A Liberal member of parliament spoke out against his own government’s plans to expand medical assistance in dying (MAID) to those with mental illness, after supporting a Conservative bill that opposed the expansion.
“There’s certainly not enough safeguards at the moment,” Dr. Marcus Powlowski, a Liberal MP for Thunder Bay-Rainy River, Ont., said Wednesday of expanding MAID to patients with mental illness as their only medical condition. That expansion is set to begin March 17.
Ed Fast, MP for Abbotsford, B.C., introduced the private members’ bill in February. It was narrowly defeated at second reading by a vote of 150-167. The Conservatives, New Democratic Party and Greens supported the bill, along with eight Liberals. Sixteen MPs — including 12 Liberals — abstained.
“There is absolutely no national consensus to expand MAID to those suffering from mental disorders,” Fast said in a statement on Thursday. “A large majority of Canadians oppose moving ahead with such an expansion without the appropriate mental health and social supports having been addressed.”
Fast said he was disappointed in those who opposed the bill, saying they “failed to defend Canada’s most vulnerable against the creeping scope of MAID.” He called the Liberal MPs who supported it “courageous.”
Humane societies help the suffering
When Canada legalized MAID in 2016, the law specified it was only for people with “grievous and irremediable” diseases, illnesses and disabilities whose deaths were “reasonably foreseeable.” Mental illness didn’t qualify. In 2021, the government removed the end-of-life criteria and originally said MAID for mental illness would be available March 17, 2023.
Last December, the government announced it would delay the introduction of MAID for mental illness by another year, to March 17, 2024, to allow the healthcare system more time to prepare.
If Fast’s bill had passed second reading, it would have gone to a committee for further study. Now it won’t.
But on Wednesday, the House of Commons agreed to form a new committee of MPs and senators to study allowing MAID for mental illness. The committee’s new report is due January 31.
Liberal MP Powlowski says he voted to support the private members’ bill despite MAID being introduced by his own party because he’s concerned people will die by MAID when proper treatment could have helped them.
In medicine, “sometimes you have to give things time,” says Powlowski, who has been a doctor for 37 years and holds a master’s degree in public health from Harvard University.
The law dictates that people who request MAID but aren’t dying must be told about treatments and social and disability supports that could relieve their suffering. The patient is not required to use the supports.
“How you can even say someone’s irremediable if they haven’t tried all sorts of treatment… is a little hard to comprehend,” Powlowski says.
A humane society helps people who are suffering. It doesn’t say death is an appropriate solution, he added. “The acceptance of death as a legitimate way of dealing with your difficulties is something that I don’t think is healthy.”
‘Giving rights back’
MAID’s expansion has been divisive in the medical community, with many psychiatrists opposed to the expansion. Doctors who support the change say mental illness should be treated the same as physical illness.
“Psychiatric illness is the result of a problem with the human brain, and the brain is part of the body. In my way of thinking, it’s just another type of medical problem,” said Dr. Derryck Smith, professor emeritus in psychiatry at the University of British Columbia. Smith calls himself an advocate for allowing MAID for mental illness and argues it should have been included when MAID was first legalized.
In 2019, a Quebec court ruled it was unconstitutional to restrict MAID to people whose natural deaths are “reasonably foreseeable.” But the judge stopped short of ruling MAID should be allowed for patients with mental illness. The government did not appeal the decision.
In 2021, as the government was changing the law to allow MAID when death isn’t foreseeable, the Senate introduced an amendment to allow MAID for mental illness, which then passed in the House of Commons.
“We’re not expanding MAID,” Smith says. “We’re just giving these rights back to people who should have had their Charter rights all along.”
Powlowski says he’s concerned people with mental illnesses will be approved for MAID without their psychiatrists being consulted. “That’s bad medicine.”
The law calls for two doctors to agree that a person is eligible for MAID. It does not specify that one of those doctors has to be the patient’s treating doctor.
Smith says doctors who assess people for MAID are “thoughtful” people and he has no concerns they will improperly approve MAID. But given the public concerns, it would be “reasonable for people requesting MAID for psychiatric illness to have a mandatory review by a psychiatrist,” he said.
Others say Canada needs to proceed with caution.
“There needs to be a lot of public scrutiny about this process,” says Dr. Sonu Gaind, former president of the Canadian Psychiatric Association, who stepped down from the MAID team at Humber River Hospital because of concerns that it is expanding too quickly. He’s currently chief of the psychiatry department at Sunnybrook Hospital in Toronto.
Gaind doesn’t object to MAID itself, but says that “what we’re doing with expansion goes so far beyond what either I or most Canadians envision.”
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