Issues around medically assisted death were examined by working groups created by the independent Council of Canadian Academies and represent some of Canada’s most august intellectuals. (Photo by THE CANADIAN PRESS)

Experts struggle with ethics of assisted death for people with mental disorders

OTTAWA — Experts the federal government charged with looking at whether people suffering only from mental disorders should be eligible for medically assisted death couldn’t even agree on what evidence is relevant to the question, according to reports tabled in Parliament Wednesday.

There was more consensus on two other issues: whether mature minors should be eligible for assisted dying and whether those facing eventual loss of mental capacity should be able to make advance requests for assisted deaths.

The three issues were examined by working groups created by the independent Council of Canadian Academies, representing some of Canada’s most august intellectuals. The government specifically instructed the council to make no recommendations on any of the three issues, so the reports released Wednesday just summarize the “state of knowledge” on the issues and canvass the pros and cons of extending the right to an assisted death to each group.

The government has already indicated it has little intention of expanding the law, which went into effect two-and-a-half years ago.

The reports come just over a month after a Halifax woman with incurable breast cancer, Audrey Parker, opted to end her life earlier than she wanted because she feared she’d eventually lose the mental competence required to seek an assisted death. Parker pleaded with the government to allow people like her to make advance requests for medical assistance in dying.

At that time, Justice Minister Jody Wilson-Raybould said she was satisfied with the law as it is.

“We’re not considering changing something in the legislation,” she said. ”We’re confident in the legislation that we brought forward, that it finds the right balance in terms of being able to access medical assistance in dying, protecting the autonomy of individuals to make the appropriate decisions for themselves as well as protecting vulnerable individuals.”

The law allows medically assisted dying only for incurably ill adults who are suffering intolerably and are already close to natural deaths. It excludes minors and those suffering strictly from mental disorders and does not allow advance requests.

The law is facing constitutional challenges, based on the fact that it is far more restrictive than the assisted-dying regime sketched out by the Supreme Court of Canada when it struck down Canada’s prohibition on physician-assisted suicide.

For Wednesday’s report on mental disorders, members of the working group — psychiatrists, a nursing professor and medical and legal ethicists, among others — could not agree on some of the most fundamental questions.

For instance, some believed permitting mentally ill people to access assisted dying “may reduce mental-health stigma by demonstrating that people with mental disorders have capacity, that their suffering is serious, that mental disorders are not due to character flaws or circumstances within their control and that their right to self-determination should be respected.”

Other members, however, believed that it could “increase mental health stigma because it might bolster the belief that the lives of people with mental disorders are intolerable, not worth living.”

The report says the issue is particularly challenging because a desire to die can be a symptom of a person’s mental disorder, clinicians disagree on which disorders can be considered incurable, and most of those suffering are not near death.

The report on “mature minors” notes that there is already plenty of jurisprudence establishing that someone under the age of 18 can have the mental capacity and maturity to make end-of-life decisions, such as refusing treatment. It says prohibiting mature minors from receiving an assisted death will eventually be challenged in court and suggests the government needs to balance the need to protect youths from exploitation and coercion while ”respecting their rights by avoiding unfair and unethical restrictions.”

The report on advance requests says they could “provide comfort and relieve anxiety” for those facing the end of life with diminished competence. However, removing the requirement for express consent immediately prior to receiving an assisted death also raises the possibility that a person’s life could be ended against their wishes.

It suggests some safeguards could be developed, such as putting time limits on advance requests and requiring the appointment of a substitute decision-maker.

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Alberta children whose only symptom of COVID-19 is a runny nose or a sore throat will no longer require mandatory isolation, starting Monday.
477 new COVID-19 cases confirmed in Alberta on Thursday

Changes being made to the COVID-19 symptom list for school-age children

Chasetin Morin
Photo from RCMP
Three men accused of assaulting Blackfalds RCMP officer going to trial

RCMP officer shot and wounded one of alleged attackers in December 2019

The Cenovus Energy Inc. logo seen at the company's headquarters in Calgary, Alta., Wednesday, Nov. 15, 2017.THE CANADIAN PRESS/Jeff McIntosh
One-time costs of Husky takeover expected to be about $500 million, says Cenovus CEO

One-time costs of Husky takeover expected to be about $500 million, says Cenovus CEO

This drum circle was one of a multitude of activities held at The Hub on Ross in downtown Red Deer. The facility was permanently closed by the provincial government his week. (Advocate file photo.)
Many Red Deerians react with anger, dismay at closure of The Hub on Ross

Many disabled people can’t afford other recerational options, says guardian

Award-winning Calgary developer Brad Remington stands with Red Deer Mayor Tara Veer at the site of three multi-family condo complexes that are planned for Capstone, west of Carnival Cinemas. (Photo by LANA MICHELIn/Advocate staff).
$36M condo project on its way to Capstone development

Calgary developer plans to create 180 housing units to open in 2022

Alice Kolisnyk, deputy director of the Red Deer Food Bank, says the agency expects an increase in demand as the COVID-19 pandemic continues. Every new subscription to the Red Deer Advocate includes a $50 donation to the food bank. (Photo by BYRON HACKETT/Advocate Staff)
Support the food bank with a subscription to the Red Deer Advocate

The community’s most vulnerable members are always in need of a hand,… Continue reading

Workers at Olymel's Red Deer pork processing plant are among those eligible for a $2-an-hour bonus because of the pandemic.
Red Deer Advocate file photo
Two Olymel workers test positive for COVID-19 in Red Deer

Two workers at Olymel’s pork processing facility in Red Deer have tested… Continue reading

Matthew Vincent Raymond arrives at Court of Queen's Bench for the opening of his murder trial in Fredericton on Tuesday, Sept. 15, 2020. THE CANADIAN PRESS/Andrew Vaughan
Shooter says he feels ‘horrible’ over Fredericton shootings that left four dead

Shooter says he feels ‘horrible’ over Fredericton shootings that left four dead

Truck driver Jaskirat Singh Sidhu walks into the Kerry Vickar Centre for his sentencing in Melfort, Sask., Friday, March 22, 2019. nbsp;A lawyer representing the truck driver responsible for the deadly Humboldt Broncos bus collision says he wants to stay in Canada once released from prison. nbsp; THE CANADIAN PRESS/Kayle Neis
Truck driver responsible for Humboldt Broncos crash seeks to stay in Canada

Truck driver responsible for Humboldt Broncos crash seeks to stay in Canada

Highway traffic moves into Calgary on Wednesday, Feb. 8, 2017. A panel is recommending Alberta fundamentally restructure its automobile insurance by abandoning costly court fights and moving to a collaborative no-fault model. THE CANADIAN PRESS/Jeff McIntosh
Alberta panel recommends no-fault auto insurance to address rising, costly premiums

Alberta panel recommends no-fault auto insurance to address rising, costly premiums

This 2020 electron microscope image made available by the National Institute of Allergy and Infectious Diseases shows a Novel Coronavirus SARS-CoV-2 particle isolated from a patient, in a laboratory in Fort Detrick, Md. Health officials north of Toronto say 46 cases of COVID-19 have now been linked to a large wedding.THE CANADIAN PRESS AP-NIAID/NIH via AP
46 cases of COVID-19 linked to wedding events in Vaughan, Ont., health officials say

46 cases of COVID-19 linked to wedding events in Vaughan, Ont., health officials say

A man walks to the lineup for COVID-19 Assessments at Toronto Western Hospital in Toronto on Tuesday October 27, 2020. THE CANADIAN PRESS/Frank Gunn
Alarm bells ring over COVID-19 and long-term care; Ontario sees slowing virus growth

Alarm bells ring over COVID-19 and long-term care; Ontario sees slowing virus growth

French policemen stand next to Notre Dame church after a knife attack, in Nice, France, Thursday, Oct. 29, 2020. French anti-terrorism prosecutors are investigating a knife attack at a church in the Mediterranean city of Nice that killed two people and injured several others. (AP Photo/Alexis Gilli)
Tunisian carrying Qur’an fatally stabs 3 in French church

Tunisian carrying Qur’an fatally stabs 3 in French church

Most Read