Thank you.
Good afternoon, honourable members of this special joint committee. I am Sean Krausert, the executive director of the Canadian Association for Suicide Prevention. Thank you for the opportunity to provide comments as you undertake this statutory review of provisions of the Criminal Code relating to medical assistance in dying and their application.
My organization acknowledges that Canadians who are deemed capable of making such decisions ought to be able to access MAID to exert control over a death process that is already happening. At the same time, efforts to prevent suicide, including healthy messaging across society, mean that we must work towards a future in which no Canadian uses death as a remedy for a difficult and painful life, especially when the challenges being faced by the individual are remediable.
I have several concerns with respect to MAID for those who are not at the end of life and who are suffering solely from a mental disorder. Three of them are policy considerations, and one is very personal.
First is a life worth living. It is imperative that, as a society, we invest in finding ways to alleviate suffering and support people in connecting to a life worth living. Expansion of MAID to include those not at the end of life carries the inherent assumption that some lives are not worth living and cannot be made so.
Second is mental health care. Finding hope and reasons to live are quintessential aspects of clinical care in mental disorders. Having MAID as a treatment option is in fundamental conflict with this approach and is likely to have a negative impact on the effectiveness of some therapeutic interventions, which may lead both patient and provider to prematurely abandon care.
Third is psychiatric policy. Ending the life of someone with complex mental health problems is simpler and likely much less expensive than offering outstanding ongoing care. This creates a perverse incentive for the health system to encourage the use of MAID at the expense of providing adequate resources to patients, and that outcome is unacceptable.
Fourth is my personal story. I likely wouldn't be here today had the option of MAID been available to me in my darkest days. I experienced multiple deep depressions and extreme anxiety through my twenties and thirties. During my worst depression in my late thirties, the pain was unbearable. While I experienced suicidal ideation, I later realized that I actually didn't want to die but rather to end the pain. That ambivalence is common with those considering killing themselves.
While I once saw myself as a burden to my family, I now see that I am a benefit—and not only to them but to my community. I am now relatively depression- and anxiety-free thanks to medication and therapy that finally worked, as well as to finding out that I had severe sleep apnea that had been undiagnosed for decades. Now I have a rich life. I was recently elected as the mayor of my town, and my first grandchild will be born in a few weeks. To think that if, in my darkest and most painful time, I had been given the option of MAID, I might have given up on a future that was better than I could have asked for or even imagined.
CASP believes that we need to consider the broader context of suicide prevention and life promotion for all Canadians.
To this end, we recommend, first, that MAID should not be provided to patients suffering from a condition that does not have reasonable foreseeability of death, unless there is clear scientific evidence that the condition is irremediable. Irremediability must always be objective and never subjective. There is no evidence that concludes that mental illness falls into this category.
Second, increased funding should be available for health care to ensure that treatments are available to patients so that lack of access to treatment does not cause the condition to be deemed irremediable. A patient's refusal to receive treatment should also not equate to irremediability.
Third, extreme caution needs to be taken with MAID and a thought-out, fail-proof, measured system of safeguards needs to be in place so that those most vulnerable will be protected so that MAID does not become doctor-assisted suicide.
Fourth, tools should be made available to health care providers—especially MAID decision-makers—on how to move forward with providing support to the patient in order to avoid premature death.
In short, CASP strongly encourages removal of mental disorder as a condition eligible for medical assistance in dying. To do so will safeguard against the premature death of persons who are suffering from mental illness alone and thereby avoid inadvertently legitimizing suicide as an acceptable option for ending a difficult and painful life.
Thank you for your time.