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Canada: yes to minors, mental illnesses on hold

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20th February 2023

Canadian Parliamentarians have recommended that euthanasia be made available to children, two weeks after the Government bowed to pressure and postponed expansion to those with mental illnesses.

Canada: yes to minors, mental illnesses on hold

Canada's federal euthanasia and assisted suicide ("Medical Assistance in Dying", or MAiD) legislation came into force in 2016, initially for those whose deaths were "reasonably foreseeable". This requirement was struck down by the courts in 2019, paving the way for an expansion of the law from terminally ill people to chronically ill and disabled people. The 2021 legislation which gave effect to this court ruling (C-7) went further, providing for MAiD on grounds of mental illness alone from Spring 2023 and requiring consideration of further expansion of the law to mature minors, and acceptance of advance requests.

As the demise of the subset clause excluding mental illnesses approached, an increasing chorus of voices called for a rethink. The Association of Chairs of Psychiatry in Canada called for a delay while the Canadian Association for Suicide Prevention issued a statement saying:

"With respect to MAiD when the sole underlying condition is a mental disorder, CASP asks all Canadians to consider the following: recognizing that the legal requirement of "irremediability" of a mental disorder in order to qualify for MAiD, there is insufficient research into this prognosis and, therefore, insufficient data to conclude irremediability of any mental disorder. As such, currently, a mental disorder alone does not satisfy this aspect of the legal test for MAiD."

The Centre for Addiction and Mental Health thus argued:

"We do not believe that eligibility for MAiD should be extended to people whose sole medical condition is mental illness at this time"

Erin Anderssen, writing in the Globe and Mail, offered this summation:

"Just as life is getting harder in Canada, it is getting easier to die."

Finally, on 2 February, the Government bowed to pressure and agreed to lay down additional legislation allowing for a one-year delay.

Now, in its newly released, overdue report, the Special Joint Committee on Medical Assistance in Dying (AMAD) has made 23 recommendations for further development - including seven pressing for expansion to "mature minors".

"That the Government of Canada..."

"...undertake consultations with… [and fund] research into the views and experiences of… minors on the topic of MAID, including minors with terminal illnesses, minors with disabilities, minors in the child welfare system and Indigenous minors, within five years of the tabling of this report."

"...amend the eligibility criteria for MAID set out in the Criminal Code to include minors deemed to have the requisite decision-making capacity upon assessment."

"...restrict MAID for mature minors to those whose natural death is reasonably foreseeable."

"...establish a requirement that, where appropriate, the parents or guardians of a mature minor be consulted in the course of the assessment process for MAID, but that the will of a minor who is found to have the requisite decision-making capacity ultimately take priority."

Writing in the British Medical Journal's Journal of Medical Ethics in 2018, doctors associated with a Toronto children's hospital considered how MAiD for minors might work in practice. The reference to consulting parents "where appropriate" in the AMAD report echoes the 2018 paper, which not only argued that parents need not be told, much less give consent, if patients did not wish, but also outlined wide parameters in which conversations about MAiD could be initiated, and recommended that hospitals work to normalise MAiD.

In the body of the AMAD report, it is conceded that although:

"Most witnesses agreed that MAID should only be expanded to include mature minors whose natural death is reasonably foreseeable, at least initially… [one witness] questioned the constitutionality of limiting MAID for mature minors to track one. Others held firm convictions that track two MAID and MAID MD-SUMC are unacceptable for minors, and feared these would inevitably follow any expansion to track one."

It is hard to imagine that the logic expressed in the courts in 2019 would be ignored in this instance. The report acknowledges:

"The discriminatory impacts of allowing MAID for minors with disabilities, who often face mental health challenges and may struggle to imagine a positive future for themselves… Minors with disabilities may feel like a burden due to the costs associated with their care, including parental time off work."

There is wider recognition in the report of the slew of stories which have horrified the watching world, concerning disabled and ill people applying for or even being recommended MAiD not because of a settled wish to die but because they are eligible and have insufficient support to live with dignity, with a recommendation that:

"That the Government of Canada continue to support persons with disabilities by implementing measures to reduce poverty and ensure economic security."

The AMAD report finally recommends:

"That the Government of Canada amend the Criminal Code to allow for advance requests following a diagnosis of a serious and incurable medical condition disease, or disorder leading to incapacity."

Canada's law is not a decade old, but it is already out of control. It is a warning: the only clear, bright, defensible line is a rejection of euthanasia and assisted suicide.

Image © longzijun / licensed for reuse under Creative Commons License 2.0

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