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Including mental illness in medically-assisted death 'reckless,' says Cooper

But psychiatric association says mental illnesses are medical illnesses, and many who suffer from depression fit the criteria.
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Parliament Hill is shown in Ottawa on Wednesday, March 11, 2020. The Trudeau government has agreed with the Senate that Canadians suffering solely from grievous and irremediable mental illnesses should be entitled to receive medical assistance in dying.

St. Albert-Edmonton MP Michael Cooper says the Senate acted hastily when it amended the Medical Assistance in Dying (MAiD) bill to include mental illness as a sole underlying condition in a sunset clause.

“The government has opened the door and this without any comprehensive study … instead of studying the issue first … the government recklessly has moved ahead,” said Cooper of the controversial Senate vote to amend Bill C-7, which was voted into law in March.

Cooper has been appointed to sit on the Special Joint Committee on Medical Assistance in Dying (MAiD). The committee is a statutory review and will look at issues surrounding palliative care, advanced directives, protections for persons with disabilities, mature minors, and mental illness.

The committee was supposed to meet on June 14, but the meeting was cancelled. Joint clerk Marc-Olivier Girard said the committee is meeting once a week, more or less, when Parliament is sitting. The final report is to be tabled in Parliament no later than May 17, 2022.

“We have a special committee that is studying, among other issues, the issue of mental illness, even though the train has left the station,” said Cooper.

The MP has many concerns when it comes to opening the door to those suffering from mental illness as a sole factor in being eligible for medically-assisted death.

“Many mental health professionals have said that it is not possible to determine your irremediability, and it's not possible to determine whether someone's underlying mental health condition can get better,” he said.

Cooper is also concerned about vulnerable populations. In Belgium and the Netherlands, the people most accessing medically-assisted death for mental illness is, as Cooper puts it, disproportionately female and disproportionately disadvantaged. This is something, data-wise, Canada is not seeing.

“We are opening the door to rendering permissible medical assistance and dying to very vulnerable segments of Canadian society. It raises, obviously, questions that have to be addressed to ensure that there are appropriate safeguards.

“But again, before we can analyze and assess what sorts of safeguards should be provided for, I reiterate, the first question is, should we have gone down this road in the first place,” he said.

Dr. Grainne Neilson, president of the Canadian Psychiatric Association, said the data in Belgium reflects the nature of the illness.

“Depression is something that is more common in women than in men, so it's like saying, you know, women are more likely to get chemotherapy for breast cancer, well, of course, they are because breast cancer is far more common in women than it is in men,” said Neilson.

The psychiatric association has taken the position to reflect a rights-based approach to the issue.

“It wasn't supposed to either support or oppose where mental illness was the sole underlying condition. Really just to suggest any new legislation on MAiD we need to protect the rights of all vulnerable Canadians without unduly stigmatising or discriminating against people with mental disorders,” she said.

There is a notion that mental illness and medical illness are separate.

“I think (what) a lot of people have difficulty (with) getting their heads around (with) this whole thing, is that psychiatrists are medical practitioners, and we treat mental illnesses, which are medical illnesses,” she said.

Neilson said MAiD has always been available for those who have been suffering from a mental illness, as long as they fit the eligibility criteria; however, the reasonably foreseeable death criteria was a difficult hurdle to navigate. That has changed since reasonable foreseeability has been removed.

There are safeguards in place and Neilson believes these safeguards are critical in protecting people. The safeguards include a 90-day reflection period, a person has to be informed of all their available means to alleviate suffering, and the person has to have seriously considered those means.

“(It) is really a deliberately arduous lengthy process that's intended to ensure that the eligibility criteria are met, and that other means to alleviate suffering have been appropriately considered by the patient and by the practitioner,” she said.

When it comes to the issue of vulnerability of people who have mental illness and their capacity to make decisions, Neilson said that is a misconception, and the vast majority of people are capable of making health decisions on their own.

There is a small population who at times lacks the capacity to make capable medical decisions, but psychiatrists are experts in doing those types of assessments.

Neilson said we don’t make people who have cancer or other chronic illnesses wait until a new treatment is available or they go into spontaneous remission.

“We give them the information, the evidence that we have and we, together with them, allow them to come to their own decisions about what further they wish to tolerate, in terms of the treatments that they want to try,” she said.

Dr. Brendan Leier, an adjunct professor at the John Dossetor Health Ethics Centre at the University of Alberta, said the issue has become more difficult because it ignores the philosophical question of, is there such a thing as irrational suicide.

“When you overlook the philosophical question at the start, then a lot of gaps sort of come in … instead of addressing the philosophical question, the government said, ‘Well, we're going to medicalize this issue. We're going to make physicians responsible for executing the process and we're going to make a bunch of medical criteria, or we're going to make a lot of pseudo-medical criteria to qualify people,’” he said.

Leier said some of the amendments that have passed have eliminated some of the stresses people had when accessing MAiD. But he does have concerns about people choosing MAiD because they don’t have access to other options.

“I don't think that anyone should ever end their life simply from despair – despair of either hope, or despair of alleviation from pain. Despair is never a great situation that anyone should act from. That's my concern and that's my consideration that any decision from despair should be avoided, and we should facilitate avoiding,” he said.


About the Author: Jessica Nelson

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