MPs say mental health and death care precautions needed

A select joint committee of the House of Commons and the Senate released an interim report Wednesday on medically assisted deaths, which discusses provisions for people with mental disorders but does not make recommendations to the government.

Due to the tight timeline and “in view of the need to do more work on this topic,” MPs and Senators on the committee do not draw conclusions in the report, but instead summarize evidence heard by the committee at two May hearings.

The report calls for “standards of practice, clear guidelines, proper training for practitioners, comprehensive patient assessment and meaningful oversight” for cases like this to be implemented well before March 2023, when people who are exclusively mentally ill should be eligible. to receive help. helped die.

The review by the committee was mandated by a law passed in March 2021 that updated the death care structure established in 2016.

The bill began a two-year time frame delaying access to near-death care for people who are solely mentally ill, and included requirements that the issue be studied within a strict timeframe—although the work of the select committee has faced delays, due in part to last year’s federal elections. autumn. .

The committee postponed its work so that it could incorporate the findings of the MAiD and Mental Illness Expert Panel, which were only published in the May 13 report.

The expert group concluded that the existing eligibility criteria and guarantees would be adequate, “provided they are interpreted appropriately in the context of mental disorders”.

The group, as well as the committee, used the terminology “mental disorders” rather than “mental illness”, stating in their reports that there is no standard definition for the latter and its use is likely to cause confusion.

Witnesses point out that some of the other terms used in the Code – “incurable”, “incurable” and “intolerable suffering” – also do not have a scientific or medical definition.

Their testimony covered a range of opinions on contentious issues relating to the balance between respect for human autonomy and protection of the vulnerable; ensure that patients are able to make a fully informed decision; what “hopelessness” means in relation to mental disorders; and distinguish between MAiD request and suicidal tendencies.

Mental health advocates warn that outcomes and treatments for mental illness are harder to predict, and the desire to die is often a symptom.

“If it were possible to distinguish the very few people with mental illness who are destined to suffer indefinitely from those whose suffering is curable, it would be inhumane to deny MAiD,” said Brian Mishard, a professor at the University of Quebec in Montreal, in a report. , as the saying goes.

“But any attempt to determine who should have access to MAiD will lead to a lot of errors, and people who would experience an improvement in their symptoms and no longer want to die will die from MAiD.”

However, several other witnesses stressed that it is up to each individual to decide what constitutes unbearable suffering if systems and funding are in place to ensure that the patient has reliable support and access to treatment.

“Most of the suffering that people talk about is not pain, but the inability to lead a normal life. This is true for people with mental illness as well as people with physical illness,” family doctor Ellen Wiebe told the committee.

While the report does not make recommendations of its own, it concludes by urging the government to take steps to “timely” implement the recommendations of the expert group.

This last paragraph is the subject of a dissenting interim report by Conservative MPs on the committee, who argue that simply endorsing the panel’s recommendations is “problematic.”

The deputies argue that there are “too many unanswered questions” on this issue and that nothing prevents the committee from reconsidering whether assistance should be offered at all for the death of this category of people.

“Legislation of this kind should be guided by science, not ideology,” the conservatives write, warning that an outcome that could “make life easier for Canadians who could do better” would be completely unacceptable.

The committee’s final report, with recommendations that also cover other areas, including access for adult minors, advance requests, the state of palliative care in Canada, and the protection of people with disabilities, is not expected before the October 17 deadline.

— Marie-Danielle Smith, The Canadian Press.

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