Justice Minister David Lametti responds to a question during Question Period in the House of Commons, in Ottawa, Thursday, Nov. 19, 2020. The federal bill revising the rules on medically assisted death in Canada has raised the ire of the Canadian Psychiatric Association over the proposed law’s explicit rejection of mental illness as grounds for ending a patient’s life. THE CANADIAN PRESS/Adrian Wyld

Justice Minister David Lametti responds to a question during Question Period in the House of Commons, in Ottawa, Thursday, Nov. 19, 2020. The federal bill revising the rules on medically assisted death in Canada has raised the ire of the Canadian Psychiatric Association over the proposed law’s explicit rejection of mental illness as grounds for ending a patient’s life. THE CANADIAN PRESS/Adrian Wyld

Exclusion of mental illness in assisted dying-bill slammed by psychiatrists

A few Canadians suffering solely from severe, irremediable mental disorders have received assisted deaths

The federal bill revising the rules on medically assisted death in Canada has raised the ire of the Canadian Psychiatric Association over the proposed law’s explicit rejection of mental illness as grounds for ending a patient’s life.

The federal government maintains that denying Canadians with debilitating mental illnesses the right to medically assisted death is simply a matter of continuing a prohibition that already exists in the law.

In fact, a small number of Canadians suffering solely from severe, irremediable mental disorders have received assisted deaths during the four years the procedure has been legally available.

The government is now proposing to expressly exclude such people as it amends the law to expand eligibility for everyone else.

Some psychiatrists say that stigmatizes people with mental illnesses, minimizes their suffering and reinforces the myth that they could be cured if they just tried harder.

What’s more, they believe the exclusion violates Section 15 of the Charter of Rights and Freedoms, which guarantees equal treatment under the law regardless of physical or mental disability.

Under Bill C-7, a mental illness will “not be considered an illness, disease or disability” for the purpose of the assisted-dying law.

“A provision that applies only to persons with mental illness, without appropriate justification, is discriminatory in nature because it is arbitrary. A provision that applies to all persons with mental illness, without appropriate justification, is unconstitutional because it is overbroad,” the Canadian Psychiatric Association says in a brief to the House of Commons justice committee, which is scrutinizing the bill.

“Explicitly stating that mental illness is not an illness, disease or disability … is inaccurate, stigmatizing, arbitrary and discriminatory.”

The bill is the government’s response to a 2019 Quebec court ruling that struck down a provision in the law that allowed only those whose natural deaths are reasonably foreseeable to seek medical help to end their suffering.

Justice Minister David Lametti has suggested that, until now, the foreseeable-death provision prevented people suffering solely from mental illness from receiving an assisted death. And the statement issued by his department on the charter implications of the bill explicitly asserts that “the bill would continue to prohibit” assisted deaths in such cases now that the near-death requirement is being scrapped.

That assertion incenses Vancouver psychiatrist Dr. Derryck Smith, who has personally been involved in two cases where people suffering solely from severe mental disorders received medical help to end their lives. And he says he knows of other similar cases.

The assertion “is absolutely false and misleading,” Smith said in an interview.

One of the cases Smith took part in involved a woman of about 40 years old who suffered from a “severe, intractable eating disorder” and was intending to starve herself to death if she did not receive medical help to end her life.

“She was approved for assisted dying and received assisted dying just for a psychiatric illness, in this case anorexia nervosa.”

To now deny someone like her the right to seek an assisted death is “such a flagrant violation of Section 15 of the charter, it’s unbelievable that they could continue with this,” Smith said.

“I mean, this is discriminating against a class of Canadians.”

The Justice Department’s charter statement on the bill acknowledges that the exclusion “has the potential” to violate charter rights.

But it argues that it is a reasonably justifiable limit on those rights based on “the inherent risks and complexity that the availability of MAID (medical assistance in dying) would present for individuals who suffer solely from mental illness.”

Those risks include, as Lametti told the House of Commons last month, “that the trajectory of mental illness is more difficult to predict than that of most physical illnesses, that spontaneous improvement is possible and that a desire to die and an impaired perception of one’s circumstances are symptoms, themselves, of some mental illnesses.”

Montreal psychiatrist Dr. Mona Gupta, who co-authored a soon-to-be-released report on the issue for the Association des médecins psychiatres du Québec, said the risks apply equally to people with debilitating physical conditions.

The course of some physical illnesses can be unpredictable. Physically ill people can spontaneously improve or become suicidal. Their capacity to consent can be compromised. But whereas doctors weigh those factors in assessing whether each individual with a physical condition is eligible for MAID, Gupta says Bill C-7 is telling all people with mental illnesses “you’re not even allowed to ask, you’re not even allowed to be assessed.”

If a person with bipolar disorder and renal failure is deemed to have the capacity to make end-of-life decisions, she says it “doesn’t really make a lot of sense” to say someone with only bipolar disorder does not.

She suspects myths about mental illness — “that it reflects a character failing, that somehow it’s transient or not real” — are behind the exclusion in Bill C-7.

As well, she suspects politicians are likely worried about someone who is “depressed after a bad divorce” seeking an assisted death. They have no conception of the kind of unbearable suffering “a very, very small group of people” with severe psychiatric conditions go through and who would be most likely to qualify for an assisted death.

READ MORE: Assisted-dying bill sparks ferocious debate among Canadians with disabilities

Gupta shares the story of a patient in her hospital, a man in his 60s with lifelong obsessive-compulsive disorder. Although he was initially reasonably functional, had a job and got married, his condition deteriorated in his 40s, manifesting in a “very, very severe handwashing obsession” that caused him to be depressed and suicidal.

He has been hospitalized many times and the water had to be turned off in his room “otherwise he would have literally destroyed the entire skin barrier of his hands from repeated washing.”

Gupta says the man has tried all pharmaceutical options and intensive in-patient psychotherapy, undergone electroconvulsive therapy twice and several rounds of transcranial magnetic stimulation, and been given intravenous ketamine and even “experimental deep brain stimulation which was provided entirely on compassionate grounds because there was really nothing else to offer.”

“Nothing has helped him. In the words of his treating psychiatrist, it’s been a total failure,” Gupta said.

The man, who must now live in an institutional setting, has thought about assisted dying and talked about it at length with his partner, who is supportive. He’s not asking for it now but, Gupta said, “He wants to know that it’s an option.”

But now, she said, the government is telling him, “for your own good, because you’re too vulnerable to know what you’re doing, we won’t even let you make a request.”

Joan Bryden, The Canadian Press


Like us on Facebook and follow us on Twitter.

Want to support local journalism during the pandemic? Make a donation here.

assisted dying

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Alberta’s chief medical officer of health Dr. Deena Hinshaw and Premier Jason Kenney say the province would look at adding additional COVID-19 measures in the coming weeks if the virus continues to spread. (Photo by Government of Alberta)
Walk-in COVID-19 vaccination clinic to open in Red Deer

Alberta adds 1,345 new cases of the virus

Public health restrictions on non-essential travel and vacation bookings are being increased in B.C. (B.C. government)
COVID-19: B.C. announces signage along Alberta border to discourage non-essential travel

B.C. extends COVID-19 indoor dining, group fitness ban until May 25

Damien Kurek
MP Damien Kurek reflects on newly-released federal budget

‘Further, they recycle old promises they have consistently failed to deliver on’

A vial of some of the first 500,000 of the two million AstraZeneca COVID-19 vaccine doses that Canada has secured through a deal with the Serum Institute of India in partnership with Verity Pharma at a facility in Milton, Ont., on Wednesday, March 3, 2021. THE CANADIAN PRESS/Carlos Osorio - POOL
Alberta begins rolling out AstraZeneca COVID vaccine for those aged 40 or older

There are more than 70 pharmacies offering AstraZeneca, including 26 offering walk-in appointments

In this image from NASA, NASA’s experimental Mars helicopter Ingenuity lands on the surface of Mars Monday, April 19, 2021. The little 4-pound helicopter rose from the dusty red surface into the thin Martian air Monday, achieving the first powered, controlled flight on another planet. (NASA via AP)
VIDEO: NASA’s Mars helicopter takes flight, 1st for another planet

The $85 million helicopter demo was considered high risk, yet high reward

FILE - Dan Smyers, left, and Shay Mooney from the band Dan + Shay perform on NBC's Today show in New York on June 28, 2019. The duo will perform at Sunday's Academy of Country Music Awards. (Photo by Charles Sykes/Invision/AP, File)
Luke Bryan wins top ACM Award, but female acts own the night

Luke Bryan wins top ACM Award, but female acts own the night

In this undated photo provided by John-Paul Hodnett are a row of teeth on the lower jaw of a 300-million-year-old shark species named this week following a nearly complete skeleton of the species in 2013 in New Mexico. Discoverer Hodnett says it was the short, squat teeth that first alerted him to the possibility that the specimen initially dubbed "Godzilla Shark" could be a species distinct from it's ancient cousins, which have longer, more spear-like teeth. The image was taken using angled light techniques that reveal fossil features underneath sediment. (John-Paul Hodnett via AP)
‘Godzilla’ shark discovered in New Mexico gets formal name

The ancient chompers looked less like the spear-like rows of teeth of related species

sign
Alberta Biobord Corp. recently hosted a virtual open house from Stettler

The company plans to develop a fuel pellet and medium density fibre board (MDF) plant near the community

The Rogers logo is photographed in Toronto on Monday, September 30, 2019. THE CANADIAN PRESS/Tijana Martin
Rogers investigating after wireless customers complain of widespread outage

According to Down Detector, problems are being reported in most major Canadian cities

People are shown at a COVID-19 vaccination site in Montreal, Sunday, April 18, 2021, as the COVID-19 pandemic continues in Canada and around the world. THE CANADIAN PRESS/Graham Hughes
Nothing stopping provinces from offering AstraZeneca vaccine to all adults: Hajdu

Health Canada has licensed the AstraZeneca shot for use in people over the age of 18

Deputy Prime Minister and Minister of Finance Chrystia Freeland responds to a question during Question Period in the House of Commons Tuesday December 8, 2020 in Ottawa. The stage is set for arguably the most important federal budget in recent memory, as the Liberal government prepares to unveil its plan for Canada’s post-pandemic recovery even as a third wave of COVID-19 rages across the country. THE CANADIAN PRESS/Adrian Wyld
Election reticence expected to temper political battle over federal budget

Opposition parties have laid out their own demands in the weeks leading up to the budget

Most Read