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opinion

If all had gone according to plan, medical assistance in dying for people whose sole underlying condition is a mental illness would be two weeks away from becoming a reality in Canada.

That expansion of MAID was set to occur March 17, but in February the Liberal government tabled a bill to postpone it for another year (the bill has been through third reading and is in the hands of the Senate). The reason was plain: adequate standards to safeguard a regime under which mentally ill people would have access to a state-assisted death were not in place.

It was the right decision. But it also highlights the many unresolved and highly complex issues around MAID as it continues to grow and grow.

Just last month, a report by Parliament’s Special Joint Committee on Medical Assistance in Dying recommended further expanding a legal option, first made law in 2016 in response to a Supreme Court decision, that was intended only for mentally competent adults suffering intolerably from incurable diseases, and whose natural death – either from disease or age – was reasonably foreseeable.

Among the joint committee’s recommendations is one to expand that original regime (intolerable suffering, reasonably foreseeable natural death) to “mature” minors, with or without their parents’ consent. Another calls on Ottawa to allow people diagnosed with a serious and incurable disease to make advance requests for MAID, before they become incapable of asking.

Such changes, were they to occur, would be but the latest. The “reasonably foreseeable” natural death standard was overturned by a Quebec court in 2019, and Ottawa chose not to appeal. Instead, it amended the MAID law in 2021 to create a second, more onerous eligibility track for people who aren’t near death but are suffering intolerably from an incurable condition.

That opened the door to expanding MAID to people with mental illnesses, setting up the deadline that would have arrived this month but is now put off to March, 2024.

The existing and proposed expansions of MAID – most of which are not required by the courts – have been unsettling even for those who supported its first iteration. This hasn’t been helped by a news story last year about wounded veterans being inappropriately counselled to consider MAID, and a smattering of reports about people with physical disabilities seeking a state-assisted death because they couldn’t access the services they needed to live a dignified life.

As well, the annual number of state-assisted deaths has risen tenfold since they first became legal, going to 10,064 in 2021 from 1,018 in 2016.

On the other hand, the law has so far worked as originally intended. Government statistics show that 98 per cent of the people who were given MAID in 2021 were suffering from cancers, heart disease, neurological disorders and other terrible sicknesses, and their natural death was imminent; 82 per cent of those cases involved patients aged 65 and up.

But the pendulum is now swinging toward a far more permissive and troubling set of rules. The recommendation that children be allowed to request MAID without their parents’ consent is morally fraught and should not happen. Helping children die wasn’t what the Supreme Court envisioned in 2015; otherwise, it would not have limited access to assisted death to adults.

There are also complex issues are around expanding MAID to people whose sole underlying condition is a mental illness. A chronic and severe mental illness can be as intolerable and irremediable as any physical one. But unless there can be concrete guidelines for establishing the capacity of a mentally ill person to consent to their death, and for deciding when a mental illness is beyond treatment, Ottawa should not take this next step.

Above all, there should be no further expansion of the right to die in Canada until Ottawa and the provinces invest in publicly funded mental-health care, more palliative care beds, more social housing for people with physical and mental disabilities, and easy access to social supports.

It is Ottawa’s duty to be absolutely certain that a lack of care for the living doesn’t turn state-assisted death from it what should be – a last resort – into just another treatment option. “Irremediable” should not be code for “we don’t have the resources to help you.” That’s barbaric.

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