CCBI News: Euthanasia and Mental Health; Dr Rory Fisher Remembered

January 16, 2024

Dear Friends of CCBI,

Euthanasia and Mental Health

All quiet at the minute on the parliamentary front…

The legislation permitting euthanasia for people suffering from mental illness is due to be implemented in March, 2024. Numerous people have made further submissions and petitions to halt implementation are still being circulated. Word has not yet come from the Justice Department about if and how the measure is to be rolled out.

Some are still unaware that the legislation allowing euthanasia procedures (MAID) in these circumstances was approved in 2021, but that only implementation has been delayed. People are still signing petitions that are unlikely to move government to revoke the law or that part of it, especially since the time allotted for further written submissions has passed. At the same time, enough dissatisfaction has been expressed from different sources that there is a possibility that the measure could be stalled for yet another year. It seems likely that, with an election in the offing, the government is watching voter behaviour carefully and cannot afford to be too arbitrary in forging ahead with its intent of providing euthanasia for people suffering solely from a mental illness. Even if there is another delay, the law itself will not change.

When a proposal was made in early 2023 for delaying implementation of the measure from March 2023 to March 2024, the Justice department was clear about the reasons:

This proposed one-year extension would provide additional time to prepare for the safe and consistent assessment and provision of MAID where the person’s sole underlying medical condition is a mental illness and allow time to consider the Special Joint Committee on MAID’s final report, expected in February 2023.

In the meantime, the Government of Canada will continue to work closely with provinces, territories, and the healthcare community to finalize and disseminate key resources. The main purpose of this proposed extension is to allow more time to ensure MAID assessors and providers are ready to assess requests for MAID for persons suffering solely from a mental illness in a safe and consistent manner across Canada by the time the proposed extension is over.

It should be clear to everyone that the government was not thinking of revoking any part of its legislation but was granting the extension to help MAID providers to develop clarity over the terms and conditions under which MAID would be allowed for people with mental illness. Given the continuing expressions of dissent and disagreement from various sectors of the Canadian population, including from many Roman Catholic sources such as CCBI, it is possible that these safeguards are still not satisfactory even to some members of the medical profession who agree with euthanasia but are unhappy with how applications are assessed and allowed in certain cases of mental illness. This could potentially delay matters, but, again, the overall thrust of current government policy is also clear in the same statement on behalf of the Justice and Health Departments in March, 2023:

The Government of Canada is also supporting the development of an accredited Canadian MAID curriculum to support clinician education and training. The curriculum will consist of seven modules, including a module on MAID and Mental Disorders. The launch of the modules will begin in the fall 2023, with the aim for all modules to be available by the end of 2023.

It is unclear if these modules have been prepared and provided to MAID assessors and providers, but they well may have been in preparation for March 17, 2024 while not yet available to the general public. If they are not satisfactory to providers, however, the final ‘go ahead’ may be delayed once again. To be determined!

While many groups and individuals have contacted government to express their hope that MAID in general and MAID concerning provision for those with mental illness should be revoked, it is rather disheartening to realize that CAMH, a leading Canadian mental health provider, noted in February 2023 when implementation was delayed:

CAMH welcomes the federal government’s legislation to delay MAiD for those whose sole medical condition is mental illness until March 2024. We have remained steadfast in our concern about the significant lack of consensus on this issue. Before eligibility for MAiD is extended to people whose sole medical condition is mental illness there must be thoughtful and inclusive discussions to develop consensus definitions of irremediableness and separation of MAiD from suicidality, and to develop additional safeguards and practice standards. People with mental illness and their families must be part of these discussions. We also need all governments to urgently invest meaningfully in equitable mental health care and supports for all. CAMH looks forward to continuing to engage in these critically important conversations. (Emphasis added)

CAMH is, therefore, not against euthanasia in principle, but only insofar as it does not find the proposed safeguards adequate. It is not contesting MAID, but only the manner in which the safeguards and other policies are being constructed. It does call for greater support for ‘equitable mental health,’ which, along with palliative care, has been grossly underfunded over decades.

It is a sad commentary on our society that we do not focus enough on the root causes of mental illness, often coupled with neglect of social structures such as housing and healthcare, not to mention the stigma and silence that persists around those who suffer from it. Our challenge in fostering a ‘culture of life’ as opposed to providing death will be to help prevent more people from thinking of MAID as ‘a way out,’ but instead accompanying them and helping them see they ‘belong.’ Of necessity, more and better palliative and end-of-life care are goals towards which we must keep striving, along with the provision of social needs such as housing.

Dr Rory Fisher and Palliative and End-of-Life Care

CCBI was saddened to hear about the death of one of our most cherished advisors, Dr Rory Fisher MB, FRCP(Ed)(C), O.Ont., recipient of the Queen Elizabeth II Diamond Jubilee Medal. Rory’s medical and ethical advice to CCBI was given clearly and with great concern for those in palliative care and for the frail elderly. He gave many lectures for us at CCBI (some videos on our website, ccbi-utoronto.ca) and we benefited greatly from his knowledge and wisdom as well as from his passion for the wellbeing of his patients. During the pandemic when we were writing about the trials, sufferings and hardships of those in some long-term care facilities, he wrote some articles for NEWS, indicating approaches to long-term care in other countries that Canada could adopt. He was always hopeful that those in healthcare could improve and learn from mistakes rather than wasting energy in berating systems – why not try to forge a path forwards? At the time of writing these articles he was far from well himself, but wanted to contribute, as he clearly had done all his life.

He leaves a strong legacy in all aspects of palliative care and especially in his advocacy for ‘the frail elderly.’ How different the world would be if there were more physicians like Rory!

We will miss him.

Requiescat in pace!

Delay of eligibility for medical assistance in dying for persons suffering solely from mental illness proposed by Ministers of Justice and Health – Canada.ca
CAMH statement on government’s proposed delay to MAiD for people with mental illness | CAMH

Pope Francis’ Intentions for January

For the Gift of Diversity in the Church
We pray that the Holy Spirit may help us to recognize the gift of different charisms within the Christian community and to discover the richness of different traditions and rituals in the Catholic Church.

Moira and Bambi