Reaction to the delay and debate around expanding MAiD

As Ottawa seeks to delay the expansion of medically-assisted dying to people suffering from mental illness, patient advocates are disappointed.

“There have been a number of Canadians, we don’t know how many, who have been patiently waiting for that sunset clause to expire on March 17 and they’re going to be very disappointed they have to wait for a longer period of time,” said retired Senator James Cowan, who is also a board member of Dying With Dignity Canada.

Medical Assistance in Dying—or MAiD—is set to open up to patients whose sole underlying condition is a mental disorder on March 17. But last week, Justice Minister David Lametti announced the federal government would ask parliament for a delay after hearing concerns the health-care system might not be ready to handle those complicated cases.

Cowan believes the crucial question isn’t if MAiD ought to be an option for people with mental illness but when.

“The courts have already established. Parliament has confirmed that MAiD is a right that you have if you meet the criteria that are set forth in the legislation,” Cowan said.

But others, such as psychiatrist Dr. John Maher, have concerns. He spoke with W5 for its documentary on medically assisted dying that aired on CTV this past weekend.

At meetings with a team of social workers and nurses, the psychiatrist talks about patients they are working to help. Much of their work focusses on suicide prevention.

“We’re talking about which of our patients are going to die. And it’s having a profound impact about what it means as professionals, as caring human beings to try and provide hope for people,” Maher said.

“It is state sanctioned suicide insofar there is a structure created that provides a pathway to death. I have a patient right now who’s saying, ‘I would never kill myself on my own but I will kill myself with MAiD because that’s not suicide.’”

Even with a possible delay to the expansion of MAiD, a team of physicians, nurses, ethicists and mental health and addictions stakeholders are preparing for an eventual expansion and developing a Nova Scotia approach.

“I think our job in Nova Scotia is to be prepared for what will happen, whenever it will happen,” said Dr. Gord Gubitz, the MAiD clinical lead at Nova Scotia Health.

Nova Scotia Health has about 60 physicians and nurse practitioners who are currently assessing patients applying for MAiD but the majority do not do this work full-time.

Dr. Gubitz said the team is adding more full-time nurse practitioners, recruiting more doctors and nurses and will hire experts in the field of mental health and addictions, as well as a social worker. They’re also developing their own set of policies. Dr. Gubitz noted his job isn’t to reopen legislation but to determine if a patient who is suffering is eligible for MAiD and if this is the right choice for them.

“For people with mental health as a sole underlying condition, they still have to meet all of the other criteria,” he said, noting their it has to be grievous and irremediable and in a state of continuing decline.

“They have to be suffering in a way that they can’t find relief from. They have to have the ability to consent,” he said, pointing out the government is now hashing out what that looks like.

Gubitz believes Nova Scotians and his team has benefitted from having one health authority that is managing and building its MAiD system in a centralized way. It allows them to build the health infrastructure needed and act proactively.

“At the end of the day, it’s all about providing high quality care as best as we can possibly do it,” he said.

Executive Director of the Nova Scotia College of Social Workers Alec Stratford said his organization believes patients who are suffering from mental illness ought to have the right to choose MAiD but he also thinks more focus and investment needs to go into supporting people who are suffering.

“When we talk about a right to die and a right to die with dignity, what we’re missing in our political and policy decisions is that we have failed in providing meaningful supports and policy that allows people to live with dignity,” Stratford said.