Thank you.
For 50 years I've been conducting research on suicide prevention and end-of-life issues and working in suicide prevention. In 1995 I held the Bora Laskin national fellowship in human rights research to study euthanasia in the Netherlands. I have published 12 books and over 180 scientific papers.
We live in a country where our laws and culture emphasize respect for autonomous choice. However, society does impose limits to protect us from making decisions that are dangerous to ourselves. We are legally obliged to wear a helmet on a motorcycle, a seat belt in a car and a hard hat at a construction site. Our government acts to protect competent people from making decisions that may endanger their health and well-being, whether they like it or not. We must protect people from making irreversible decisions to die when there is hope for recovery.
I believe suffering from a mental illness may be as intense as suffering from a physical illness. The key issue is whether it is possible to determine if suffering from a mental illness is interminable and irremediable. The expert panel report on MAID and mental illness states that there are no specific criteria for knowing that a mental illness is irremediable, and they do not provide one iota of evidence that anyone can reliably determine if an individual suffering from a mental illness will not improve.
According to research, 50% to 60% of persons with depression or anxiety will recover without any treatment. Even the most severe mental illnesses, such as schizophrenia, are unpredictable: 50% of people with schizophrenia meet objective criteria for recovery for significant periods during their lives.
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. 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.
Throughout the western world, it has been statutory and customary practice to protect suicidal persons from dying. Almost all high-risk suicidal persons I have talked with would meet the current requirements for MAID. Over 90% of people who die by suicide have a diagnosable mental disorder. They usually have had many years of mental health treatments, and they are convinced that their suffering is intolerable, inevitable and interminable. They are almost always wrong in their assessment. Even in extreme cases where a person is taken to hospital unwillingly, only 10% will attempt again, and only 1% to 3% will die. The vast majority are happy to have been saved and are usually very thankful to be alive.
For every heart-wrenching story of someone who suffered interminably from a mental illness, there are so many more people who got help and were happy to be alive. If MAID for people with mental illness becomes legal next year, a large proportion of suicidal people could be dead instead of getting the help they need.
Canada already has the most liberal access to MAID in the world. Elsewhere, all people who receive MAID are denied their request if there are other treatments available to alleviate physical and mental suffering. Both the physician and patient must agree that there is no reasonable alternative. In Canada the physician must inform patients of potential treatments, but if the patients don't feel they are acceptable, medical professionals are still obliged to end their lives.
In the Netherlands no one is forced to try the treatments, but the doctors are not allowed to end people's lives if they believe their suffering may be alleviated by other means. In the Netherlands only 5% of requests for MAID for a mental disorder are granted. After receiving an average of 10 months of psychiatric evaluations, almost all requests are refused, usually because untried treatments are available.
Even in medical cases of terminal illness, 40% of requests are refused because the doctor believes there is some untried treatment for the suffering, and hardly any of those who are refused repeat their request after trying the treatments. The expert panel's report ignored the research showing that a large proportion of people feeling utterly hopeless with a mental disorder will improve over time. It provides no evidence indicating that anyone can tell if a mental illness is incurable, irreversible and enduring, because the research indicates this is currently not knowable.
I have personally known—