Recent from the Office of the Chief Coroner (OCC) of Ontario reveal troubling trends about Ontarians accessing MAiD (Medical Assistance in Dying) due to socioeconomic and psychological vulnerabilities. The OCC’s MAiD Death Review Committee, living up to its motto, “speak for the dead to protect the living,” has highlighted several cases that offer important lessons for Ontario – and Canada as a whole.
Take the case of Mr. A, a man who declined multiple support programs and services and had a history of mental illness, suicidality (a term referring to the risk or presence of suicidal thoughts, behaviours, or actions), and addiction to alcohol and opioids. Despite these clear vulnerabilities, his substance use was not explored during his MAiD assessments, nor was he offered treatment. Adding to the troubling circumstances, Mr. A’s family expressed concerns about his request to die, which he hadn’t initiated himself. Instead, a psychiatrist brought up MAiD during an assessment, and his MAiD provider went so far as to drive him to his appointment with death.
The Committee rightfully raised the alarm over the danger of a psychiatrist suggesting MAiD to vulnerable patients. For someone like Mr. A, with a history of mental illness and suicidality, such a suggestion carries an implicit message: a healthcare professional believes your life may no longer be worth living. Vulnerable patients may consequently feel pressured to consider MAiD, eroding their hope of recovery or causing them to feel like a burden.
This may be why other jurisdictions, unlike Canada or Ontario, have prohibited doctors from raising MAiD with patients. For example, the state of Victoria in Australia healthcare provider-initiated conversations about MAiD.
Mental illness is another significant factor in MAiD cases, as seen in the story of Mr. B. Just one year before being euthanized, Mr. B survived a suicide attempt that required extensive medical and surgical intervention, as well as rehabilitation. Despite his history, a psychiatrist deemed him eligible for MAiD based on his profound existential suffering.
In Canada, there is no requirement to address mental illness before granting a MAiD request if the patient also has a qualifying physical illness or disability. This means that Canada is already, in effect, allowing MAiD for mental illness in cases where physical conditions coexist.
Contrast this with the U.S., where safeguards are stronger. In that have legalized assisted suicide, if an assessing physician suspects that a patient’s judgment is impaired by mental illness or depression, they are required to refer the patient for counselling. goes further by mandating counselling for all patients who request assisted suicide. Implementing similar measures in Canada would significantly strengthen safeguards for vulnerable individuals.
Socioeconomic vulnerabilities are another glaring issue. Consider Ms. B, who suffered from multiple chemical sensitivity syndrome, along with depression, anxiety, PTSD, and a history of suicidality. Social isolation and her inability to find housing suitable for her medical needs were major factors in her request for MAiD. Some members of the Committee argued that Ms. B’s psychiatric condition should have disqualified her from receiving MAiD, yet she was still euthanized.
Currently, medical professionals are only required to inform patients about available services or treatments – such as counselling, disability supports, community services, or palliative care – but patients are not required to try any of these options before being approved for MAiD. This procedural approach prioritizes eligibility over meaningful care, leaving gaps that vulnerable individuals can fall through.
The Committee’s reports highlight the need to address suffering holistically – by tackling the social, psychological, and economic factors that contribute to a patient’s request for MAiD. They also stress the importance of family involvement and moving away from a purely procedural approach. As some members of the Committee put it, “The practice of MAiD would benefit from moving away from a procedural-focused approach to a care-focused approach.”
Instead of simply determining whether a patient qualifies for MAiD, healthcare providers must exhaust every avenue to help patients live well despite their suffering. This is not just a moral imperative – it is a necessary safeguard to protect the vulnerable from being driven to irreversible decisions they might otherwise avoid.
While the reports offer an opportunity for the medical community to learn, they should also serve as a wake-up call for legislators across the country. The gaps in Canadian law around MAiD are glaring. It is time to strengthen safeguards to ensure that no vulnerable person is pressured into choosing death over the possibility of a better life.
Canadian lawmakers cannot afford to wait and see what happens – they must act now.
Daniel Zekveld is a Policy Analyst with the Association for Reformed Political Action (ARPA) Canada.
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