It’s the right call to delay MAID changes

A medically assisted death can provide choice to those suffering from debilitating physical conditions and diseases. But the move to expand medical assistance in dying (MAID) to individuals suffering solely from a mental disorder understandably provokes questions and concerns.

With that expansion set to happen next month, the federal government has taken the welcome action to delay it for a year, time the government and many Canadians hope can be spent to better address the ramifications.

Some believe it should be taken off the table entirely. To declare that, ahead of any further work, would be premature.

There has been no shortage of media coverage detailing the real and perceived shortfalls of the expansion as currently envisioned. There has been less about the other side of that coin — that denying people with mental illness access to MAID is inherently inequitable. People suffering serious mental illness deserve the same rights as those suffering other incurable conditions.

Yet the chorus of concerns have made clear that this expansion of medically assisted deaths demands further scrutiny. There’s a lot to consider.

To qualify for a medically assisted death, there are checks and balances meant to provide assurances that the individual is making an informed decision free of pressure and that they are suffering from a “grievous and irremediable medical condition.”

That means a “serious illness, disease or disability” that is an advanced state of decline that cannot be reversed and that causes “unbearable physical or mental suffering,” according to guidelines.

The condition does not have to be terminal; only that it “cannot be relieved under conditions that you consider acceptable.” That rigour is reassuring. And yet there have been reports of people seeking medically assisted deaths for suffering exacerbated by poverty and a lack of social supports. To then extend it to those whose sole condition was a mental disorder without enhanced protocols seems fraught.

The Centre for Addiction and Mental Health had praised the intent to delay, saying it remains concerned about the “significant lack of consensus on this issue.” It said there needs to be discussions to define irremediability, how to distinguish suicidal thoughts from a request for MAID and the need for additional safeguards.

The centre’s statement echo some of the issues highlighted by a parliamentary committee that examined the expansion of MAID. Does the patient have the capacity to make an informed decision?

Is the mental disorder irremediable and how much uncertainty is acceptable?

What about those situations where a MAID request stems from inadequate health care and social supports?

That latter point puts a spotlight on the accessibility of care for mental health in the community, or more accurately, just how hard it can be to get timely treatment. It would be premature to entertain thoughts of a medically assisted death for a physical ailment, without exhausting all possible avenues for treatment. Those with mental disorders must be afforded the same level of care.

Yet given the lack of resources, can we be assured that an individual with a mental-health condition has been offered all the care possible?

That also speaks to the crux of the concern to expand MAID based solely on mental illness. Unlike physical ailments such as cancer, where the outcome can be determined with greater certainty, the prognosis and evolution of a mental illness can be less sure, a parliamentary committee that examined the issue heard.

That has been offered up as one argument why the expansion should not go ahead. And yet to deny those with a mental-health disorder access to MAID would seem discriminatory, minimizing their pain and suffering compared to those individuals with a physical condition.

The Liberal government says it’s still committed to implementing MAID for those with a mental disorder. It’s clear that making the move next month was too soon. The government now has a year to ensure the proper safeguards and protocols are in place.