Canada Postpones Plan to Allow Euthanasia for Mentally Ill

Craig McCulloh

Voice of America News

Originally posted 8 Feb 24

The Canadian government is delaying access to medically assisted death for people with mental illness.

Those suffering from mental illness were supposed to be able to access Medical Assistance in Dying — also known as MAID — starting March 17. The recent announcement by the government of Canadian Prime Minister Justin Trudeau was the second delay after original legislation authorizing the practice passed in 2021.

The delay came in response to a recommendation by a majority of the members of a committee made up of senators and members of Parliament.

One of the most high-profile proponents of MAID is British Columbia-based lawyer Chris Considine. In the mid-1990s, he represented Sue Rodriguez, who was dying from amyotrophic lateral sclerosis, commonly known as ALS.

Their bid for approval of a medically assisted death was rejected at the time by the Supreme Court of Canada. But a law passed in 2016 legalized euthanasia for individuals with terminal conditions. From then until 2022, more than 45,000 people chose to die.

The info is here.

Summary:

Canada originally planned to expand its Medical Assistance in Dying (MAiD) program to include individuals with mental illnesses in March 2024.

• This plan has been postponed until 2027 due to concerns about the healthcare system's readiness and potential ethical issues.
• The original legislation passed in 2021, but concerns about safeguards and mental health support led to delays.
• This issue is complex and ethically charged, with advocates arguing for individual autonomy and opponents raising concerns about coercion and vulnerability.

I would be concerned about the following issues:

• Vulnerability: Mental illness can impair judgement, raising concerns about informed consent and potential coercion.
• Safeguards: Concerns exist about insufficient safeguards to prevent abuse or exploitation.
• Mental health access: Limited access to adequate mental health treatment could contribute to undue pressure towards MAiD.
• Social inequalities: Concerns exist about disproportionate access to MAiD based on socioeconomic background.

An autonomy-based approach to assisted suicide: a way to avoid the expressivist objection against assisted dying laws

Braun, E.

Journal of Medical Ethics 

2023;49:497-501

Abstract

In several jurisdictions, irremediable suffering from a medical condition is a legal requirement for access to assisted dying. According to the expressivist objection, allowing assisted dying for a specific group of persons, such as those with irremediable medical conditions, expresses the judgment that their lives are not worth living. While the expressivist objection has often been used to argue that assisted dying should not be legalised, I show that there is an alternative solution available to its proponents. An autonomy-based approach to assisted suicide regards the provision of assisted suicide (but not euthanasia) as justified when it is autonomously requested by a person, irrespective of whether this is in her best interests. Such an approach has been put forward by a recent judgment of the German Federal Constitutional Court, which understands assisted suicide as an expression of the person’s right to a self-determined death. It does not allow for beneficence-based restrictions regarding the person’s suffering or medical diagnosis and therefore avoids the expressivist objection. I argue that on an autonomy-based approach, assisted suicide should not be understood as a medical procedure but rather as the person’s autonomous action.

Conclusion

Assuming that the expressivist argument is valid, it only applies to (partly) beneficence-based approaches to assisted dying that require irremediable suffering. An autonomy-based approach to assisted suicide, as put forward by the German Federal Constitutional Court, avoids the expressivist objection. It understands

assisted suicide as an act justified by autonomy and does not imply objective judgments of whether the person’s life is worth living. I have argued that on an autonomy-based approach, assisted suicide should not be understood as a medical intervention but rather as an autonomous action that does not invoke

traditional medical principles such as beneficence.

A pdf is here.

Said differently: 

The article argues that an autonomy-based approach to assisted suicide can avoid the expressivist objection against assisted dying laws. The expressivist objection is the claim that assisted dying laws send the message that suicide is a good thing, which could lead to more people committing suicide. The author argues that this objection is not valid because autonomy is a fundamental value that should be respected, even if it means allowing people to die.  (Autonomy > beneficence)

What happens if you want access to voluntary assisted dying but your nursing home won’t let you?

Neera Bhatia & Charles Corke

The Conversation

Originally published 30 MAY 22

Voluntary assisted dying is now lawful in all Australian states. There is also widespread community support for it.

Yet some residential institutions, such as hospices and aged-care facilities, are obstructing access despite the law not specifying whether they have the legal right to do so.

As voluntary assisted dying is implemented across the country, institutions blocking access to it will likely become more of an issue.

So addressing this will help everyone – institutions, staff, families and, most importantly, people dying in institutions who wish to have control of their end.

The many ways to block access

While voluntary assisted dying legislation recognises the right of doctors to conscientiously object to it, the law is generally silent on the rights of institutions to do so.

• While the institution where someone lives has no legislated role in voluntary assisted dying, it can refuse access in various ways, including:

• restricting staff responding to a discussion a resident initiates about voluntary assisted dying

• refusing access to health professionals to facilitate it, and

• requiring people who wish to pursue the option to leave the facility.

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What could we do better?

1. Institutions need to be up-front about their policies

Institutions need to be completely open about their policies on voluntary assisted dying and whether they would obstruct any such request in the future. This is so patients and families can factor this into deciding on an institution in the first place.

2. Institutions need to consult their stakeholders

Institutions should consult their stakeholders about their policy with a view to creating a “safe” environment for residents and staff – for those who want access to voluntary assisted dying or who wish to support it, and for those who don’t want it and find it confronting.

3. Laws need to change

Future legislation should define the extent of an institution’s right to obstruct a resident’s right to access voluntary assisted dying.

The info is here.

Updated Physician-Aid-in-Dying Law Sparks Controversy in Canada

Richard Karel

Psychiatric News

Originally posted 27 May 21

Here is an excerpt:

Addressing the changes for people who may be weighing MAID for severe mental illness, the government stated the following:

“If you have a mental illness as your only medical condition, you are not eligible to seek medical assistance in dying. … This temporary exclusion allows the Government of Canada more time to consider how MAID can safely be provided to those whose only medical condition is mental illness.

“To support this work, the government will initiate an expert review to consider protocols, guidance, and safeguards for those with a mental illness seeking MAID and will make recommendations within a year (by March 17, 2022).

“After March 17, 2023, people with a mental illness as their sole underlying medical condition will have access to MAID if they are eligible and the practitioners fulfill the safeguards that are put in place for this group of people. …”

While many physicians and others have long been sympathetic to allowing medical professionals to help those with terminal illness die peacefully, the fear has been that medically assisted death could become a substitute for adequate—and more costly—medical care. Those concerns are growing with the expansion of MAID in Canada.

The info is here.