Chris Selley: The euthanasia committee did its job. Now it’s Parliament’s turn

“Desperate people shouldn’t have to live in misery for want of proper health care. But that doesn’t make euthanasia proper health care,” Chris Selley writes. Photo by Adobe Stock

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The special joint committee on medical assistance in dying’s latest report, released Wednesday afternoon, takes a long, thoughtful and occasionally befuddling path to the simple and correct recommendation: “That the government of Canada amend the Criminal Code to indefinitely exclude persons whose sole underlying medical condition is a mental illness from eligibility for medical assistance in dying (MAID).”

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In arriving there, it explores an intriguing philosophical and medical debate: Can doctors accurately distinguish between mental illness and suicidality? I don’t think it’s particularly relevant to the question who should be eligible for euthanasia, which the federal government has punted into the future twice, but it’s intriguing nonetheless. (The joint committee moots yet another punt as one of four options, but thankfully rejects it. People who are suffering terribly with mental illness, and desire euthanasia, at least deserve not being strung along year after year.)

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Suicidal behaviour is not technically considered a mental illness itself, which I think stands to reason. There are times when suicide is rational; for example if you’re suffering an irremediable, terminal illness, and you have weeks to live, and you’re in intractable pain. Those were the initial criteria for MAID, of course, and at least in theory, I think they hold up.

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But suicidality is intertwined with mental illness. Research published in 2002 concluded “98 per cent of those who committed suicide had a diagnosable mental disorder.”

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“Unlike physical conditions, suicidal ideation is part of the diagnostic criteria for many mental disorders, including depression, post-traumatic stress disorder and borderline personality disorder,” Dr. Jitender Sareen, head of psychiatry at the University of Manitoba, told the committee. “This goes to the core psychiatric practice, which is grounded in assessing and treating hopelessness and preventing suicide.”

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“I worry that in some cases, we may not be responding to an autonomous, enduring request for assisted dying, but rather to the voice of the illness itself,” Dr. Sandip Singh Gandham, Alberta’s medical lead for MAID, echoed. “That is not a distinction we can afford to get wrong.”

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“If people seek MAID because they cannot access the conditions necessary to live with dignity, that is not a triumph of autonomy; it is a failure of care,” he added. “In such cases, the suffering may be real, but its drivers may be remediable through social response rather than death as a medical intervention.”

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That’s ice-cold comfort in Canada, where remedies for remediable health-care situations take ages to arrive, if they ever do. And the awful thing is, Canada can afford to get the distinction wrong. Indeed, it can afford that more than getting the distinction right. It’s cheaper.