On 2nd February 2023 the Canadian government tabled a bill to defer by one year the authorisation of euthanasia and assisted suicide for those people whose only medical problem is mental illness.
The gradual sliding of the law
In 2016 Canada legalised what its law calls Medical Assistance in Dying (MAD) which covers the practices of euthanasia and assisted suicide.
In 2021, a mere five years later, a new law extended these practices to those people suffering from a serious and incurable disease but whose life is not threatened in the short term. The criterion has become even more uncertain and extendible, as it is based upon the fact, for patients, that they themselves consider their physical or mental suffering to be unbearable. A physically handicapped person or suffering from a chronic disease is now eligible for euthanasia. The legislator additionally intended that the law should be applicable to people suffering from mental disorders from 17th March 2023, leaving time for thought about the conditions to be met in order to ensure the safety of patients.
A group of experts was therefore established, as intended by the 2021 law. In May 2022, the group submitted a report including 19 recommendations to the ministers of Justice and of health. They concerned the need to pay particular attention to the conditions for determining the incurability, the irreversibility of a pathology, the contours of a persistent and intolerable suffering, taking into account suicidal tendencies, the capacity for decision making and the consent of people confronting vulnerability, and the means for pain relief.
In that context and after the reservations expressed by psychiatric specialists an announcement was made to defer the application of MAD until 17th March 2024 for people suffering from mental disorders.
The major challenge of suicide prevention
Indeed, the Canadian Association of Psychiatric Presidents, which includes the heads of the psychiatric departments of the 17 medical faculties, signed a declaration in December 2022 calling for deferment of the application of MAD to mental disorders.
They underlined that patients need better access to treatments, including for addictology and drug addiction. In particular, patients in rural communities may not have access to mental health treatments, as well as those facing dependency. This situation is of particular concern in the post covid period which is experiencing an epidemic of psychiatric consultations and long waiting times before receiving suitable treatments.
Apart from the serious question of access to treatment, many questions remain controversial with respect to the definitions of eligible people, the evaluation of their condition, the improbable discernment between a request for suicide to be prevented by seeking a suitable treatment or to “assist” by abandoning all treatments.
Whilst the national week for suicide prevention was under way since 5th February 2023, Georgia Vrakas, an associate professor in the department of psycho-education and social work at the university of Quebec made a public testimony. “I am a clinic psychologist and university professor. My fields of expertise are mental health and suicide prevention. And I have been living with a serious mental condition for at least the last 23 years, if not longer. I only discovered in 2021 that I have a bipolar condition. Until then, my doctors had all diagnosed a major recurrent depressive condition.” She explained having wished “to die to put an end to my suffering”. She explained that during a severe crisis, she called the suicide prevention centre and her doctor, which led her to find a psychiatrist who was finally able to give the correct diagnosis and start a suitable treatment in May 2021. “Where indeed should one draw the line between suicide and medical assistance in dying for people living with a mental disorder? Irrespective of the supervision and safety measures established, it is impossible to draw a line which does not exist.” She recalled the total contradiction of the slogan “It is better to prevent than to die” which was chanted during the suicide prevention week. She concluded that the Federal Government should take heed and consider the means to be established in order to truly reduce the suffering of people living with a mental disorder. According to John Maher, a psychiatrist specialised in mental diseases and chief editor of the Journal of Ethics in Mental Health “MAD deeply undermines the decades of efforts made in suicide prevention.”
The challenge of suicide prevention is key: will Canada be able to take it into consideration in order to protect the most vulnerable Canadians? In the debate opened by the French Government on the end of life, Alliance VITA recalls that suicide prevention can suffer no exceptions. “Nobody should be excluded from suicide prevention.” recalls Tugdual Derville in his essay published in January: Doctor, do I have the right to live a little longer?