QUEBEC – La Presse is promoting euthanasia for Quebecers suffering from mental disorders in view of the expansion of Bill C-7.
As of March 2023, Bill C-7 will allow Quebecers suffering from mental disorders to resort to "medical assistance in dying" to offer them this "health care" service according to the Government of Canada's website. In anticipation of this, "Doctors across the country are preparing for the possibility that the eligibility criteria for MAiD will be expanded to include people with mental illness," reports Nathalie Collard for La Presse, on December 11, 2022.
In her French article titled "Is Quebec ready to extend medical assistance in dying (MAiD) to people with mental health problems?", Mrs. Collard informs that this question "will arise in three months, when the temporary exclusion provided for in the federal law expires." Meanwhile, "a committee is looking at the issue in Ottawa," says Nathalie Collard.
She continues, "How do we know if the desire to die is specific to the disease or to the patient's will? And how do we determine the irreversible nature of a condition? There are many grey areas in mental health, it is true. But doctors assure us that there are also grey areas in cases of physical suffering and that the MAid is not excluded for that reason, so why make it an exclusion criterion in cases of mental health disorders? Their question is legitimate".
Is their question truly legitimate? Dr. Paul Saba, a family physician in Montreal and author of the book Made To Live , maintains a contrary view. He wrote a brief in French on the subject and its name says it all: "People with mental illness or cognitive disorders should not be euthanized".
In this brief, Dr. Saba writes, "My medical code of ethics limits me to act in order to protect and improve the health of my patients individually and collectively, to do no harm to my patients, to prescribe only what is medically necessary, and to act with the best medical practices using scientific principles. MAiD for patients with mental health or cognitive decline is contrary to these ethical principles. These are set out in the code of ethics of the Collège des médecins du Québec."
On the other hand, according to La Presse, the majority of Quebec physicians and psychiatrists would support the expansion of Bill C-7:
"The Collège des médecins du Québec and the Association des médecins psychiatres du Québec are both in favour of broadening the criteria. Advocacy organizations for people with mental health problems are also in favour. They are advocating for recognition of their suffering and an end to their infantilization".
However, Dr. Saba states that "The World Medical Association (WMA), which represents more than ten million physicians in 112 countries, strongly encourages physicians to refuse to participate in an act of euthanasia and physician-assisted suicide, even where national law permits."
In addition, "The American Psychiatric Association issued a statement of their position in 2016: 'A psychiatrist should not prescribe or administer any intervention to a non-sick person for the purpose of causing death,'" writes Dr. Saba.
Natalia Manole, a civil litigation attorney who also contributed to Dr. Saba's brief maintains a similar view: "From a legal perspective, Mrs. Manole considers that the request for medical assistance in dying in people with mental illnesses does not meet the requirement of free and informed consent. The more mentally ill or cognitively impaired a person is, the less apt they are to give free and informed consent.
"It is well known that Elon Musk, the founder of Tesla and Space X, has Asperger's syndrome. If the law is expanded, people like him could be euthanized," adds Dr. Saba.
Furthermore, it seems strategic to change this law after three years of pandemic, telework and numerous confinements that have increased the rate of depression for many Canadians.
"The recent COVID pandemic has increased depression among Canadians as [indicated] by the Canadian Mental Health Association's (CMHA) December 2020 COVID-19 Mental Health Impact Survey...," writes Dr. Saba.
"... our health and social system is deficient for people with mental disorders; it does not provide all the necessary treatment options to ensure that consent is truly informed. The mentally ill population is also likely to commit suicide and will seek euthanasia assistance," writes Dr. Saba.
According to Dr. Saba, "it is not in the best interest of Quebecers to expand the criteria for killing our fellow citizens and all those suffering from mental health problems and cognitive decline," because "there is always a reason to live, but as caregivers we must find that reason so that the person wants to live. No one really wants to commit suicide, people just want to end the suffering. We have to help them relieve their suffering".
Furthermore, Dr. Saba emphasized that "In Quebec, we have a responsibility to improve our health care system for people with mental health problems, including rapid access to psychiatrists, psychologists and social workers.
According to a La Presse report published by Louise Leduc, 3,663 people received "medical assistance in dying" between 2021 and 2022.
"This is an increase of 51% (or 1236 more people) compared to the previous year and a sign of a practice that is becoming more and more common. More so, in fact, than in countries where it has been in place for much longer," writes Leduc.