Most Canadians know that the right to die will soon be the law of the land. Most Canadians enthusiastically approve. But how many know that right may well extend to the mentally ill – people whose sufferings are psychological?
The answer is, very few. Almost no one seems to be aware that we are rushing headlong into a moral quagmire, with profound questions that have not been debated in Parliament and have largely been ignored in the news media.
Everyone in my informal canvass of liberal-minded friends and neighbours was shocked to hear that euthanasia for psychological suffering is even on the table. Yet three months from now, it could be the law of the land. That is what the parliamentary committee on assisted dying proposed in its report last week. The rationale is that psychiatric patients should have the same rights as everybody else.
Think about it. Legalizing marijuana is so fraught with complications that it won't happen any time soon. But legalizing euthanasia for seriously depressed people? No problem!
Obviously, psychiatric illness can produce grievous suffering. But it is not the same as terminal cancer. Psychiatrists' practices are filled with people who want to die. Their decision making is frequently impaired by their illness. People who are suicidal often change their minds. And major mental illness, although often incurable, can often be relieved. So can the conditions that make it worse, such as social isolation, poverty and homelessness. You are not likely to find a mental health leader in Canada who has argued that the right to die would serve the greater good of psychiatric patients.
Like most Canadians, I believe the time has come for a narrow right-to-die law for people who are near the end stage of life. The current Quebec law and the Oregon law are good models. Instead, the Liberal-dominated parliamentary committee has advocated the most expansive euthanasia laws in the world. Its report is a rushed and slipshod piece of work, uninformed by experiences in other jurisdictions and overwhelmingly influenced by the zealotry of the right-to-die movement.
Harvey Chochinov, a professor of psychiatry and also the Canada Research Chair in palliative care at the University of Manitoba, believes the parliamentary committee's report is recklessly ill-considered. "It's very worrisome that they went so far, and so far beyond the Supreme Court decision," he says. "Quebec spent years deliberating this. [The committee] spent a few weeks."
Dr. Chochinov is uniquely qualified to comment. He chaired the external panel on assisted dying that was created by the previous federal government. That panel spent five months diving into the issues. Its 462-page report was a carefully considered framework for implementing assisted death that dealt comprehensively with the legal, professional and ethical pitfalls. It is everything the parliamentary report is not.
One of the experts the panel interviewed was Linda Ganzini of Oregon, a world leader in the field of psychiatric illness and capacity to consent. Dr. Ganzini told them she was dumbfounded that Canada was considering euthanasia for psychological suffering.
Evidence from the Benelux countries shows that when patient autonomy is extended to those with psychological conditions, it doesn't play out well. Recently a Dutch man in his 30s who suffered terribly from autism and social isolation asked a psychiatrist for euthanasia. The psychiatrist refused, both on grounds of conscience and because he thought the man was treatable. He referred the man to another doctor (as obliged to by the law), who said yes.
Between 2011 and 2014, 110 people in the Netherlands (whose population is about half of Canada's) were euthanized for psychiatric suffering. They made up just a tiny fraction of the total, but the numbers are growing fast. Psychiatrist Scott Kim of the U.S. National Institutes of Health analyzed 66 of these cases. He found that women made up 70 per cent of the total. Personality disorders were prominent, and many suffered from social isolation and loneliness. Some had never been hospitalized, and some had received no obvious treatment. One woman was accepted for euthanasia because she said she had had a life without love, and therefore no right to exist.
In Belgium, people have been euthanized because they were suffering from depression, eating disorders or post-traumatic stress disorder. Many were disturbingly young.
Canada's parliamentary committee on assisted death has treated this issue as if the debate is over. In fact, it never began. We're about to jump right off a moral cliff – and we don't even know it.