Expert says government decision to delay MAiD expansion not necessary

By The Canadian Press

The chair of a federal expert panel on medically assisted death is questioning what the Liberal government is hoping to accomplish by delaying the expansion of the assisted-dying regime.

“I don’t think it’s necessary,” Dr. Mona Gupta said in an interview.

She said the federal government has already followed through with its commitment to study the expansion, which will allow people whose sole underlying condition is a mental disorder to seek a medically assisted death.

The expert panel determined that the proper safeguards are in place for the change to happen on March 17, but the government has faced pressure from critics who disagree with the expansion.

With legislation passed in 2016, Canada legalized medical assistance in dying, also known as MAID, for people who were suffering intolerably and whose death was reasonably foreseeable.

A series of court challenges and a parliamentary review resulted in new legislation in 2021, which recognizes a Quebec Superior Court ruling that said limiting MAID eligibility to those whose death was reasonably foreseeable was unconstitutional.

The 2021 update included a sunset clause to allow the government two years to conduct an independent study before expanding of the program to include people whose sole underlying condition is a mental disorder.

The strict eligibility criteria set out in the law include a minimum 90-day evaluation period by at least two independent assessors. People must be informed about alternative means to alleviate their suffering and offered a chance to withdraw their request at any time.

Justice Minister David Lametti made the announcement late Thursday, saying the government is listening to concerns the health care system might not be prepared to handle complex cases involving mental disorders.

Gupta, who is a psychiatrist and associate professor at the Universite de Montreal, said she does not know what will be accomplished by the delay.

“I do know that there are people who are opposed to this practice,” she said.

“I do not believe that anything that could possibly happen in three months, or a year or two years, or whatever the time period is going to be, is going to change their point of view.”

It’s not clear how long the delay will be, but Lametti said the government is not backing away from the plan to expand the program.

“We do have to respect decisions of the courts,” he said Thursday. “They have said that medical assistance in dying is a right that Canadians have, and so the process will continue to move forward, but we’re going to do it in a measured and prudent way.”

The Liberals plan to introduce new legislation in the House of Commons once Parliament resumes in late January and seek the support of other parties to pass it quickly.

Gupta said it is up to the people who are raising concerns to work with the federal government to “very clearly” indicate what more they would like to see done.

“They bear some responsibility to say what it will take in order for people with mental disorders to be allowed to exercise their Charter rights,” she said.

“Even the premise that this is required, I think needs to be questioned. Why do we need to have all sorts of new things in place that we don’t have for everybody else in Canadian society who makes a MAID request?”

She said critics have failed to properly explain what they require in order to be satisfied with the expansion moving forward.

“We need to ask ourselves the question about whether this readiness argument, which is being brought forward at the 11th hour, is not merely a way to camouflage the real argument, which is certain people are opposed to this practice,” she said.

“But they don’t want to say it, because that’s already been litigated, and the governments have already accepted that.”

Jocelyn Downie, a law professor and medical ethics expert, said she was disappointed but not surprised by the decision because there has been a “massive campaign to put pressure on the government to do precisely this.”

“It’s been, I would say, very effective, not just in terms of the effectiveness of getting this result, but it’s been effective at creating a sense of public concern and expert concern about this.”

Downie added she does not think a delay is the right decision from a legal and clinical perspective.

Gary Chaimowitz, the president of the Canadian Psychiatric Association, said the safeguards currently embedded in the national standards “in our view protect all vulnerable Canadians.”

He said people with mental disorders concurrent with other medical conditions are already being assessed under the current MAID regime, and a new set of laws specific to people whose sole underlying condition is a mental disorder “would be discriminatory.”

“We feel physical and mental health are linked and cannot be arbitrarily separated in that way,” he said.

Ellen Cohen, a social worker who resigned from the federal government’s expert panel on MAID and mental illness in December 2021, said she doesn’t believe proper safeguards are in place for the expansion of MAID.

She said she was “very excited” to learn of the proposed delay, adding that more resources for mental health and addiction should be made available to communities before MAID is offered to people whose sole underlying condition is a mental disorder.

Madeline Li, a cancer psychiatrist who sits on several MAID-related panels, said she was “really pleased that the government has given us the time to make sure that we can provide MAID to people with mental disorders safely.”

She said a delay would give clinicians more time to improve how MAID will be delivered to such patients.

“This delay will allow us to properly develop those practice guidelines,” she said.

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