Parliamentary committee examines medical assistance in dying and mental disorders

OTTAWA — A psychiatrist told Parliament’s Special Joint Committee on Physician-Assisted Dying that people with mental disorders can suffer for decades and their distress is just as valid as that of someone with physical pain .

People suffering “only” from mental disorders should be able to take advantage of medical assistance in dying next March.

Psychiatrist Justine Dembo, who assesses candidates for medical assistance in dying, also warned the all-party committee on Friday against perpetuating the stigma attached to mental illness.

Advocates for people with mental illnesses warn that it is more difficult to predict outcomes and treatments for these illnesses, and that a desire to die is often a symptom. But an expert panel said earlier this year that the eligibility criteria and safeguards already in federal law on medical assistance in dying would be adequate.

Both arguments were made on Friday by a handful of witnesses who appeared before MPs and senators on the Select Committee on Physician-Assisted Dying, which is deliberating on policies to recommend to lawmakers before the March 2023 deadline.

Ellen Cohen, coordinator of the National Mental Health Inclusion Network, told committee members that Canada needs laws to help patients, not hurt them.

“I don’t think safeguards were really recommended,” she said.

Ms. Cohen resigned last December from the federal government’s Expert Panel on Physician-Assisted Dying and Mental Illness. She felt that there were no places to determine how vulnerable people could be protected.

In its report published last May, this group of experts concluded that the current eligibility criteria and existing safeguards would be adequate “as long as they are interpreted appropriately to take into consideration the specificity of mental disorders”.

Assess on a case-by-case basis

Ms Dembo, who was also a member of the expert panel, said adhering to these guidelines for people with mental disorders “would ensure an extremely comprehensive, thorough and careful approach”. She reminded the Special Joint Committee on Friday that people with mental disorders can suffer for decades.

“To argue that someone with mental illness should just not qualify, with this big sweeping statement, where people don’t even have the chance to be assessed as unique individuals in their circumstances, is is very stigmatizing for me,” she said.

Although the parliamentary committee’s interim report, released in June, does not make its own recommendations, it concludes by urging “the federal government to work with provinces, territories and other stakeholders to ensure that the committee’s recommendations experts are implemented in a timely manner”.

The joint committee’s final report is due October 17. It should also make recommendations on other aspects of physician-assisted dying, including access for mature minors, advance requests, the state of palliative care, and protection for people with disabilities.

Ms Cohen called the March 2023 deadline for implementing law reform unrealistic. But psychiatrist Dembo disagrees: She argued to MPs and senators that assessors are already gaining experience by following existing guidelines.

“It will depend on the commitment and the effectiveness of the various provincial and local organizations in the implementation of the guidelines based on the report of the special group, she pleaded. I hope they will get there.”

The Reluctant Conservatives

This work of the special joint committee was provided for in the federal law on medical assistance in dying, which required that a parliamentary review be launched five years after the law came into force in 2016. The committee had begun its work in 2021, but was dissolved when the federal election was called last fall.

Conservative MPs on the committee presented a dissenting interim report in June, saying it would be “problematic” to simply endorse the panel’s 19 recommendations.

Tory MPs argued that there were “far too many unanswered questions” on the subject, and nothing is preventing the joint committee from reviewing whether medical assistance in dying should be offered to this category of people.

“Legislation of this nature must be guided by science, not ideology,” the Conservatives wrote in May, warning that it would be “totally unacceptable” to facilitate “the deaths of Canadians who could recover.”


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