UVic researcher warns MAID vote ignores health-care gaps

Since the landmark Carter V. Canada decision in 2015, Medical Assistance In Dying (MAID) for those experiencing mental illness and suicidal tendencies has been a hot-button topic on Parliament Hill – resulting in a number of reports, studies and debates among politicians, psychologists, physicians and academics. On June 17, the Special Joint Committee of Medical Assistance in Dying tabled their last report, recommending that the federal government exclude people whose sole underlying condition is a mental disorder. The twice-delayed, study heard from 44 witnesses including

researchers, people with lived experience, and international experts. “I think it is a reflection of a lot of uncertainty around the issue, and I think it is also a reflection of the fact that there has really not been any noticeable improvement in health-care systems over the past three or four years. I think that the reasons that they were delaying it before were to give the health-care system more time to prepare, and I don’t think the witnesses provided evidence that there has been

meaningful improvement in a way that would prepare the health-care system to do this in a way that is equitable and safe,” said Jay Tang. Tang is a sociology PhD student at UVic who has spent four years studying MAID in the context of literature and community perspectives, with a focus on those with disabilities, mental illness and members of the LGBTQ+ community. They spent time interviewing members of the LGBTQ+ community with mood disorders, hearing their thoughts and perspectives around MAID for those with

mental illness. “I’m currently doing my second round of interviews where we are chatting more about crisis services in the context of mental health crisis and suicide prevention, and how folks feel that introducing maid for mental illness into that landscape of services will change both how those services are delivered and how people will feel about accessing them,” said Tang, who also has lived experience with mental illness and suicidal tendencies. A main topic of conversation during the committee’s study is the current state

of mental health support services and health care, especially for those who are already in vulnerable situations financially, geographically, socially or culturally. “I think that, in my mind, it’s absurd to be having a discussion about introducing death as a medically necessary service that is funded by the government when so many fundamental aspects of mental health care, including therapy and prescriptions, people are paying for out of pocket generally,” said Tang. “I think that introduces a vast inequity about the resources that people have

available to them and the ways that we can assess irremediably or incurability in the sense of mental illness.” On top of Canada’s struggling health-care system being unable to completely meet the needs of those with mental illnesses, Tang also points at the external social factors that influences or exacerbates people’s mental health like poverty, food insecurity, or discrimination – for which there has been little remedy. Committee witness Dr. Sandip Singh Gandham said requests for death don’t arise in a vacuum, but they may

emerge in the “context of trauma, poverty, isolation, inadequate housing, long ways for treatment, and lack of access to care and supports. … In such cases, the suffering may be real, but its drivers may be remediable through social response rather than death as a medical intervention.” “We know that there is a lot of discrimination in health care. We know health care was built on a foundation of racism and colonialism. And I think it’s very strange that we seem to entirely put that

away when we are talking about MAID. We are assuming that doctors are perfectly following regulations they are perfectly assessing criteria they are doing everything in good faith, when we know that is not the case in essentially any other aspect of health care,” said Tang. Tang also pointed at legislative gaps and the lack of consensus as to what makes someone’s mental illness irremediable or incurable. “Currently, under the Criminal Code, the term is ‘grievous and irremediable medical condition,’ which includes a couple of

different things, but the irremediable part of it is that the suffering caused by the illness cannot be relieved under any means that the patient finds acceptable, which is a difficult criteria to handle,” said Tang. A number of Dutch experts testified at the committee. In the Netherlands, assisted dying on the grounds of mental health suffering is legal, and patients need to go through a certain number of treatments before a doctor can consider them as irremediable, Tang says. However, under Canadian law, the

legislation is loose and doesn’t have the same safeguards if Parliament were to move forward with MAID for mental illness. “Some of the witnesses said that they had observed a decrease in the availability of other psychiatric care since euthanasia in their case for mental disorders was introduced. They’ve seen a normalization of it as a, quote unquote, treatment option,” said Tang. “And there’s also been a drastic increase in both requests and provisions of euthanasia for people under 30 for psychiatric illnesses specifically. So

I don’t necessarily know that that could be pointed to as a success story.” Justice Minister Sean Fraser is expected to respond to the committee’s decision by a July 11 deadline. Additionally a number of charter challenges are making their way through the courts, which could affect the government’s final decision.

MAID, Medical Assistance in Dying, Jay Tang, UVic, Special Joint Committee on MAID, mental illness, Criminal Code, Sean Fraser, charter challenges