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Expanding MAiD to the mentally ill takes us on a slippery slope of politicians using it as a way to cut healthcare costs

Doug FirbyA close friend of mine died a few days ago. Her painful end came three years after her husband died of complications related to COVID.

Losing him drove Sheila into a pit of despair so deep she couldn’t crawl out. While I and one of her sisters tried to lift her up with empathy and words of encouragement from afar – we both live in the West, and Sheila was in Ontario – she descended into the darkest of places. Lonely days of endless grieving were blotted out with alcohol and self-starvation.

By the time she was admitted to hospital with a ruptured gall bladder, her 80-pound frame was too fragile to survive the trauma of emergency surgery. She got her heart-breaking wish to be reunited with her life partner.

medical assistance in dying (MAiD)

Photo by Jon Tyson

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Sheila’s ordeal and her steadfast decision to slowly take her own life made me reflect on the fraught debate over when, or perhaps even whether, to expand the mandate of MAiD, or medical assistance in dying. A simpler and older term for this is euthanasia. The ethical issues in this debate are agonizing and complex, and will profoundly affect the national consensus on when it is right to help someone bring about their own end.

For those reasons, I welcome the federal government’s decision to pause for three years the planned access to MAiD for individuals whose sole underlying condition is mental illness. The expansion was to come into effect in March, but most provinces, much of the medical community, and even the Canadian Mental Health Association warned they simply were not ready to implement this radical shift in health care.

The extension, the second one so far, will allow for a committee of MPs and senators to reconvene in two years to assess the state of readiness for the extension of MAiD. And there is good reason for the pause. At the moment, there are no finalized national standards to determine whether a mentally ill person might qualify for MAiD, and no transparent review process is in place.

Some critics, including Dying with Dignity Canada and three senators, see a further delay as an issue that affects constitutional rights. Senator Pamela Wallin said it appears the government no longer subscribes to “the notion of choice and how important it is.”

But put yourself in the position of the medical experts who will be asked to decide whether someone is too mentally ill to continue living. It is clearly at odds with their bio-ethical training to “first, do no harm.”

Decisions involving people who have incurable physical diseases that are certain to bring about painful deaths, such as cancer, are relatively straightforward. It is indeed compassionate to allow those individuals to make a peaceful exit while they are of sound mind and can surround themselves with loved ones.

MAiD essentially improved on a practice that has been going on for many years. Physicians have for decades administered a powerful brew of painkillers to terminal patients in their final hours that they know will bring about their deaths. It is known as the Brompton cocktail, and it has been allowed because doctors are technically just treating the pain symptoms.

The big difference between the cocktail treatment and MAiD is that, invariably, the Brompton cocktail is employed only when death is imminent.

Decisions involving people with incurable and severe mental illness are more difficult to assess. A physician must somehow find objective evidence that the patient’s illness will produce “intolerable suffering,” and that there are no viable treatment options to relieve that suffering. As many critics of expanded MAiD point out, would such suffering be inevitable if the treatment of mental illness was better funded?

There’s another important consideration, however. As anyone who has tried to support a suicidal person knows, a person who is set on ending their own life will find a way to make it happen. Often, as with Sheila, it will be slow and painful. Canadian author Miriam Toews brilliantly described the futility of trying to save a loved one bent on her own destruction in her novel All My Puny Sorrows.

I frankly don’t know whether Sheila could have been saved with better mental health support. What I do know is that her friends had not given up on hoping she could find a reason to live right up until the moment her heart stopped. For that reason, I would never want to see someone in circumstances like hers have access to MAiD.

Of course, there is another worry about state-sanctioned euthanasia that has always made me uneasy. And it is that it can become a cost-saving convenience for governments looking to save taxpayer dollars. We introduced MAiD as an act of compassion for terminal patients but there are dark forces that will eventually realize there is a strong business case to see it expanded. Think of the thousands of dollars per patient that can be saved! It is a slippery slope.

As the country wrestles with the complex ethical issues that arise from MAiD for the mentally ill, three years will go by in a flash. It is a debate that all Canadians would do well to be engaged in.

Doug Firby is an award-winning editorial writer with over four decades of experience working for newspapers, magazines and online publications in Ontario and western Canada. Previously, he served as Editorial Page Editor at the Calgary Herald.

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