Good evening, chairs and members of the committee.
Parliament's core obligation is to protect the life and promote the well-being of Canadians. Expanding MAID to include it for reasons of mental illness is an unprecedented threat to that. It appears driven by, one, a flawed claim or perception of constitutional obligation; two, a strong prior commitment to expansive MAID by a core of people with dominant input in the policy process who overwhelmingly emphasize the need for access, not protection; and three, a lack of appreciation of how problems in jurisdictions that allow it will be even more serious here, because of weaker legal standards.
First, there is no constitutional requirement to introduce death to “solve” often severe suffering from mental illness. This is emphasized in a letter to cabinet by 31 Canadian law professors, including constitutional and human rights scholars; in several academic publications, including our forthcoming article; and in committee submissions by law scholars and the vulnerable persons standard.
These also clarify why it is not discriminatory to limit access to MAID. No court—definitely not the Supreme Court—has ruled that death induced by physicians is an inherently or predominately beneficial procedure to which all must have access as a right. It is a complex practice that the court ruled should be permitted in exceptional circumstances as a carefully crafted exemption to a crucial Criminal Code prohibition.
In fact, the opposite is true. Singling out disabled persons—and, soon, also persons with mental illness whose disease cannot be determined to be irremediable—exposes disabled persons already subject to systemic discrimination to a serious risk of death. This also threatens their right to life. It attaches the highest possible discriminatory stigma to what it means to have mental illness and to be disabled: namely, that our system offers them death rather than sufficient support, while it continues to protect others.
Second, before this committee, some medical experts insist we need to offer MAID for mental illness as a “constitutional right”, while they hesitate when asked whether we can do so safely and whether irremediability can be determined in individual cases. That, I would put forward, is a caricature of how cautious policy and law-making should work. Medical, policy and ethics experts must inform government, MPs and the courts of what MAID expansion will mean. With Canada's MAID policy, this has been turned upside down: Parroting constitutional rights rhetoric, government has given some with a prior vested commitment privileged positions to implement it.
It is striking that those who now reassure us that concerns are unwarranted claimed from day one that MAID for mental illness was unproblematic and should not be treated differently, yet they were given authority to evaluate if other safeguards were needed, and then failed to recommend them, which leaves it up to the discretion of individual professionals whether people will live or die. Authorities didn’t even reach out to the broader mental health community when a patient advocate and bioethicist resigned in protest from the expert panel on MAID and mental illness. It is further troubling, as one submission highlights, that some of the same experts have recently provided misleading information to MPs when the recent bill aimed at suspending the expansion went up for a vote in Parliament.
Third, the claim that we need only a few psychiatrists willing to do this because few patients will qualify is wrong; instead of reassuring, it is concerning.
First, in Belgium and the Netherlands, the practice remains controversial in part because a few psychiatrists have driven the practice in problematic directions. A criminal prosecution temporarily stalled expansion in Belgium, where one psychiatrist was involved in nearly half of the mental health euthanasia cases from 2007 to 2011. In those countries, physicians must agree that there are no other options left. Approval rates for psychiatric euthanasia are low—5% to 10%—mostly because of lack of irremediability, but when euthanasia for mental illness became more broadly practised, demand for it increased steeply, from 500 in 2008 to 1,100 in 2015. Demand in Canada will be higher, and no legal constraint will keep the approvals low.
When regulators state they are ready, we need to ask, “For what?” Yes, there will be flimsy regulations with rules that leave so much discretion that there will be little basis for criminal prosecution or professional discipline. Our law and professional rules will offer a largely open-ended licence to end the lives of mentally ill patients. This is an egregious form of discriminatory abandonment of mentally ill Canadians and their families.
I urge you not to hide behind a rhetoric of a constitutional right to let this expansion go forward.