I am writing to you regarding Bill C-218 and would be very grateful if you would acknowledge receipt of this letter. I have known suicidal individuals and people suffering from mental illness, and I am deeply troubled by the idea that the government could encourage them, in any way, to resort to medical assistance in dying (MAID).

There are very good reasons why the implementation of MAID for mental disorders without other medical conditions has been postponed twice. In Quebec, it was even rejected. The opinions of healthcare professionals reflect deep divisions on this issue. While a majority of the population still supports MAID in general, only a minority of that population supports it in these specific cases.

It is crucial to emphasize that MAID for mental disorders is not a logical extension of current practice. On the contrary, it contradicts the fundamental principles of that practice. Indeed, the two essential criteria for eligibility for medical assistance in dying (as currently practiced) are (a) the irremediable nature of the patient’s condition and (b) the patient’s free and informed consent.

However, the irremediable nature of a mental or psychological disorder cannot be determined in the same way as for a physical illness. Scientific knowledge of mental disorders is not currently as advanced as that of physical illnesses. Psychiatrists are unable to predict which of their patients with similar mental disorders will see their condition improve; nor can they say how long it will take.

Many people who have experienced long periods of acute mental distress are convinced that they would no longer be alive today if MAID had been available while they were being treated for their illness.

Furthermore, the very nature of psychiatric symptoms often prevents patients from exercising their freedom of choice, making the ethical practice of MAID almost impossible.

Here is what the Canadian Association for Suicide Prevention (CASP) says on this subject:

“With regard to patients’ ability to provide consent to medical assistance in dying, the very nature of mental illness can impair decision-making capacity. Those suffering from acute mental illness are routinely encouraged to avoid making major decisions. The decision to prematurely end one’s life is of enormous and grave importance and should not be made by someone suffering from mental illness.”

A particular difficulty arises from the practical impossibility of reliably distinguishing between the rational (desired) motivation underlying a typical MAID request, on the one hand, and the expression of pathological suicidal desires that appear rational, on the other. This is again the perspective of the ACPS.

“For people at the end of life, there may be little or no overlap between medical assistance in dying and suicide in the traditional sense of the term. However, the risks of overlap increase sharply for people with chronic, but non-terminal, conditions, and particularly for those with mental disorders.”

The constitutional rationale that compelled the Parliament of Canada to create an exception to the Criminal Code allowing for MAID is based on a trade-off between “justice” for those frustrated by prohibition, on the one hand, and the state’s responsibility to protect those made vulnerable by the introduction of MAID, on the other. According to the Carter decision, an outright ban on MAID is unreasonable, and such a trade-off is necessary.

However, for the reasons stated above, the number of potentially vulnerable individuals will increase dramatically if Parliament decides to extend access to MAID to those suffering from mental illness but not other medical conditions.

Furthermore, in accordance with the medical perspective of Quebec’s law on end-of-life care, the National Assembly of Quebec determined that medical assistance in dying could not constitute legitimate medical care solely for individuals with mental illness. This was the conclusion of a special committee’s work, and this conclusion, undoubtedly shared by the majority of Quebecers, was subsequently ratified by the National Assembly in the new version of the law on end-of-life care.

I have just outlined the reasons why the practice of MAID for purely psychiatric purposes has been met with such a lukewarm reception and its introduction has been delayed for so long. In short, this introduction will lead to the unnecessary deaths of people whose conditions are by no means irreversible, in many cases, and whose requests do not stem from a genuine choice but from the symptoms of the illness itself. I strongly encourage you to seize this opportunity, not to inadvertently broaden the eligibility criteria for medical assistance in dying, but to set firm limits by definitively rejecting MAID offered for mental disorders in the absence of other medical conditions.