Feds must pause MAiD expansion

Opinion

Hey there, time traveller!
This article was published 08/12/2022 (650 days ago), so information in it may no longer be current.

While it is not, as has often been in correctly assumed, associated with the Hippocratic Oath that provides an ethical framework for physicians, the phrase “First, do no harm” still has value as a guiding principle for those who pursue careers in medicine.

It should also be embraced by those whose ambitions and skills direct them toward politics. And it most certainly should inform the deliberations of the federal government as it continues discussions regarding changes scheduled to take effect next spring related to medical assistance in dying (MAiD) legislation.

Under the current legislation, effective March 17, 2023, MAiD will be made available to individuals with a mental illness as their sole underlying condition, provided they meet eligibility requirements.

The looming change has prompted several groups — including leading psychiatrists at Canada’s medical schools and advocates for military veterans suffering mental-health injuries and illnesses — to urge the federal government to pause the scheduled MAiD expansion at least until adequate research and consultation can be carried out.

It’s advice the government would do well to heed. MAiD, a controversial practice since its inception by the Trudeau government in 2016, was originally available only to those diagnosed with a terminal illness and whose death was foreseeable. After a Quebec court ruled that restriction unconstitutional, MAiD legislation was amended to include adults whose death was not reasonably foreseeable.

Under these less restrictive guidelines, Canadians have witnessed several cases in which individuals with chronic medical conditions have chosen assisted death in response to hardships created by a lack of government and/or societal supports.

Critics have argued MAiD was never intended for such circumstances, and that the criteria for granting MAiD requests should be made more rigorous. Instead, the scheduled change to include mental-health conditions in the acceptable rationales will make Canada’s MAiD framework among the most liberal in the world.

And according to the groups demanding the government hit “pause” on the scheduled change, the expansion of MAiD must be delayed or deferred because Canada is simply not ready to deal with its inevitable consequences.

As it stands now, doctors across the country are deeply divided on the issue of assisting in the deaths of those with mental illness, in large part because there is an ongoing fear that more people will die before they even have a chance at recovery.

The association representing lead psychiatrists at medical schools asserts doctors will not have the necessary tools and training when the change is implemented. Among the unresolved issues are what constitutes a mental-health condition that is “irremediable” and therefore justifies assisted death, and how clinicians will differentiate between patients experiencing suicidal ideation and those who are rationally seeking assisted death.

“There’s much more finesse and sophistication required in the implementation,” said Dr. Valerie Taylor, psychiatric chair at the University of Calgary.

There’s also a concern that patients with mental illnesses in rural communities — where access to mental health care may be lacking — will be more likely to view MAiD as a way out.

Dr. Jitender Sareen, head of the psychiatry department at the University of Manitoba, recently told The Canadian Press that those struggling with addiction, who have little to no access to harm-reduction services such as supervised injection sites, could also look to medical assistance in dying to relieve their suffering.

“We’re in the middle of an opioid epidemic. And we’re in the middle of a mental health pandemic. Post-COVID, wait times for access to treatment are the highest ever,” he said.

“As a group of department heads in the country who are responsible for medical education both for psychiatrists and residents, we’re saying, ‘Look, let’s put things aside as far as whether we agree with this law change or not.’ We’re just concerned we’re not ready for March.”

A spokesperson for Health Minister Jean-Yves Duclos would only say the government is “aware” of the experts’ concerns and will continue to collaborate with provinces and territories leading up to the scheduled change.

For their part, veterans’ rights advocates have expressed concerns about expanding MAiD, particularly in light of reports some veterans have been offered assisted death while seeking to navigate the labyrinthian process of government support for service-related injuries and ailments.

“My fear is that we are offering a vehicle for people to end their lives when there are treatment options available, but those treatment options are more difficult to access,” said Oliver Thorne of the Veterans Transition Network.

Add to these well-founded concerns the fact the parliamentary committee tasked with studying MAiD legislation is months behind schedule and won’t submit its recommendations — originally expected in October — until mid-February, and one is confronted with what seems to be overwhelming evidence the legislated expansion of MAiD in March will be a change imposed with undue haste.

In the interest of doing no (further) harm, the government must hit pause.

» Winnipeg Free Press and The Brandon Sun