-39.

Lévesque explained:

Time is of the essence, as both houses will not be sitting for the next two weeks and will come back on the week of March 6 before another break week. That means the Senate will only have one sitting week to study and vote on C-39 before the deadline of March 17 2023.

Lévesque reported that Justice Minister David Lametti is confident that the Senate will vote on the bill quickly but it was the Senate that originally amended Bill C-7 to include euthanasia for mental illness.

Lévesque reported that Marc Gold, the government's representative in the Senate stated:

“We are confident that the Senate will complete a final vote on Bill C-39 before March 17.”

Lévesque reported that during the parliamentary debate on Bill C-39:

Lametti said the main objective of C-39 is to give more time to nurses and practitioners to get more training on the issue and to give the government more time to consider a new report from the parliamentary committee looking at extending eligibility of assisted dying.

NDP MP Alistair MacGregor told Lametti at a committee meeting this week that elected officials studying the issue “always felt under the gun” because of the sunset clause expiring and welcomed the one-year extension provided by the new bill.

Conservatives, on the other hand, are clear that they oppose the extension of MAID to people suffering from mental disorders and have another year to try to make this clause disappear.

Speaking in the Commons on Wednesday evening, things got emotional as Liberal MP John McKay spoke about the hurdles of navigating through the health system for 25 years ever since his stepson was diagnosed with schizophrenia.

The Euthanasia Prevention Coalition welcomed Bill C-39 but it is not a victory since it only delays and stops the implementation of euthanasia for mental illness. For the sake of John McKay's stepson, euthanasia for mental illness should not even be considered.

I do not trust this government. I still fear that Bill C-39 may be held up in the Senate and not meet the March 17 deadline.

Previous article:

• Canada to delay euthanasia for mental illness until March 2024 (Link). 
• Bill C-314 would prohibit euthanasia for mental illness in Canada (Link).
  

Canada to delay euthanasia for mental illness until March 2024.

This is not a victory. The government is only delaying the implementation of euthanasia for mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

David Fraser reported for The Canadian Press that Justice Minister David Lametti introduced Bill C-39 to delay the implementation of euthanasia for mental illness (for one year) until March 17, 2024.

Bill C-7, which was passed on March 17, 2021, among other things, legalized euthanasia for mental illness with a two-year moratorium. Therefore euthanasia for mental illness alone was to be implemented on March 17, 2023. The latest government plan delays the implementation for one more year.

This is not a victory since it only delays the implementation of euthanasia for mental illness. 

Further to that, I do not trust the government. As stated by Peter Zimonjic for CBC news:

If Bill C-39 is not passed by March 17 of this year, MAID for people solely suffering from mental illness will become law in Canada. The legislation cannot be passed after that date because the two-year time limit will have ended.

It is possible that the bill to delay implementation of euthanasia for mental illness will be held up or defeated in the Senate and thus permitting euthanasia for mental illness on March 17, 2023.

David Lametti

According to the Canadian Press report:

Canadians whose sole condition is a mental disorder will not be eligible for a medically assisted death for another year under legislation introduced in the House of Commons Thursday.

Justice Minister David Lametti introduced the bill seeking to delay extending the eligibility until March 17, 2024.

“We need to be prudent. We need to move step by step, making sure that people within the profession, Canadian society at large, has internalized this step,” Lametti told reporters.

“To be honest, we could have gone forward with the original date, but we want to be sure. We want to be safe. We want everybody to be on the same page.”

The Liberal government backed off from implementing euthanasia for mental illness this year because most psychiatrists are stating that it is impossible to determine if a person with a mental illness has an irremediable medical condition, as required by the law. 

There have also been many sad stories of people with disabilities who died by euthanasia based on poverty, homelessness or an inability to receive medical treatments.

People with mental illness are often living in poverty, experiencing homelessness or unable to get the necessary treatment for mental illness. Permitting euthanasia for people with mental illness is not about autonomy but rather abandonment of people in need of care.

Yesterday I reported that Alberta Premier Danielle Smith objects to expanding euthanasia to include mental illness. Québec has already objected to euthanasia for mental illness. Provinces must assert their constitutional authority and prevent euthanasia for mental illness.

Further reading:

• Quebec Court expands euthanasia law by striking down the terminal illness requirement. (Link). 
• Canada passes Bill C-7 allowing euthanasia for mental illness (Link). 
• Canada's law will provide not prevent suicide for some psychiatric patients (Link). 
• Euthanasia for mental illness. Killing people with an uncertain prognosis (Link). 
• Abbotsford police investigating euthanasia death (Link). 
• Canada is not as advertised. Euthanasia is eugenics (Link). 
• Canada's euthanasia law is the most permissive in the world (Link). 
• (MAiD) euthanasia for disability and poverty (Link). 
• (MAiD) euthanasia for mental illness and poverty (Link). 
• Veterans affairs worker advocates euthanasia for PTSD (Link).
• Abandoning people. Canada's broadening euthanasia laws (Link). 
• Mother wants to stop 23-year-old son from dying by euthanasia (Link). 
• Bereaved mother speaks out against euthanasia (Link). 
• Woman died by euthanasia because of inadequate home care (Link). 
• Infant euthanasia proposed by Quebec College of Physicians (Link). 
• How poverty not pain is driving people with disabilities to euthanasia (Link). 
• Ontario man seeks euthanasia to avoid homelessness (Link). 
• Why did they kill my brother? (Link). 
• Canada's doctors offer euthanasia before receiving a request (Link). 
• Food bank clients asking for euthanasia based on poverty (Link). 
• No other options. An expose on euthanasia in Canada (Link). 
• Poverty and euthanasia creates public interest but euthanasia is abhorent on its own (Link).