Canada already has one of the most liberal assisted dying laws in the world, offering the practice to terminally and chronically ill patients.
But under a law that takes effect in March, assisted dying would also become available to people whose only medical condition is mental illness, making Canada one of about a half-dozen countries to allow the procedure for that category of people.
This move has divided Canadians, some of whom see it as a sign that the country’s public health system does not offer adequate psychiatric care, which is notoriously underfunded and in high demand.
Prime Minister Justin Trudeau’s government, which has been criticized for implementing the policy, has defended its actions by pointing to a 2019 Quebec court decision that officials say mandates the expansion.
Conservative Party members have accused the government of promoting a «culture of death». There has also been opposition from left-wing politicians who would like the government to focus its health policy on expanding mental health care.
Jason French is among those trying to explain why a doctor should help him die.
With copies of a document detailing his troubled mental health history stuffed in his backpack, he attended an event in Toronto to push for assisted dying to be available for people like him.
He suffers from severe depression and has twice attempted to take his own life, he said.
“My goal from the beginning was to get better,” said Mr. French, of Toronto, who agreed to share his name, but not his age because many in his life don’t know about his illness. “Unfortunately I am resistant to all these treatments and the truth is that I cannot continue to suffer. “I can’t continue to live my life like this.”
But Dr. John Maher, a psychiatrist in Barrie, Ontario, who specializes in treating complex cases that often take years to improve, said he worries that hopeless patients are opting for assisted dying instead.
“I’m trying to keep my patients alive,” he said. “What does it mean for the role of the doctor, as a healer, as a bringer of hope, to offer death? And what does this mean in practice?”
Canada’s current assisted dying law applies only to people who are terminally ill or living with physical disabilities or chronic, incurable conditions. The country’s Supreme Court decriminalized assisted dying in 2015 governed that forcing Canadians to endure intolerable suffering violates their fundamental rights to freedom and security.
About 13,200 Canadians had an assisted death last year, a 31 per cent increase from 2021, according to one study. relationship by the Federal Ministry of Health. Of these, 463 people, or 3.5%, were not terminally ill but had other medical conditions. Approved patients have the option to end their lives by using lethal drugs administered by a doctor or nurse or by taking prescribed medications.
There is still uncertainty and debate over whether assisted dying will become available to the mentally ill early next year, as expected. Amid concerns over how to implement it, Parliament has delayed its implementation for the past three years and may delay it again.
Clinical guidelines to address these concerns were published last March, but some people involved in providing mental health care say they are insufficient.
The proposed change to include the mentally ill has been particularly controversial among some psychiatrists, with Dr. Maher and others saying it confounds their efforts to prevent suicide.
But advocates argue that mentally denying sufferers access to the same human option to end their suffering amounts to discrimination.
“I have deep empathy for patients who are in profound pain,” said Dr. Alexandra McPherson, a professor of psychiatry at the University of Alberta and a death counselor. You said you treat a small number of patients «with severe disabling mental disorders who suffer in the same way as patients I see in cancer care.»
Lisa Marr, a former paramedic diagnosed with post-traumatic stress disorder who lives in Nova Scotia, said she was desperate to take advantage of the new law. She suffers from bipolar disorder, depression and excoriation disorder, or skin picking, due to anxiety and, by her own estimate, she has made 15 attempts on her life but «has always managed to get out of she».
“The only reason I haven’t done it yet, I think, is that I’m waiting for that decision in March,” he added.
Canada amended its criminal code to legalize assisted dying for terminally ill patients in 2016, and in 2021, in response to the Quebec court ruling, the country loosened the law to add more seriously ill people in “serious” conditions. and irremediable.»
Eligible patients must wait 90 days before receiving an assisted death and be approved based on reviews by two independent doctors. One of the assessors must be a specialist in the patient’s disease or have consulted a specialist.
A group of experts and a special parliamentary commission worked to address the concerns of the public and the medical community standards of practice AND recommend doctors and regulators.
The government also funded the development of a training program for doctors and nurses evaluating patients for assisted dying.
“The work has been done,” Dr. Mona Gupta, chair of a government-appointed think tank, psychiatrist and bioethics researcher at the University of Montreal, told a special parliamentary committee in November. «We are ready.»
Anyone in Canada who requests assisted dying must be judged by doctors or nurses who assess them as not impulsive and not suicidal, and those who are mentally ill should be assessed to demonstrate that their condition is «irremediable.»
But some psychiatrists also worry that they won’t always be able to determine whether or not someone seeking an assisted death will actually get better.
“The research we have shows that psychiatrists are no longer good at identifying who is not going to get better,” said Dr. Maher, the Ontario psychiatrist. “The challenge for us is that this is not a short-term process. “When people have been sick for years, healing takes years.”
The Center for Addiction and Mental Health, Canada’s largest teaching hospital for psychiatric care and research, said doctors need more guidance to help them assess those who are acutely suicidal or likely to do a rational choice to end one’s life.
“We have been clear that we have concerns about the expansion at this time,” said Dr. Sanjeev Sockalingam, the center’s medical director, who agreed to have several professional groups assist doctors in preparing for March.
Ms Marr, the paramedic, said the wait for the law to come into force had been exhausting. She takes eight psychiatric drugs every day. “All the medications I take are barely keeping me together,” said Ms. Marr, who is on disability leave and spends most of the day in her room, leaving the house only for therapy.
Her father had an assisted death after he was diagnosed with prostate cancer, and her mother died shortly after, all while she juggled her job as a paramedic.
“Then, my mental health started to deteriorate,” he said.
Uncertainty about whether mentally ill people would be allowed assisted dying motivated Mr. French to leave his home after work, which his depression rarely allows, to attend a screening of a documentary funded by Dying With Dignity , a charity that promotes assisted dying.
He went with several copies of a five-page document he had created explaining his case, hoping to give it to medical experts during screening.
Death doesn’t scare him.
“My biggest fear is surviving,” he said.
He said he is not suicidal. But, she added, “I don’t want to have to die terrified and alone, and have someone find me somewhere. I want to do it with a doctor. “I want to die within a few minutes, in peace.”
Both Canada and the United States have a three-digit suicide and crisis hotline: 988. If you are having suicidal thoughts, call or text 988 and visit 988.ca (Canada) or 988lifeline.org (United States) for a list of additional resources. This service offers bilingual crisis support in every country, 24 hours a day, seven days a week.
Audio produced by Sara Diamante.
