Hundreds of public submissions may not be considered in an upcoming report on whether Canada is ready to allow medical assistance in dying (MAID) for those whose sole condition is mental illness.
The Special Joint Committee on Medical Assistance in Dying has received hundreds of written submissions. But due to the committee requiring that they be translated into both French and English, some may not be included as evidence to inform the final report, which is to be submitted January 31.
The legislation to allow medical assistance in dying for mental illness alone comes into effect March 17.
At the committee’s November 28 meeting, Michael Cooper, Conservative member of Parliament for St. Albert-Edmonton, asked the clerk to confirm how many briefs had been received and how many could be used in the committee’s study.
“My understanding, for the record, is that there have been more than 900 submissions and none of those will be able to be used as part of the evidence because they will not be able to be translated in time,” said Cooper. “I think it underscores a simple point, that we’re not ready.”
‘New frontier’
The committee, which includes both MPs and Senators, first met October 31. It has heard from 21 witnesses, including doctors and academics.
A previous version of this committee released a report in February 2023. That report made several recommendations about topics related to MAID, including MAID for mature minors and the use of advanced directives.
It recommended that a joint committee of MPs and Senators be created five months before MAID for mental illness becomes legal to “verify” how prepared Canada is for allowing MAID for mental illness.
The call for briefs gave a deadline of November 16, dictated they had to be fewer than 1,000 words and gave no language requirement. The committee passed “a routine motion” saying all briefs must be translated into English and French before committee members could receive them, the committee clerk told Canadian Affairs in an email.
But the clerk could not say which briefs would be considered in the report.
“The contents of the draft report are to be decided upon by the committee in the course of its in-camera deliberations, which cannot be made public,” the clerk responded.
It is understandable that there would be a lot of public input into a “high-profile” committee like this, said Jonathan Malloy, a political science professor at Carleton University who studies Parliamentary committees.
Traditionally, briefs were limited to written documents that accompany a witness’s testimony. He is not aware of committees formalizing how they will use information besides witness testimony. Deciding what to do with material besides witness testimony and briefs is a “new frontier” for committees, he said.
Only six briefs were on the committee’s website as of Thursday morning. All are from witnesses who testified in person. Four say Canada is ready to allow MAID for mental illness; two say Canada is not.
Those who say Canada is ready point to the model practice standard Health Canada published earlier this year to help physicians determine a person’s eligibility for MAID. Physicians across Canada are being trained on these guidelines and modules created by the Canadian Association of MAID Assessors and Providers.
Those who say Canada is not ready point to the difficulty of determining if mental illnesses are “irremediable” — an eligibility requirement for MAID. They say the law’s safeguards are not strong enough to keep people from accessing MAID because of poverty or inadequate mental-health supports.
The law requires that a person seeking MAID whose natural death is not “reasonably foreseeable” be informed of treatments and supports to relieve their suffering. The applicant doesn’t have to use them.
‘Inconceivable development’
Some organizations posted their submissions on their own websites.
ARCH Disability Law Centre, a legal clinic that works with disabled people, wrote to the previous committee in 2022, saying many of its clients had opted for MAID because they could not afford necessary supports to live.
“This has not changed,” ARCH’s November submission says. Some of ARCH’s clients are on long wait lists for mental-health supports or cannot access them at all, it says.
“ARCH is deeply concerned that expanding MAID to cases where mental disorder is the sole condition will lead to even more cases of people with disabilities, including mental health and psychosocial disabilities, contemplating, applying for and receiving MAID due to socio-economic suffering,” the brief says.
Cardus, a non-partisan think tank, also posted its brief online. It recommends “an indefinite pause” on MAID for mental illness. The brief says doctors interpret eligibility criteria for MAID differently, and there is a lack of oversight to determine if criteria are followed. The brief also mentions the lack of available mental-health supports.
Dying with Dignity Canada, which advocates for MAID access in Canada, also submitted a brief. It will not publish its brief online until the committee has reviewed all submissions, Dying with Dignity Canada said in an email.
The Quebec citizens’ organization Vivre Dans La Dignité, did not provide its submission. In a blog post, it said all briefs not being translated in time was an “inconceivable development.”
Vivre Dans La Dignité asked the committee about the status of its brief. It shared the clerk’s response, in French, with Canadian Affairs. Translated, it says, “because of the very large volume of communications received, no decision has been made about the distribution of these briefs or communications.”
Dr. Scott Kim, a psychiatrist and senior investigator in bioethics at the National Institutes of Health and member of the Council of Canadian Academies panel that released a report about MAID in 2018, expressed concerns that thousands of people may be approved for MAID for mental illness.
Canadian Affairs obtained a copy of Kim’s brief, the contents of which were previously published in an opinion piece for the Globe and Mail.
Kim studies MAID for mental illness in the Netherlands, where it has been allowed for decades.
The Netherlands had 115 cases of MAID for mental illness in 2022 — between five and 10 per cent of all requests, his brief says. This means there were between 1,150 and 2,300 requests for MAID for mental illness. Canada’s population is about double the Netherlands. If Canadians request MAID for mental illness at the same rate as the Dutch, that would mean Canada could have between 2,500 and 5,000 requests a year, his brief says.
Kim estimates the approval rate in Canada could be considerably higher because of a lack of mental health supports in Canada and Canada’s less-restrictive MAID laws.
Dutch law has stricter eligibility criteria for MAID. Dutch law says a person is only eligible if a doctor believes their suffering is “lasting and unbearable” and there is “no other reasonable solution” to the suffering. Canadian law says a person is eligible if their suffering “is intolerable to them and that cannot be relieved under conditions that they consider acceptable.”
Some doctors have told the committee few people will qualify for MAID for mental illness.
Dr. Stefanie Green, a family doctor and co-founder of the Canadian Association of MAID Assessors and Providers, told the committee that the approval numbers would be “very small,” perhaps even fewer than 20, she said.
There were 13,241 MAID deaths in Canada in 2022, accounting for four per cent of all deaths in the country, Canadian Affairs recently reported. There have been 44,958 MAID deaths in Canada since it became legal in 2016.
