Justice Minister David Lametti responds to a question during Question Period in the House of Commons, in Ottawa, Thursday, Nov. 19, 2020. The federal bill revising the rules on medically assisted death in Canada has raised the ire of the Canadian Psychiatric Association over the proposed law’s explicit rejection of mental illness as grounds for ending a patient’s life. THE CANADIAN PRESS/Adrian Wyld

Justice Minister David Lametti responds to a question during Question Period in the House of Commons, in Ottawa, Thursday, Nov. 19, 2020. The federal bill revising the rules on medically assisted death in Canada has raised the ire of the Canadian Psychiatric Association over the proposed law’s explicit rejection of mental illness as grounds for ending a patient’s life. THE CANADIAN PRESS/Adrian Wyld

Exclusion of mental illness in assisted dying-bill slammed by psychiatrists

A few Canadians suffering solely from severe, irremediable mental disorders have received assisted deaths

The federal bill revising the rules on medically assisted death in Canada has raised the ire of the Canadian Psychiatric Association over the proposed law’s explicit rejection of mental illness as grounds for ending a patient’s life.

The federal government maintains that denying Canadians with debilitating mental illnesses the right to medically assisted death is simply a matter of continuing a prohibition that already exists in the law.

In fact, a small number of Canadians suffering solely from severe, irremediable mental disorders have received assisted deaths during the four years the procedure has been legally available.

The government is now proposing to expressly exclude such people as it amends the law to expand eligibility for everyone else.

Some psychiatrists say that stigmatizes people with mental illnesses, minimizes their suffering and reinforces the myth that they could be cured if they just tried harder.

What’s more, they believe the exclusion violates Section 15 of the Charter of Rights and Freedoms, which guarantees equal treatment under the law regardless of physical or mental disability.

Under Bill C-7, a mental illness will “not be considered an illness, disease or disability” for the purpose of the assisted-dying law.

“A provision that applies only to persons with mental illness, without appropriate justification, is discriminatory in nature because it is arbitrary. A provision that applies to all persons with mental illness, without appropriate justification, is unconstitutional because it is overbroad,” the Canadian Psychiatric Association says in a brief to the House of Commons justice committee, which is scrutinizing the bill.

“Explicitly stating that mental illness is not an illness, disease or disability … is inaccurate, stigmatizing, arbitrary and discriminatory.”

The bill is the government’s response to a 2019 Quebec court ruling that struck down a provision in the law that allowed only those whose natural deaths are reasonably foreseeable to seek medical help to end their suffering.

Justice Minister David Lametti has suggested that, until now, the foreseeable-death provision prevented people suffering solely from mental illness from receiving an assisted death. And the statement issued by his department on the charter implications of the bill explicitly asserts that “the bill would continue to prohibit” assisted deaths in such cases now that the near-death requirement is being scrapped.

That assertion incenses Vancouver psychiatrist Dr. Derryck Smith, who has personally been involved in two cases where people suffering solely from severe mental disorders received medical help to end their lives. And he says he knows of other similar cases.

The assertion “is absolutely false and misleading,” Smith said in an interview.

One of the cases Smith took part in involved a woman of about 40 years old who suffered from a “severe, intractable eating disorder” and was intending to starve herself to death if she did not receive medical help to end her life.

“She was approved for assisted dying and received assisted dying just for a psychiatric illness, in this case anorexia nervosa.”

To now deny someone like her the right to seek an assisted death is “such a flagrant violation of Section 15 of the charter, it’s unbelievable that they could continue with this,” Smith said.

“I mean, this is discriminating against a class of Canadians.”

The Justice Department’s charter statement on the bill acknowledges that the exclusion “has the potential” to violate charter rights.

But it argues that it is a reasonably justifiable limit on those rights based on “the inherent risks and complexity that the availability of MAID (medical assistance in dying) would present for individuals who suffer solely from mental illness.”

Those risks include, as Lametti told the House of Commons last month, “that the trajectory of mental illness is more difficult to predict than that of most physical illnesses, that spontaneous improvement is possible and that a desire to die and an impaired perception of one’s circumstances are symptoms, themselves, of some mental illnesses.”

Montreal psychiatrist Dr. Mona Gupta, who co-authored a soon-to-be-released report on the issue for the Association des médecins psychiatres du Québec, said the risks apply equally to people with debilitating physical conditions.

The course of some physical illnesses can be unpredictable. Physically ill people can spontaneously improve or become suicidal. Their capacity to consent can be compromised. But whereas doctors weigh those factors in assessing whether each individual with a physical condition is eligible for MAID, Gupta says Bill C-7 is telling all people with mental illnesses “you’re not even allowed to ask, you’re not even allowed to be assessed.”

If a person with bipolar disorder and renal failure is deemed to have the capacity to make end-of-life decisions, she says it “doesn’t really make a lot of sense” to say someone with only bipolar disorder does not.

She suspects myths about mental illness — “that it reflects a character failing, that somehow it’s transient or not real” — are behind the exclusion in Bill C-7.

As well, she suspects politicians are likely worried about someone who is “depressed after a bad divorce” seeking an assisted death. They have no conception of the kind of unbearable suffering “a very, very small group of people” with severe psychiatric conditions go through and who would be most likely to qualify for an assisted death.

READ MORE: Assisted-dying bill sparks ferocious debate among Canadians with disabilities

Gupta shares the story of a patient in her hospital, a man in his 60s with lifelong obsessive-compulsive disorder. Although he was initially reasonably functional, had a job and got married, his condition deteriorated in his 40s, manifesting in a “very, very severe handwashing obsession” that caused him to be depressed and suicidal.

He has been hospitalized many times and the water had to be turned off in his room “otherwise he would have literally destroyed the entire skin barrier of his hands from repeated washing.”

Gupta says the man has tried all pharmaceutical options and intensive in-patient psychotherapy, undergone electroconvulsive therapy twice and several rounds of transcranial magnetic stimulation, and been given intravenous ketamine and even “experimental deep brain stimulation which was provided entirely on compassionate grounds because there was really nothing else to offer.”

“Nothing has helped him. In the words of his treating psychiatrist, it’s been a total failure,” Gupta said.

The man, who must now live in an institutional setting, has thought about assisted dying and talked about it at length with his partner, who is supportive. He’s not asking for it now but, Gupta said, “He wants to know that it’s an option.”

But now, she said, the government is telling him, “for your own good, because you’re too vulnerable to know what you’re doing, we won’t even let you make a request.”

Joan Bryden, The Canadian Press


Like us on Facebook and follow us on Twitter.

Want to support local journalism during the pandemic? Make a donation here.

assisted dying

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

Just Posted

A woman wears a face mask and shield to curb the spread of COVID-19 while walking in North Vancouver, B.C., on Wednesday, January 6, 2021. THE CANADIAN PRESS/Darryl Dyck
57 new cases of COVID-19 in Interior Health region

Thirty people in the region are in hospital, 16 of whom are in intensive care

The TNRD is undertaking a Master Trails Plan for the community of Blue River. (Darcy Lawrey / Pexels Photo)
TNRD to develop trails plan for Blue River

A survey is available for public input on the TNRD website.

From left: Councillor Lucy Taylor, Councillor Barry Banford, Councillor Bill Haring, Mayor Merlin Blackwell, Councillor Lynne Frizzle, Councillor Lyle Mckenzie and Councillor Shelley Sim. (District of Clearwater photo)
District of Clearwater council approves tax rate increases for 2021

The 2021 tax rate bylaw will see adoption May 6.

Ian and Roger Nadeau are shown in front of one of their Thompson Valley Charters coaches. (TVC photo)
Hwy 5 Kamloops to Edmonton bus run delayed until May 20

Thompson Valley Charters delays start of new route to abide by BC Health travel advisory

A vial of the AstraZeneca COVID-19 vaccine is shown at a facility in Milton, Ont., on Wednesday, March 3, 2021. The White House says it is making plans to share up to 60 million doses of the Oxford-AstraZeneca COVID-19 vaccine. THE CANADIAN PRESS/Carlos Osorio - POOL
65 new cases of COVID-19 in Interior Health

The total number of cases in the region is now at 11,075 since the pandemic began

Jose Marchand prepares Pfizer COVID-19 vaccination doses at a mobile clinic for members of First Nations and their partners, in Montreal, Friday, April 30, 2021. The National Advisory Committee on Immunization is coming under fire after contradicting the advice Canadians have been receiving for weeks to take the first vaccine against COVID-19 that they’re offered. THE CANADIAN PRESS/Ryan Remiorz
Trudeau says he is glad he got AstraZeneca, vaccines are only way out of pandemic

‘The most important thing is to get vaccinated with the first vaccine offered to you’

B.C.’s provincial health officer, Dr. Bonnie Henry. THE CANADIAN PRESS/Jonathan Hayward
Dip in COVID-19 cases with 572 newly announced in B.C.

No new deaths have been reported but hospitalized patients are up to 481, with 161 being treated in intensive care

Solar panels on a parking garage at the University of B.C. will be used to separate water into oxygen and hydrogen, the latter captured to supply a vehicle filling station. (UBC video)
UBC parkade project to use solar energy for hydrogen vehicles

Demonstration project gets $5.6M in low-carbon fuel credits

FILE – A student arrives at school as teachers dressed in red participate in a solidarity march to raise awareness about cases of COVID-19 at Ecole Woodward Hill Elementary School, in Surrey, B.C., on Tuesday, February 23, 2021. THE CANADIAN PRESS/Darryl Dyck
B.C. ‘should be able to’ offer 1st dose of COVID vaccine to kids 12+ by end of June: Henry

Health Canada authorized the vaccine for younger teens this morning

A woman in the Harrison Mills area was attacked by a cougar on Tuesday, May 4. B.C. Conservation Officers killed two male cougars in the area; the attack was determined to be predatory in nature. (File photo)
2 cougars killed following attack on woman in Agassiz area

Attack victim remains in hospital in stable condition

A woman wears a face mask and shield to curb the spread of COVID-19 while walking in North Vancouver, B.C., on Wednesday, January 6, 2021. THE CANADIAN PRESS/Darryl Dyck
B.C. CDC updates info, acknowledging small respiratory droplets can spread COVID-19

Large droplets, not aerosols had been fixture of public health messaging for many months

A picture of Shirley Ann Soosay was rendered from a postmortem photographer and circulated on social media. (DDP graphic)
B.C. genealogist key to naming murder victim in decades-old California cold case

In July 1980, Shirley Ann Soosay was raped and stabbed to death

Mary Kitagawa was born on Salt Spring Island and was seven years old when she was interned along with 22,000 B.C. residents in 1942. (B.C. government video)
B.C. funds health services for survivors of Japanese internment

Seniors describe legacy of World War II displacement

Most Read