Trudeau government delays expansion of medically assisted death for mental disorders

The committee recommended medically assisted death should only be expanded when “it can be safely and adequately provided,” and urged the government to allow another parliamentary review of the system’s preparedness a year before such a fundamental change is enacted.

Holland’s decision puts the brakes on key policy that was slated to be legislated before March 17.

Holland said there will “never be a total consensus” on the need to expand MAID to those suffering from mental disorders.

But he said the Liberal government has not veered off its belief that people with a mental illness who have suffered “in an absolute state of mental torture and hell” should have the right to access medical assistance in dying.

However, the question now is “one of readiness,” he said.

He cited the committee report, opposition of provinces including Alberta, Saskatchewan, Manitoba and Quebec, and evidence that shows that health practitioners have not taken up the training necessary to ensure adequate safeguards are in place.

“More time is required,” Holland told reporters. He said the government will table legislation “in the coming days” to make clear what kind of timeline the government is now looking at.

The joint Commons-Senate committee report said while it did not conduct a full review, it heard enough evidence of ongoing concerns to warrant delaying the initiative.

It cited “conflicting evidence” from 21 witnesses, including legal and medical experts, practitioners, representatives of professional associations, mental health organizations and regulators, as well as representatives of Health Canada and the Department of Justice, about whether the medical system had developed standards, training, practices and strong enough oversight to protect the most vulnerable from harm if MAID was expanded.

It said under the current criminal code criteria, eligibility for MAID requires a person must have a “grievous and irremediable medical condition,” which is defined as “a serious and incurable illness, disease or disability” that has led to an “advanced state of irreversible decline” and intolerable suffering.

“The committee heard that it is difficult, if not impossible, to accurately predict the long-term prognosis of a person with a mental disorder,” the report says.

The committee heard differing evidence on how professionals would distinguish between suicidality and “a reasoned wish to die” by persons trying to access MAID.

The committee noted differing legal opinions on whether providing — or denying — an assisted medical death to Canadians suffering from a mental disorder violates Charter rights to life, liberty and security of the person.

It noted differing views on the availability of trained medical professionals to assess a person’s eligibility for MAID, remarking that although medical training courses have been developed, only “a little over 100 psychiatrists out of 5000 in Canada (approximately two per cent) have signed up” for the training. Some witnesses said while that seems small, only two per cent of Canadian physicians provide MAID services.

It all added up to a big red light for the Liberals.

“What we’ve said all along is that it’s essential that this be done right,” said Holland.

The Star reported last weekend that the number of Canadians ending their lives through medically assisted death under the current law has grown at a speed that outpaces every other nation in the world, just as Canada was poised to expand its eligibility criteria.

Data from all 11 countries where the controversial end-of-life treatment exists shows Canada is the fastest-growing adopter in history, an analysis by the Investigative Journalism Bureau and the Toronto Star found.

Assisted deaths accounted for four per cent of all deaths in Canada in 2022 — up from one per cent in 2017, the first full year the legislation was in place. The number of MAID deaths quadrupled during that time. In 2022, the total number hit 13,000 nationwide — a 31 per cent jump from the previous year.

But Holland appeared to suggest those numbers did not affect the government’s decision.

When asked, he said it is “important to remember” that 96 per cent of those cases are people suffering from a terminal diagnosis like cancer and availing of medical assistance to decide when to end their own suffering, “making that choice about the few days, scant days, that are left to them and so that’s what’s happening in our system.”

“You know, these are tough conversations: that we’re all going to die. How we die is something that terrifies each and every one of us, but we need to have mature, non-partisan conversations about that,” said Holland.

Holland said those who suffer from mental illness should “eventually have” the same right as those with terminal physical illnesses have to access MAID, “but the system needs to be ready, and we need to get it right. And it’s clear from the conversations we have that the system is at this time not ready and therefore needs more time,” said Holland.

Justice Minister Arif Virani said the government has been trying to balance the autonomy of individuals and the protection of vulnerable individuals. He claimed the promised legislation “spurred the health-care system and the health professions to come up with a response” to how to strike that balance, but he said while the medical system has developed the training, professionals have not taken it up in the numbers necessary.

“Those health-care system actors are not ready.”