Euthanasia for the Mentally Ill Still on the Table Despite a "Pause" in Implementation in Canada
While Medical Assistance in Dying (MAID) accounted for 1% of deaths in Canada in 2017, the first full year it was authorized, that figure had quadrupled by 2022.
The health and mental health ministers of three Canadian territories and five provinces have succeeded in convincing the Canadian government to pause indefinitely the implementation of Medical Assistance in Dying (MAID) for the mentally ill. However, this pause does not signify a permanent halt to the plan.
The expansion of euthanasia for the mentally ill was initially scheduled for March 17. However, Canada's Health Minister, Mark Holland, stated that there are not enough psychiatrists ready to approve requests from mentally ill individuals seeking MAID. He acknowledged that healthcare professionals need more training and said that provincial and territorial governments "need more time."
This does not mean, however, that the expansion of MAID is likely to end here. Dr. Moira McQueen, Executive Director of the Canadian Catholic Bioethics Institute (CCBI), shared with the Catholic News Agency (CNA) that abolishing the euthanasia law is unlikely, and Canada's Liberal government under Prime Minister Justin Trudeau is simply warning that the healthcare system is simply not ready to handle cases of mentally ill individuals seeking death.
In 2016, MAID and assisted suicide were legalized in Canada. As initially drafted, the law authorized the practice for people whose death was "reasonably foreseeable" and suffering from a "grievous and irremediable medical condition". Although the law prohibited the practice for cases of mental illness, it was amended in 2021 to allow individuals suffering from "grievous and irremediable" depression and other mental health issues to access MAID once its implementation was in place.
While MAID accounted for 1% of deaths in Canada in 2017, the first year it was authorized, the numbers had quadrupled by 2022. That year, over 13,000 Canadians resorted to MAID, a 31% increase from 2021, according to an official study. The study showed that 4.1% of deaths in Canada were attributable to MAID, while the figures for the provinces of Quebec and British Columbia reached 6.6% and 5.5% respectively in 2022, surpassing the Netherlands, which had the highest national rate at 5.1%.
Many disabled individuals, who were not terminally ill but facing challenges unresolved by the Canadian healthcare system and veterans' services, were offered MAID, according to the CBC. Canada now holds the sad record for the fastest number of such deaths in world history.
"Implementation was delayed for two years to develop safeguards. These are not sufficiently adequate and implementation is now delayed until 2027," McQueen told CNA in an email. "The law should be revoked to prohibit this aspect of euthanasia. It is very unlikely that the government will revoke this amendment or MAID in general," she added.
McQueen said that provinces and territories "can regulate how and where euthanasia is administered, but cannot declare it illegal. For example, Quebec now authorizes the procedure in funeral homes."
"While provincial Health Ministers have called for an indefinite pause in the implementation of the expansion of MAID in Canada, I note that they seek to 'foster increased collaboration between the provinces, territories and the federal government'," she said.
McQueen, a lawyer with a doctorate in moral theology, is the executive director of the CCBI and author of "Bioethics Matters: A Guide for Concerned Catholics."
Professor Tim Stainton of the Canadian Institute for Inclusion and Citizenship at the University of British Columbia has previously called the Canadian law the greatest threat to disabled people since the Nazis' eugenics program in the 1930s. A disability advocate, Stainton shared his concerns with CNA that Canada could offer euthanasia to the mentally disabled as well as people with Down syndrome, and that the lobbying group Dying with Dignity Canada has sought to expand euthanasia to "mature minors" without parental consent.
"Again, a complicated question; the government would say 'no' and generally, it believes it could not legally consent, but that's not true in many cases," Stainton explained. "We know that people with developmental disabilities and autism are euthanized under Dutch law, which is generally more restrictive and better regulated than Canada's, so in my opinion, there is definitely a risk here."
Speaking of a possible increase in euthanasia deaths if MAID is expanded, Stainton wrote that it would depend on the nature of the expansion. "I have always said it's not the volume that matters, because one unjust death is one too many," he said.
Critics of MAID have pointed to alarming reports of disabled individuals requesting MAID due to poverty, squalid conditions in long-term care facilities, homelessness, and lack of proper care. According to the Canadian media The Walrus:
"It sometimes happens that even if these applicants are approved for MAID due to their physical health, it may be their lack of financial support and healthcare that pushes them towards this option."
Stainton highlighted discussions in the Canadian Parliament to expand euthanasia to minors, even though there is no indication of legislative plans. However, Dying with Dignity Canada provided testimonies to the Special Joint Parliamentary Committee on Medical Assistance in Dying (AMAD), which discussed the possibility of expanding eligibility to mature minors and individuals suffering from mental illness.
Although Canada is not specifically mentioned, in a 2021 report, United Nations human rights experts expressed concern about euthanasia being imposed on disabled people. "Disability should never be a ground or justification to end someone's life directly or indirectly," they wrote.
In a January 27 article in the Toronto Star, psychiatrist K. Sonu Gaind of Sunnybrook Hospital in Ontario commented on the rise of euthanasia in Canada, stating that he is concerned about what it "says about our society." Gaind and three other medical experts authored a paper in July 2023 in which they concluded: "Canada's MAID regime lacks the necessary safeguards, data collection, and oversight to protect Canadians from premature death."
The polling group Leger surveyed Canadian opinion in 2022 regarding Canada's permissive euthanasia law and found the country divided. Leger found that 51% of Canadians supported extending euthanasia to mature minors, compared to 23% opposed and 26% undecided. The survey found that 65% supported advance directives in the face of deteriorating cognitive condition, while 45% favored extending euthanasia to people with serious mental disorders.
McQueen told CNA that there is a spiritual component to discussions on euthanasia in Canada, where Quebec leads the country in terms of the percentage of MAID cases. She wrote that only 13% of Catholics in Quebec practice their faith regularly.
"It has more to do with the fact that we don't really care what others do – it's their business and everything revolves around 'rights,' autonomy, and choice. Framed within this individualistic mindset, it is difficult for ideas about the common good or altruism to survive. Live and let live, die and let die!" she wrote.
She added that the "culture of death" is taking hold in Canada:
"I thank God for those who continue to believe 'In God We Trust' and who trust in this God who gives us life and asks us to cherish it for all, protecting it from conception until natural death."
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Medically assisted dying is legal in Belgium, Canada, Colombia, Luxembourg, the Netherlands, New Zealand, Portugal, Spain, and parts of Australia. Passive euthanasia, or the refusal of treatment or withdrawal of life support, is legal in the United States, the United Kingdom, European countries, and much of South America.
The Catholic Church has long advocated for palliative care, which allows patients to be accompanied with care and pain management that does not hasten death. Euthanasia and assisted suicide, the Church teaches, are offenses to human dignity and are and always will be morally unacceptable.
Citing the first chapter of Genesis, which affirms the intrinsic value of life, "regardless of ability or health," Canada's Catholic bishops said in November 2023: "For these reasons, we, the members of the Canadian Conference of Catholic Bishops, unanimously and unequivocally oppose the performance of euthanasia or assisted suicide (MAID) within healthcare organizations with a Catholic identity. We oppose any efforts by governments or others to compel these facilities to perform MAID in violation of Catholic teaching."
They stated that the practice of euthanasia "would deeply betray the identity of these institutions" and the "moral teachings of the Church on the sanctity of life and the dignity of the human person."
This article was originally published by the National Catholic Register (Article Link). It is republished and translated with the author's permission.