Canadian Senate Amends Assisted Dying Bill, Expands Access to Those With Mental Illness

A screen displays a patient's vital signs during open heart surgery at the University of Maryland Medical Center in Baltimore on Nov. 28, 2016. Some experts fear that legislation intended to make it easier for intolerably suffering Canadians to receive medical assistance to end their lives might actually make it harder in some cases and will create confusion among doctors who provide the procedure. Patrick Semansky/The Canadian Press/AP

The Senate voted to give the Canadian government 18 months to expand access to medical assistance in dying (MAiD) to people suffering solely from mental illnesses.

On Tuesday, senators voted 57-21 to amend Bill C-7, which prohibits MAiD for people whose sole medical condition is a mental illness. The amendment would allow people suffering from mental illness to access medical assistance to end their lives..

The amendment sets a “sunset” time limit, which will repeal the mental illness exclusion clause 18 months after receiving Royal Assent for Bill C-7. Proponents said the intention was to give the federal government, along with provinces, territories, and medical associations, time to come up with appropriate guidelines and safeguards.

Sen. Denise Batters, who voted against the amendment, said one of the basic criteria to access assisted suicide is that “one’s condition or illness must be irremediable,” but the introduction of a sunset clause would mean that the mental illness exclusion would automatically be removed when the specified time period draws to an end.

“The term sunset clause is just a euphemism for the sunsetting of vulnerable people’s lives. This will mean that after a short period of time … mental illness will be grounds for being put to death,” Batters said.

The sunset clause on the mental illness exclusion was proposed by Sen. Stan Kutcher, who sits on the Independent Senators Group. Kutcher said the exclusion is a violation of the right to equal treatment under the law and is therefore unconstitutional.

He also argued that the exclusion is “stigmatizing and discriminating” for people with mental illnesses, because it suggests that they don’t have the mental capacity to decide when their suffering has become intolerable.

Justice Minister David Lametti said that the exclusion is necessary because there is no consensus among psychiatrists on whether people suffering solely from mental illnesses should ever be allowed access to assisted dying. Lametti said that a wish to die is often a symptom of a mental illness.

“Some have suggested the unpredictability of mental disorders is no different than that of physical disorders. This is simply untrue,” said Dr. Sonu Gaind, chief of psychiatry and medical director of Humber River Hospital.

“It is a false equivalence to equate the unpredictability of illnesses like cancer, neurodegenerative diseases, or disorders with known underlying biology, with mental illnesses that we lack fundamental understanding of,” Gaind said.

Until the exclusion is lifted, senators also agreed to another amendment to clarify that it will not apply to people suffering from neurocognitive disorders such as Alzheimer’s disease, dementia, Parkinson’s disease, and Huntington’s disease.

Advance Requests for MAiD

Senators voted on an amendment on Wednesday to allow individuals who are afraid of losing their mental capacity to make advance requests for medical assistance to end their lives.

The amendment to Bill C-7 was approved by a vote of 47-28, with eight abstentions.

Sen. Pamela Wallin, who proposed the amendment, describes the current law as “a perverse diagnosis lottery.” Someone who is diagnosed with incurable cancer can fortunately receive MAiD, but “if the lottery deals you the Alzheimer’s card, then you may not be allowed to make an advance request because the diagnosis alone may be considered disqualifying.”

Wallin, who has a family history of dementia, said she wants to “seek the peace of mind that an advance request and consent to it will provide.”

“I am certainly not alone in this belief. The majority of Canadians have come to the same conclusion.”

Proposal to Form Review Committee Rejected

On Monday, senators rejected another amendment aimed at creating a parliamentary committee to review access to MAiD for those with neurodegenerative diseases.

Conservative Sen. Pierre-Hugues Boisvenu, who proposed the amendment, wanted the committee, which was to report back within one year, to look at the issue of advanced directives for such people.

Conservative Senate leader Don Plett proposed on Wednesday an amendment to make it a crime for medical practitioners to discuss assisted dying with a patient unless the patient raised the subject first.

Plett said that his amendment would help alleviate the concerns raised by disability communities about feeling pressured to receive an assisted death.

His amendment was defeated by a vote of 66-18, with one abstention.

With files from The Canadian Press