WATCH: Seeking doctors to euthanize the mentally ill

Not just for those already dying

Euthanasia has been legal in Canada since 2016, for people whose death was “reasonably foreseeable.” In 2021, the requirement for death to be reasonably foreseeable was removed and anyone suffering from a “grievous and irremediable” physical medical condition, who is defined as being in an advanced and irreversible state of decline and is suffering intolerably, became eligible for what is known as MAID, Medical Assistance in Dying.

Mental illness is just like physical illness, isn’t it?

It was also in 2021 that the Canadian government appointed an Expert Panel to examine expanding MAID to the so-called mentally ill. This may have been viewed by some as an inevitable development once euthanasia had been legalized—after all, in the words of Dr. Donna Stewart of University Health Network, a Toronto-based medical research organization, “There’s a stigma against mental illness. It’s easier to see and understand the suffering of somebody with a physical illness, but I think we need to accept that people with mental illness suffer just as much as people with physical illness do.”

The Canadian authorities have accepted this position, writing, “The Government of Canada recognizes that mental illness can cause the same level of suffering as that of physical illness.” It fully intended to expand MAID criteria to include the mentally ill by March of this year and would have done so—if enough doctors had been on board. But Canadian physicians haven’t signed up in sufficient numbers for the program to go forward, and so it has been put on halt for another three years, as discussed in the video below.

Aside from this glitch, MAID has been remarkably successful, depending on how one defines success. MAID is now the sixth leading cause of death in Canada, representing 3.3% of deaths in 2021. According to surveys, as many as half of Canadians want to see it expanded to people with “disabilities.” In fact, surveys have also shown that 41% of young Canadians want MAID to be made available to anyone suffering from “poverty.”

Support for hesitant doctors 

Despite the delays in signing up doctors for participating in euthanasia of the mentally ill, the government isn’t backing down even in the face of what may be a physicians’ revolt. After allotting three years for its panel of experts to draft “recommendations on protocols, guidance, and safeguards to requests for MAID by persons who have a mental illness,” it is now allotting another three years, to the same end: to “provide practitioners with more time to participate in training and become familiar with available supports, guidelines, and standards.”

In other words: Doctors who don’t want to be part of MAID for the mentally ill will be taught how it’s done. If it’s still difficult for them, the government will “support” them. The message is that this is going to happen, one way or another.

No light at the end of the tunnel?

Since the inevitability of death is no longer required to qualify for assisted suicide, one hurdle toward implementing euthanasia for those with emotional issues has already been surmounted. Now it’s enough to show evidence of suffering and decline with no hope in sight for improvement. For those who have already been told by their psychiatrists that their depression, or bipolar disorder, or schizophrenia, is “treatment-resistant,” where drugs do not help (which is anywhere between 20 and 60 percent of those with psychiatric disorders, according to studies), the idea of a way out via MAID may be appealing. Or it may be terrifying.

Many of the testimonies received by the Canadian Parliament were written by physicians and others who had been through periods of emotional turmoil (usually classified by psychiatrists as mental illness) and came out the other side. One testimony from a Mr. Krausert stressed that he “likely would have chosen MAID in his ‘darkest days’ of depression and anxiety and now has a rich life with successful medication and therapy.”

Therapy, shown to be superior to medication in many cases in a recent meta-study, is not readily available to many Canadians, who often wait over a year to reach the top of the list. Meanwhile, many take medication; at any given time, around 40 percent of Canadians with depressive disorders are on anti-depressants, with many more taking other psychiatric drugs. Many of these drugs have “black-box” warnings due to their known and relatively common side-effects of homicidal and suicidal ideation—that is, people who wouldn’t have thought about ending it all before starting medication suddenly wish for death after a few days or weeks on “anti-depressants.”

A Dr. Black also gave testimony to the Parliament, noting that even “in suicide, it’s very rare to have a combination of fatalistic motivation, which is a controlled response to a perceived stress, an agreed-upon lack of remedy, and a rational calculation of the likelihood of change...” In other words, even the most severely “mentally ill” do not fulfill the criteria for MAID as they stand. 

So what’s the government going to do? They will doctor the guidelines.

Believe me, it’s hopeless

People going through emotional turmoil are already in a vulnerable state, and Canadian doctors opposed to killing them are concerned that they would be especially vulnerable to “well-meaning hints” that MAID might put them out of their misery. Even those with the benefit of being in therapy are still vulnerable to such suggestions, as many therapists wittingly or unwittingly encourage their clients to rely on “professionals” to assess their mental state and future prospects.

This is all aside from concerns that politicians working on budgetary issues will be all too aware that MAID will have the ability (as it may already have for physical ailments) to save Health Canada money that government leaders may think are vital for other projects. Treatment, and especially therapy, is expensive; a lethal injection doesn’t cost much.

Currently, around 60 percent of applications for MAID are approved. This suggests that doctors have assessed that in all these cases, “decline” is “irreversible,” that is, nothing in medicine can do anything for them anymore. Doctors learning how to apply MAID are encouraged and actually taught to be definitive about the future prospects of their patients, with one topic covered in the MAID course for physicians being, “Navigating Complex Cases with Confidence.”

Indeed, in his testimony to Parliament, Dr. Gupta stated that, “There are illnesses that we will never be able to cure. We are 100% sure of that.” But mental illness is virtually never cured, according to psychiatrists. So-called mental disorders can only be “managed.” And Health Canada is now drawing up new guidelines for what “management” means.