The federal government tabled legislation on Thursday to delay until next year an expansion of Canada’s medical assistance in dying law to allow mental illness as a sole condition.
The MAID legislation was set to expand this March, a change that would have made the country’s euthanasia rules one of the broadest in the world.
“It is clear more time is needed to get this right,” Justice Minister David Lametti said in a news conference Thursday.
The one-year delay comes after months of controversy revealed divisions among psychiatrists, who would be needed to approve mental-health patients for an assisted death, as well as concerns from a number of mental-health and disability organizations.
Psychiatric department heads at top universities and clinicians working with the most severely ill patients raised the risk that people may receive an assisted death when they still had a chance to recover, especially without strict guidelines to assess complex cases.
National practice standards will be ready only in March, however, leaving little time for regulatory bodies and hospitals to adopt them. A federally funded curriculum for doctors will not be available until the fall. And the parliamentary committee studying the issue had delayed their final report until mid-February, creating a compressed timeline for their recommendations to factor into the legislation or standards.
Mr. Lametti said the pause would give provinces and territories more time to prepare for the change. He said he expected the amended legislation to pass before the March 17 deadline. If it doesn’t, the existing law allowing the expansion will come into effect.
Under current MAID legislation, only capable adults with a nonterminal physical illness may receive an assisted death, if they have an irremediable condition that is causing them intolerable suffering, and if there are no treatments that the patient feels are acceptable. In 2022, the first full year this criteria was allowed, roughly 500 patients without a foreseeable death received MAID, according to Heath Canada estimates, among about 10,000 total cases.
Currently, patients with a mental illness may receive MAID, but only if they also suffer from a qualifying physical condition. The expansion to mental illness as the sole reason was controversial because research shows that psychiatrists often struggle to reliably predict recovery rates for patients. There were concerns that especially without clear guidelines, doctors might mistake patients making a rational choice to receive MAID with those experiencing suicidal ideation, a common symptom of mental illness.
Mental-health advocates had also pointed to treatment delays in the health care system, which have been exacerbated by the pandemic, and the role that limited affordable housing options, poverty and a lack of social support often play in patient outcomes.
“Delaying the expansion for MAID for mental illness is only the tip of the iceberg of what the Canadian government must do,” said Ramona Coelho, a family physician whose practice is predominantly low-income and marginalized patients, and who has been a vocal critic of expanding MAID to mental illness.
Her patients, she says, often have trouble accessing timely care and affordable housing. “Canada has not done its part to ensure them a quality of life that should rightfully be theirs.”