Parliamentary committee calls for ‘clear guidelines’ in assisted dying interim report

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Quebec contemplates giving Alzheimer’s patients advance consent for medical aid in dying
Quebec has tabled a bill to change its medical assistance in dying law. If adopted, the eligibility requirements would be expanded to include patients with certain neurocognitive diseases. As Global’s Olivia O'Malley reports, the motion has been a long time coming but opposition parties say the important issue should be debated for more than two weeks – May 25, 2022

A special joint committee of the House of Commons and Senate released an interim report on medically assisted dying today that addresses provisions around people with mental disorders.

The report does not provide recommendations, “given the need to carry out additional work on this theme,” but instead summarizes the testimony the committee heard during two May hearings.

It does call for “standards of practice, clear guidelines, adequate training for practitioners, comprehensive patient assessments and meaningful oversight” for such cases to be implemented well ahead of March 2023, when people suffering solely from mental disorders are due to become eligible for assisted dying.

The committee’s review was mandated in legislation passed in March 2021 that updated the framework around medical assistance in dying that was established in 2016.

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That bill started a two-year clock delaying access to assisted dying for people suffering solely from mental disorders and included requirements that the issue be studied on a strict timeline — though the special committee’s work has faced delays, due in part to last fall’s federal election.

The committee delayed its work so that it could incorporate the findings of the Expert Panel on MAiD and Mental Illness, which were only released in a May 13 report.

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Assisted dying laws expanded to include mental illness

The expert panel concluded that existing eligibility criteria and safeguards would be adequate “so long as those are interpreted appropriately to take into consideration the specificity of mental disorders.”

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The panel as well as the committee used the terminology “mental disorders,” rather than “mental illness,” stating in their reports that there is no standard definition for the latter and its use could cause confusion.

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Witnesses noted that some other terms used in the Code — “irremediable,” “incurable” and “intolerable suffering” — do not have scientific or medical definitions, either.

Their testimony covered a range of views on controversial questions around the balance between respecting a person’s autonomy and protecting the vulnerable; making sure patients are capable of making a fully-informed decision; what “irremediality” means with respect to mental disorders; and distinguishing between a request for MAiD and suicidality.

Mental health advocates have warned that it is harder to predict the outcomes and treatments of mental illnesses, and a wish to die is often a symptom.

“If it were possible to distinguish the very few people with a mental illness who are destined to suffer interminably from those whose suffering is treatable, it would be inhumane to deny MAiD,” the report quotes Brian Mishara, a Université du Québec à Montréal professor, as saying.

“But any attempt at identifying who should have access to MAiD will make large numbers of mistakes, and people who would have experienced improvements in their symptoms and no longer wish to die will die by MAiD.”

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Still, several other witnesses emphasized that it should be up to the individual to make their own decision as to what constitutes unbearable suffering, as long as systems and funding are in place to ensure that a patient has robust support and access to treatment.

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“Most of the suffering that people talk about is not pain but lack of ability to have a normal life. That’s true of people with mental illness as well as those with physical illness,” Ellen Wiebe, a family doctor, told the committee.

While the report makes no recommendations of its own, it concludes by urging that the government take steps to implement the recommendations of the expert panel “in a timely matter.”

That last paragraph is the subject of a dissenting interim report from the Conservative MPs on the committee, who argue that it is “problematic” to simply endorse the expert panel’s recommendations.

The MPs argue that there are “far too many unanswered questions” on the subject, and that nothing precludes the committee from revisiting whether assisted dying should be offered to this category of people at all.

“Legislation of this nature needs to be guided by science, and not ideology,” the Conservatives write, warning that an outcome that could “facilitate the deaths of Canadians who could have gotten better” would be completely unacceptable.

A final report from the committee, complete with recommendations that also address other areas including access for mature minors, advance requests, the state of palliative care in Canada and the protection of people with disabilities, is not expected until an Oct. 17 deadline.

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