Dr. Madeline Li, a psychiatrist at Princess Margaret Cancer Care in Toronto, says the MAID expansion will allow doctor training to be built around the best-practice standards still being developed.Christopher Katsarov/The Globe and Mail
The federal government will ask Parliament to delay the coming expansion of assisted dying for mental disorders after many leading psychiatrists and mental-health advocates argued that proper safeguards are not yet in place and the health care system is not ready for the controversial change.
“At the end of the day we want to be prudent, we want to move in a step-by-step way, so we don’t make mistakes,” Justice Minister David Lametti announced in a press conference Thursday. He said provinces, territories and health care professionals had made clear that more time was needed.
“We know we need to get this right in order to protect those who are vulnerable,” he said.
The new law, which is currently slated to come into effect March 17 of next year, would make Canada one of only a few countries in the world that allow assisted dying for mental illness.
Delaying the expansion will require new legislation to pass though Parliament, which has now adjourned until the end of January. The government will have less than two months to amend the law, although Mr. Lametti said discussions were already under way.
It was not clear how much extra time the government would ask for, but Mr. Lametti stressed that it was only a delay, and the government still considered expanding MAID a priority. “We plan to take this next step,” he said. “We are committed to ensuring that our laws protect everyone while supporting the autonomy and freedom of choice that are central to Canada’s MAID regime.”
When medical assistance in dying became legal in 2016, after a Supreme Court decision, only patients with a terminal illness were eligible. In late 2019, a Quebec judge ruled that this legal restriction was unconstitutional, and Parliament amended the MAID legislation to include adults who didn’t have a reasonably foreseeable death.
The change took effect immediately for Canadians with physical illnesses, but was paused for cases based solely on mental disorders to give more time to study the issue. That two-year study period would have officially ended next March.
The decision to expand MAID to mental disorders has been a divisive issue among psychiatrists, and the focus of polarizing testimony at the parliamentary committee studying the issue this year. In the past few months, psychiatric chairs at Canada’s medical schools and organizations such as the Ontario Psychiatric Association have called for a delay to allow more time for standards and best practices to be developed, as well as a more careful review of the existing science.
The MAID law, for instance, requires that a person must have an irremediable illness to qualify. But experts argue that it is challenging – if not impossible – for psychiatrists to reliably predict who will recover from a mental illness. Researchers have also raised concerns that suicidal patients will be hard to identify among those making a rational request for an assisted death.
Critics have raised concerns that standards of care have not been completed to guide doctors and hospitals to apply the law consistently. Federally funded physician training is not yet finished. The law would also be expanding at a time when the health care system has been crippled by the fallout from the pandemic, and is overwhelmed with rising patient needs and strapped resources.
“I’m relieved and grateful that the government will give us the time to do this right,” said Madeline Li, a psychiatrist at Princess Margaret Cancer Care in Toronto, and the scientific lead for the government-funded assisted-dying curriculum for doctors.
Dr. Li said the extension will allow doctor training to be built around the best-practice standards still being developed, and give health care organizations more time to put in a clear process for staff dealing with complex MAID requests.
“This permits a thoughtful consideration of the gaps in the present legislation and the challenges of implementation,” said Jack Haggarty, the chair of psychiatry at Northern Ontario School of Medicine University.
One issue, he said, that requires more discussion is how patients seeking MAID will get access to treatment that might help them, and how issues such as poverty and housing issues will be properly considered in decisions.
However, Mona Gupta, a psychiatrist at the University of Montreal and the chair of the federal expert panel on MAID and Mental Illness, argued that the delay was not necessary, and that the system would have been prepared in March to handle the new eligibility. She said the decision amounted to a “continued violation” of the rights of a patient population that the courts have said should have access to MAID.
“If we are going to deprive people of a right, than we have to be pretty darn clear of what it is we are going to get done in order to ensure that people can exercise their rights,” Dr. Gupta said. “Otherwise, it can always be argued that we are not in a state of perfect readiness.”
Sonu Gaind, the chief of psychiatry at Humber River Hospital, who has been an outspoken critic of the MAID expansion, said that he hopes the delay will allow for more consultation, as well as a careful consideration of the potential risks to marginalized and vulnerable patients. “This is not something where you jump off the deep end,” without clear, evidence-based guidelines, Dr. Gaind said. “It would be the height of discrimination to expose people to arbitrary deaths.”
Mr. Lametti said that, while some experts, such as Dr. Gupta, felt that doctors were ready to deal with MAID cases for mental disorders, the government’s decision “is about making sure that everybody is ready.”
As well, he said a delay will allow the government time to fully consider the recommendations that come from the parliamentary committee, which just finished hearing testimony late in November and now is slated to submit a final report in mid-February.