Halifax, Canada – Changes to Canada’s assisted dying regime have divided the country, with advocates hailing “a memorable day for end-of-life rights” and critics warning of increased risks to the most vulnerable citizens.
The passage of Bill C-7 this month means that medical assistance in dying (MAID), previously reserved only for people with “reasonable foreseeability of natural death”, will be more widely available in Canada.
The law extends the country’s MDA regime – also called voluntary euthanasia – to people who might not face imminent death but who have reached a state of “intolerable physical or psychological suffering” due to illness or disease. ‘an incurable handicap.
The revised law follows a decision of the Superior Court of Quebec in 2019, which declared the “reasonable foreseeability” clause unconstitutional. But advocates for the mentally ill and disabled say their concerns were brushed aside in the government’s rush to pass the legislation.
“We are shocked, dismayed – we are completely caught off guard,” John Maher, an Ontario-based psychiatrist and ethicist who specializes in the treatment of serious mental illness, told Al Jazeera.
“We now have patients who ask us to stop treatment – patients who will get better – because they no longer need to keep trying… It is incitement to suicide.”
Canadians seeking MAID must meet a number of criteria, including being 18 years of age or older, applying voluntarily, and being in an advanced state of irreversible decline causing extreme suffering. Those seeking assisted dying solely on the basis of a psychiatric disorder will not be eligible until March 2023, leaving the government two years to explore appropriate safeguards.
In the meantime, a group of experts will be responsible for suggesting guidelines and protocols.
Justice Minister David Lametti said the government consulted widely with medical professionals, legal experts and community groups before revising the law. In a statement to Al Jazeera, he noted that anyone seeking MAID must undergo two independent medical assessments. There will be enhanced safeguards for people whose natural death is not reasonably foreseeable, including a requirement that they be informed of all possible support services and care options.
“These safeguards are designed to protect against abuse and have been developed specifically to address concerns raised during consultations,” Lametti said.
But Jewelles Smith, communications coordinator for the Council of Canadians with Disabilities, said the government’s consultation process was woefully inadequate, in fact ignoring input from people with disabilities.
“We’re really, really worried. I mean more than concerned, ”Smith told Al Jazeera. “I have had many late night conversations with members of my community who are panicking.”
“ Risk of coercion ”
The inclusion of disability as a specific category in the MAID law has sowed fear among community members, as has the condition requiring a single signature from an independent witness on requests for assistance in dying, she said. declared.
“The single signature requirement, for us, definitely puts people at risk of coercion,” Smith said. Although people whose death is not imminent will have to wait 90 days for an assessment of their eligibility – during which time they can be referred to alternative resources and supports – it can often take several months longer to obtain such. resources, she said.
“It is discriminatory to offer people the possibility of dying when you do not offer the possibility of living … I have heard so much fear from people who are now afraid to go to the hospital. , they are afraid to reach out.
We now have patients who ask us to stop treatment – patients who will get better – because they no longer need to try any more … It is an incitement to suicide
United Nations human rights experts have highlighted similar concerns, noting that older people with disabilities “may feel subtly pressured to end their lives prematurely due to behavioral barriers as well as the lack of services and supports. appropriate ”.
Maher described the C-7 as “a resolutely capacitist policy disguised as compassion”. Clients with mental health issues are often impoverished, stigmatized and pushed to the margins of society, he noted: “The suffering is deep, but much of it can be addressed literally by social supports. , with care, with accommodation, with food, with a social bond.
Around 7,000 requests in 2019
According to a Health Canada report published last year, 5,631 cases of MAID were reported in 2019, up 26% from the previous year. The average age of people receiving MAID was 75, with cancer being the most frequently cited underlying medical condition.
Of the 7,336 written requests for MAID reported in 2019, just over a quarter did not move forward, either because the patient died naturally, was found ineligible or withdrew his request.
Stefanie Green, president of the Canadian Association of MAID Evaluators and Providers, called the passage of Bill C-7 “an important step in the right direction” to enable all Canadians to consider their options. end of life options.
“I don’t think that because they have a non-terminal illness that should exclude them from this opportunity,” Green told Al Jazeera.
– Die with Dignity Canada (@DWDCanada) March 17, 2021
Responding to concerns that people with disabilities or those with mental health issues may be pushed into assisted dying, Green said this had never been the case in the hundreds of consultations she has conducted. “Marginalized communities fear the lack of access to this care much more than they fear being forced into it,” she said.
Helen Long, CEO of Dying with Dignity Canada, spoke about a recent Ipsos survey showing that seven in ten Canadians agreed to remove the “reasonably foreseeable” requirement from national MAID legislation.
“This access is very important for those with chronic illnesses. This gives Canadians choice and autonomy for their own health care, “Long told Al Jazeera, noting that his organization regularly hears from people” who feel a lot relieved to know that MAID is now more accessible, people living in pain and those who want it. know that it is an option if they need it ”.
A parliamentary review of Canada’s MAID legislation is scheduled to begin in mid-April. Among other things, it will explore the eligibility of “mature minors” and how to handle advance requests from patients who do not currently meet the eligibility criteria, but fear losing the ability to apply later.
“These are two very serious debates that need to take place,” Green said.
Meanwhile, Ms Smith said members of the disability community were planning to take legal action against the “fundamentally flawed” legislation – although she acknowledged that it could take 10 years to raise a challenge under the Canadian Charter of Rights and Freedoms.
“In a decade,” she said, “this could be so ingrained in our society – the assumptions about life worth living – that it could change the very fabric of our community.