If there is one thing that the test of time has taught us, it is that advances in the field of medical assistance in dying (MAiD) have been won through social consensus. Strong social consensus.
The fruit is not ripe, far from it, for people suffering from a mental disorder who, on the basis of this one heavy criterion, would also like to have access to an anticipated end of life marked out by our laws. Let us hope, however, that the web of prejudices and misunderstandings still surrounding mental illness does not unduly hinder access to MAID and that a day will come when this expansion will be accepted.
The federal Minister of Health, Mark Holland, confirmed Monday what a parliamentary committee strongly recommended to him, namely a further postponement of the extension of MAID to people who suffer from a mental disorder, and including this condition alone would be enough for them to request MAID. The parliamentary committee, very divided on the issue, claims to have heard around twenty experts with contradictory versions. Minister Holland, whose government had already postponed this “hot potato” for the first time last year, affirms that Canada is not ready for such a step forward.
On Thursday, Ottawa announced the possible postponement of this enlargement to 2027, after the next elections. This is far too far in the timetable for such a crucial issue, and these cumulative postponements leave the dignity of suffering people in limbo.
If Quebec remains a model of compassion for end-of-life care, it is largely thanks to the social and transpartisan consensus that paved the way for MAID about ten years ago. Although since this launch, enlargements have been granted – both by the court and by governments – certain barriers remain difficult to break through. This is the case with the exception of people suffering from a mental disorder, who would also like to be able to resort to this anticipated form of ending their suffering. Experts agree that if it is one day authorized, MAID intended for people with a mental disorder will be exceptional, rare and granted to people whose pathology has lasted for years and seriously handicaps them despite the treatments.
Critics of providing MAID based solely on mental disorder raise several objections. First, they say, how can we be sure of the irremediable or irreversible nature of a mental illness? Then, they argue, will it not always be very difficult to draw a clear line between a request for medical assistance in dying for mental disorder and suicidal thoughts? Finally, they ask, does this complex and delicate field not target those among the most vulnerable people in society without us having any guarantees that they will be protected from abuse? In short, they conclude, even if we must recognize that these people are grappling with suffering as great as people suffering from a physical illness and that they deserve to experience relief from their ills, we would not be entirely just not ready to take this step.
Among the reasons also given for postponing the decision, there is the need to build clear and defined standards of practice and to offer training to health professionals. Several Canadian provinces have pleaded for more time. Quebec is in the mix: the minister responsible for end-of-life care, Sonia Bélanger, notes that everything may have gone a little too quickly on Ottawa’s side. “When we haven’t reached a place, well, it’s better to delay,” she said Tuesday.
Last year, when expanding MAID by allowing advance requests, Quebec refused to include people suffering from a mental disorder. This was to the great dismay of the College of Physicians of Quebec, which still considers this exclusion stigmatizing. “It must be recognized that the high level of suffering caused by certain mental health problems is as unrelievable as that encountered in any other health problem,” argued the College last March.
Although we must take note of the total lack of consensus on the question of mental disorders and MAID, it seems that it is only a matter of time, as if the idea still had to progress a bit in the spirits.
Let us express two hopes: first, that the objections which hold us back do not come from the web of prejudices still surrounding, unfortunately, mental illnesses. Secondly, that the fears are not insidiously linked to the obvious lack of resources in the field of mental health, as if the refusal to extend MAID to people suffering from mental disorders resulted from a hypothesis of lack of therapies and treatments. Some people who have been cloistered in their psychological suffering for years hope that this final gesture of compassion will be granted to them by society.