Is Quebec ready to extend medical aid in dying (MAID) to people suffering from mental health disorders?
The question will arise in three months, when the temporary exclusion provided for by federal law will expire. A committee is currently looking into the matter in Ottawa. Without prejudging his findings, physicians across the country are preparing for the possibility that the eligibility criteria for MAID will be expanded to include people with mental disorders.
The Quebec government has not yet spoken, but it seems obvious that a two-tier system would create an untenable situation, both for the medical profession and for patients who would have to turn to the courts to assert their rights.
The delicate discussion about MAID and mental health has already begun in Quebec. A year ago, in a report recommending making advance requests for MAID available to people suffering from an incurable disease, the Special Commission on the Evolution of Act respecting end-of-life care chose not to include people with mental health conditions. In the absence of consensus, she did not want to decide.
Since then, the ball has been in the court of the Minister of Health. We think it’s time to pick up the discussion where our elected officials left off last year.
The College of Physicians of Quebec and the Association of Psychiatric Physicians of Quebec are both in favor of broadening the criteria. Organizations defending the rights of people with mental health disorders too. They campaign for recognition of their suffering and for people to stop infantilizing them.
Other patients, however, claim that the danger of a wrong diagnosis, which is more difficult to pose in terms of mental health, can lead to slippages. Those working on suicide prevention are concerned about the message that such a change would send to society.
Because of the pandemic, all these valuable points of view have not had the impact they should have had. Quebecers had other worries.
Hence the importance of continuing this debate in the public arena.
We have to explain what we are talking about when we talk about MAID for people with mental health problems.
We are talking about serious cases that are long-lasting, over several years or decades. Cases resistant to treatments and therapies whose suffering is no longer bearable and which would be evaluated by a committee of experts. It is not a question of someone who would be in a suicidal crisis or in temporary depression.
How can we know if the desire to die is specific to the disease or to the will of the patient? And how to determine the irreversible character of a state? There are many gray areas in mental health, it’s true. But doctors assure us that there are also gray areas in cases of physical suffering and we do not exclude MAID for all that, so why make it an exclusion criterion in cases of mental health disorders? Their question is legitimate.
It is of course impossible to have this discussion without taking into account the state of our health care system.
One wonders how one will justify resources for end-of-life mental health care when they are so scarce for those who wish to get better.
Same question concerning the shortage of residential resources: in Canada, there is a crying lack of these resources which can make all the difference for people who suffer from serious mental health problems. They offer a better quality of life to those who too often find themselves on the street, in absolutely appalling conditions.
The importance of investing in mental health care and services cannot be repeated enough.
But we cannot ignore the people who suffer psychologically and who ask us to treat them on an equal footing with those who suffer physically. We must recognize their autonomy and avoid considering them with paternalism when it comes to medical assistance in dying.
The new Minister for Health and Seniors, Sonia Bélanger, has just inherited this sensitive file. We submit a suggestion to him: the holding without delay of a national forum which would continue the discussion initiated by the Special Commission. We could hear doctors, ethicists and other experts as well as patients who would come and talk to us about their reality. This forum should be accompanied by a broad province-wide consultation to take the pulse of the population.
We must treat this question with great empathy. Yes, you have to be in tune with Quebec society. But not at the expense of the basic rights of people who suffer.