MAID expansion to mental illness likely to be paused in Canada

[_Gollum_]

Gutting. To me the fact that MAID wasn't available to everyone yesterday is a moral abomination. So messed up. (With the caveat of course that the pause hasn't been confirmed yet and there's still a chance it could go the other way).

Ottawa prepared to halt plan to allow MAID for mental illness

Federal government will follow recommendations of parliamentary committee studying issue, sources say

www.theglobeandmail.com

The federal government is prepared to table legislation that would pause the expansion of medical assistance in dying to people whose sole condition is mental illness if a parliamentary committee that is studying the issue recommends it, three sources told The Globe and Mail. The government expects that the committee will make such a recommendation based on evidence presented in hearings and questions from MPs over the past two months, the sources said. The committee was hearing its final witnesses on Tuesday. It will write a report, with its recommendations, to be tabled in the weeks or months ahead.

The government opened up MAID to people who were not facing imminent death in 2021, but the legislation carved out a temporary exclusion for mental illness. This meant people without physical ailments were still unable to qualify for assisted death. That exemption was extended twice by former prime minister Justin Trudeau and is currently set to end in March of next year. Mark Carney has not spoken about the issue, but the Prime Minister has been under pressure, including from religious figures and disability advocates, to delay it further – or scrap it altogether.

The committee has heard from physicians and Health Canada officials that the country may not be ready to move ahead, that the health care system isn't ready for the expansion and that determining eligibility would be complex. The parliamentary committee's co-chairs, Liberal MP Marcus Powlowski and Conservative Senator Yonah Martin, have both previously spoken out against the expansion.

During the final hearing on Tuesday evening, two Dutch psychiatrists urged parliamentarians not to expand MAID to mental illness alone. Jim van Os, a professor of psychiatry at Utrecht University Medical Center, said the Dutch experience offered "a warning for Canada." Dr. van Os noted that requests for what he described as "psychiatric euthanasia" for people under 30 increased to nearly 900 per year from 30 in the past six years. Completed deaths rose five-fold. Most of those people, he noted, were traumatized, marginalized and living in poverty. Dutch law, he said, requires that a patient exhaust all other options first. No such safeguard is in place in Canada, he added. "That single difference will in our assessments drive Canadian numbers beyond ours."

Wilbert van Rooij, a Dutch psychiatrist with 30 years of experience, spoke of the moral toll on the psychiatry profession. Asking psychiatrists to determine when a patient should die, he said, "is a burden psychiatry was never designed to carry."

A third Dutch psychiatrist, Sisco van Veen, took a more nuanced approach. He argued that it is "hard to justify excluding patients with psychiatric disorders whose suffering can be immense." Dr. van Veen said that psychiatric euthanasia remains relatively rare at about 2 per cent of all cases.

The heads of psychiatry at 13 Canadian medical schools wrote to the committee last week calling for the federal government to halt the expansion to mental illness. They argued that there is no accurate way to determine when a mental disorder is incurable or to adequately protect vulnerable patients.

 

[king_yaroglek]

Of course it was. Imagine how many wageslaves the government and elites would lose.

 

[bucketofcats]

They want to pause this, but also refuse to actually help those with mental illness. Most of the homeless in Ottawa are mentally ill and get laughably little support.

We're too valuable to kill off, but too worthless to be helped.

 

[lachrymost]

Let's hope none of these do-gooders end up with a taste of their own medicine, trapped in decades of treatment-resistant suffering! Anything and everything must be lived through, as long as there's no guarantee it will last forever ("remediable").

Even though intellectually I knew this would happen, I have been living off this weird hopium. It's insane how hope works. It's so evil, but I want more of it I guess. Even though I know an indefinite pause and yet another temporary pause would probably amount to the same thing, I really want that temporary pause so I can keep huffing that hope.

I sort of wish they would just make some insane standards for the mental health route, since that would be better than nothing. Everyone needs to be at least 35, have a net worth of 200k, completely fry their brains with 60 rounds of ECT. Just do something that addresses the most popular objections.

I can't defend the criteria for MAiD; it never should have been "irremediable" in the first place or limited to the disabled, but of course you have to start somewhere. The established rhetoric around it means that the pro-MAiD side usually makes the dumber arguments. They end up saying shit like it "isn't really suicide" or "it will prevent suicide". We are not sending our best. Suicide is so stigmatized that even the pro-suicide arguments have to masquerade as anti-suicide.

There's still the Dying with Dignity lawsuit, although federal lawyers keep putting off their part to respond. That's the last shred of hopium I guess. Fuck me. Indefinite suffering. I don't know how to remotely cope with being so powerless and tortured. Right now I'm making this powerless tortured post. It was so worthwhile and meaningful; I'm so fulfilled and everything is so worth it.

 

[Ashu]

Gutting. To me the fact that MAID wasn't available to everyone yesterday is a moral abomination. So messed up. (With the caveat of course that the pause hasn't been confirmed yet and there's still a chance it could go the other way).

Ottawa prepared to halt plan to allow MAID for mental illness

Federal government will follow recommendations of parliamentary committee studying issue, sources say

www.theglobeandmail.com

The federal government is prepared to table legislation that would pause the expansion of medical assistance in dying to people whose sole condition is mental illness if a parliamentary committee that is studying the issue recommends it, three sources told The Globe and Mail. The government expects that the committee will make such a recommendation based on evidence presented in hearings and questions from MPs over the past two months, the sources said. The committee was hearing its final witnesses on Tuesday. It will write a report, with its recommendations, to be tabled in the weeks or months ahead.

The government opened up MAID to people who were not facing imminent death in 2021, but the legislation carved out a temporary exclusion for mental illness. This meant people without physical ailments were still unable to qualify for assisted death. That exemption was extended twice by former prime minister Justin Trudeau and is currently set to end in March of next year. Mark Carney has not spoken about the issue, but the Prime Minister has been under pressure, including from religious figures and disability advocates, to delay it further – or scrap it altogether.

The committee has heard from physicians and Health Canada officials that the country may not be ready to move ahead, that the health care system isn't ready for the expansion and that determining eligibility would be complex. The parliamentary committee's co-chairs, Liberal MP Marcus Powlowski and Conservative Senator Yonah Martin, have both previously spoken out against the expansion.

During the final hearing on Tuesday evening, two Dutch psychiatrists urged parliamentarians not to expand MAID to mental illness alone. Jim van Os, a professor of psychiatry at Utrecht University Medical Center, said the Dutch experience offered "a warning for Canada." Dr. van Os noted that requests for what he described as "psychiatric euthanasia" for people under 30 increased to nearly 900 per year from 30 in the past six years. Completed deaths rose five-fold. Most of those people, he noted, were traumatized, marginalized and living in poverty. Dutch law, he said, requires that a patient exhaust all other options first. No such safeguard is in place in Canada, he added. "That single difference will in our assessments drive Canadian numbers beyond ours."

Wilbert van Rooij, a Dutch psychiatrist with 30 years of experience, spoke of the moral toll on the psychiatry profession. Asking psychiatrists to determine when a patient should die, he said, "is a burden psychiatry was never designed to carry."

A third Dutch psychiatrist, Sisco van Veen, took a more nuanced approach. He argued that it is "hard to justify excluding patients with psychiatric disorders whose suffering can be immense." Dr. van Veen said that psychiatric euthanasia remains relatively rare at about 2 per cent of all cases.

The heads of psychiatry at 13 Canadian medical schools wrote to the committee last week calling for the federal government to halt the expansion to mental illness. They argued that there is no accurate way to determine when a mental disorder is incurable or to adequately protect vulnerable patients.

Fucking whitecoats, fuck off. What gives you the right to pontificate about the life and death of sufferers from mental states you have no concept of or sympathy with. As if you were experts in anything human.

 

[_Gollum_]

Listened to an interview with two people on the committee


Basically what I gather from that interview is that the committee has been stacked against the pro-MAID side, especially in regards to who they're calling to testify. Apparently they haven't even called the Canadian Psychiatric Association to speak before the committee, despite the CPA requesting to do so. The CPA has been "rebutting" some of the arguments heard in committee via letter because they haven't been able to appear. The committee also has not heard from a single person directly suffering from mental illness who would qualify to receive it if the expansion goes ahead, including a 50-year-old woman who has had bipolar and PTSD for 30+ years, and who has requested to appear.

The anti-MAID side is raising concerns about the difficulty of determining "irremediability" and they worry that some people will receive MAID who could still have gone on to lead "healthy, happy" lives. They claim that "psychiatrists" say that determining irremediability would be like "flipping a coin", which is just absurd on its face; the people who would be eligible for MAID under this expansion would invariably be people who have been suffering for multiple decades and who have run the gamut of the MH system, but they seem to be imagining that the target demographic is 20-year-olds who have been experiencing depression for 6 months.

 

[KuriGohan&Kamehameha]

Listened to an interview with two people on the committee


Basically what I gather from that interview is that the committee has been stacked against the pro-MAID side, especially in regards to who they're calling to testify. Apparently they haven't even called the Canadian Psychiatric Association to speak before the committee, despite the CPA requesting to do so. The CPA has been "rebutting" some of the arguments heard in committee via letter because they haven't been able to appear. The committee also has not heard from a single person directly suffering from mental illness who would qualify to receive it if the expansion goes ahead, including a 50-year-old woman who has had bipolar and PTSD for 30+ years, and who has requested to appear.

The anti-MAID side is raising concerns about the difficulty of determining "irremediability" and they worry that some people will receive MAID who could still have gone on to lead "healthy, happy" lives. They claim that "psychiatrists" say that determining irremediability would be like "flipping a coin", which is just absurd on its face; the people who would be eligible for MAID under this expansion would invariably be people who have been suffering for multiple decades and who have run the gamut of the MH system, but they seem to be imagining that the target demographic is 20-year-olds who have been experiencing depression for 6 months.

The elephant in the room in all these discussions seems to be that the Psychiatry community is incredibly resistant to defining what constitutes as "incurable/irremediable". An exception to this would be acknowledging the poor prognosis of certain eating disorders, which can become physically fatal if a person does not succeed in recovery.

For whatever reason, many in the psychology and psychiatry profession do not seem to acknowledge that a person who is living in misery, with a poor quality of life, for years and years and years, and who has run through the gamut of medical interventions, is unlikely to recover without the aid of some groundbreaking experimental treatment that doesn't exist yet.

I understand that acknowledging a poor prognosis can be viewed as bad for morale, but like you, I think it is completely ludicrous to compare someone suffering from 6 months of depression, who may not have had the opportunity to explore many therapeutic interventions, to people who have been suffering for years upon years with no end in sight. It always blows my mind to see arguments that a person with a condition that has been labeled as "treatment resistant" after a multitude of interventions, and years and years of trying to turn things around, could just randomly one day become happy and healthy out of nowhere, so therefore euthanasia for individuals with mental illnesses should be blanket banned. Where is the evidence based logic there?

It's controversial, but I think a lot of the resistance is ego-driven and unwillingness to admit that a not insignificant amount of people are being failed by the current standards of treatment. Of course, it's not the individual doctors at fault, but they take offense as if it was so, as if the current methods at our disposal for treating mental illnesses are foolproof and their effectiveness is reflective of the physician's own competency. When in reality, it's simply that the research for neurological conditions is lagging far behind all other areas of medicine, the fact that psychiatry and neurology are split as disciplines only further serves to support this.

It shouldn't cause such an outcry to acknowledge when a person has done all they can to help themselves, or seek help from the medical system. However, it is one of the most cognitively dissonanced topics in the modern day political climate, imo. It's funny they describe making such weighty decisions as "flipping a coin", when to those of us who have been suffering for years and years, our lives and our pain should be worth more contemplation than that.

If a professional doesn't have the critical thinking skills and empathy to sit down with a case and attempt to make an educated guess regarding a patient's prognosis, in the context of that individuals's prior medical history, their environment, and if there are any further interventions to consider- rather viewing such a decision as making as a coin toss, I would question if they are truly cut out to be a doctor.

Yet, they have absolutely no shame in lying to patients. In my opinion, constantly feeding a patient false hope is a worse ethical violation than being honest that their situation is outside of your scope, and that there's nothing more you can offer them in regards to treatment. We are a long way away from the psychiatry profession at large taking such a stance though.

 

[ceilng_tile]

Dr. van Os noted that requests for what he described as "psychiatric euthanasia" for people under 30 increased to nearly 900 per year from 30 in the past six years. Completed deaths rose five-fold. Most of those people, he noted, were traumatized, marginalized and living in poverty.

How is this an argument *against* voluntary euthanasia? These seem like pretty legitimate reasons to want to die.

 

[autisticmessiah]

How is this an argument *against* voluntary euthanasia? These seem like pretty legitimate reasons to want to die.

If someone is poor and unable to work due to disability all the provincial/federal safety nets are very lackluster and leave you way below the poverty line so they should really increase the pay they give out a lot before going ahead with MAID for mental illness unless they want people to die only because they're in legislated poverty and they've been traumatized and made mentally ill only from it. A lot of them very likely do want people who can't work to die I bet.

 

[lachrymost]

The anti-MAID side is raising concerns about the difficulty of determining "irremediability" and they worry that some people will receive MAID who could still have gone on to lead "healthy, happy" lives. They claim that "psychiatrists" say that determining irremediability would be like "flipping a coin", which is just absurd on its face; the people who would be eligible for MAID under this expansion would invariably be people who have been suffering for multiple decades and who have run the gamut of the MH system, but they seem to be imagining that the target demographic is 20-year-olds who have been experiencing depression for 6 months.

Yeah "flipping a coin" is stupid; I'm sure there is no good evidence that someone like Clarie Brosseau has a fifty percent chance of recovering.

I also love when people complain about the lack of mental health supports, when the whole point of MAiD is that it's for people who have had extensive mental health treatment already. And if there aren't enough psychiatrists around to treat people, then where are these psychiatrists willing to assess people for MAiD going to come from? They're a very small proportion of psychiatrists.

But MAiD is plagued by its imprecise criteria. What does "irremediable" mean? It's up to the assessors, I guess. How much treatment does someone have to have first? It's up to the assessors. Sure I beleive the spirit of the law is that it's for people who have tried almost everything and almost certainly won't get better, but it really is just up to who you see, and you can doctor shop. Unless the doctors get stopped! I've seen assessor Ellen Wiebe in the news a few times over attempts to thwart her generous interpetation of the MAiD crtieria, so the law sometimes intervenes when they get too trigger-happy.

May the slope be a slip-and-slide. Sigh. Man I wish I had a gun, but you know, I'm Canadian.

 

[ButterflySucideBaby]

Not that I think younger people shouldn't have the peaceful freedom of choice, but I wonder how much of this would no longer be a discussion/debate if they just stopped giving it to people under 30, that seems to be the arbitrary point people get emotionally get hung up over during these conversations.

 

[_Gollum_]

I understand that acknowledging a poor prognosis can be viewed as bad for morale, but like you, I think it is completely ludicrous to compare someone suffering from 6 months of depression, who may not have had the opportunity to explore many therapeutic interventions, to people who have been suffering for years upon years with no end in sight. It always blows my mind to see arguments that a person with a condition that has been labeled as "treatment resistant" after a multitude of interventions, and years and years of trying to turn things around, could just randomly one day become happy and healthy out of nowhere, so therefore euthanasia for individuals with mental illnesses should be blanket banned. Where is the evidence based logic there?

I would also add that "getting better" for people in this position, who have suffered for years and years and tried many interventions, does not necessarily entail leading a "healthy, happy life", because such severe suffering leaves scars. And oftentimes, the psychiatric interventions themselves leave scars. It's unrealistic to expect that someone like the woman in the article, who's approaching her 50s, will go on to have a good quality of life even if her bipolar is successfully treated. She will still be dealing with the fallout of her illness for the rest of her life, and that trade-off may not be worth it to her.

But our society's mantra seems to be "continued life at all costs", rarely considering the question of "when is a life worth living?", which in any case can only be determined by the individual since they are the only ones experiencing their own subjective experience. This whole thing reeks of paternalism: we know best. It's up to us to determine when you've suffered enough to deserve mercy, not you!

 

[TAW122]

Sadly, that is likely the outcome in Canada. Every few years (2 years) the temporary exclusion (not so much temporary if they continuously extending it indefinitely!) clause keeps getting extended, and it would be the 3rd time if they push it again before March 2027 (less than a year from now), since they already extended the exclusion twice already (first time in 2023, and the second in 2025 or so).

That alone makes me lose hope for Canada and it's MAID program (not that I would have a chance to use it as I'm a US citizen), but I digress.

 

[BlueMist96]

This will never be accepted by the vast majority of people. It's just not going to happen. It's a miracle that it's even available for the terminally ill in the first place.

 

[FadingShadows]

The anti-MAID side is raising concerns about the difficulty of determining "irremediability" and they worry that some people will receive MAID who could still have gone on to lead "healthy, happy" lives.

And of course if your goal ISN'T a "healthy, happy life", that in itself proves you're too messed up to make that decision, because who doesn't want that, right?

Like, absolutely, there are some people whose desire to die is a result of factors they'd choose to change if they could, not an innate part of their being, but then you've got people like me (a lot of us here, I know) for whom that's just not the case. I've never wanted to be "fixed". Forcible attempts at "fixing" me made me want it even less because now I have the exact kind of trauma that's being referred to elsewhere in the post. I can remember being in a private church-run elementary school, and while the other kids were talking about what they were going to do when they went home, I was thinking, "I'd like to cut myself and bleed." No diagnosed mental illnesses at that point (undiagnosed autism, but still not the type of things they tried to pin on me later). I'd never heard about self-harming, I had no idea it was a thing people actually did; it was just something fundamental in me. I was FASCINATED by the scene in The Secret Of NIMH where Mrs Brisby gets cut by a wire when she's trying to get out of the cage. I don't in any way enjoy seeing animals being hurt, even in fiction, but that resounded with me because I was thinking, "What if that was my arm? I wish that was my arm."

And obviously things went downhill for me in various ways, but I'm still capable of perceiving the difference between, "Today, my death wish is directly related to how godawful my life has become," and, "Today my death wish is a generalized reflection of my lifelong contempt for my existance as a whole." In order for me to live a "healthy, happy life," my entire being would have to be COMPLETELY rewritten. Overwritten, brainwashed, reprogrammed. Even if I agreed with the idea that I've just been mentally ill my entire life and don't know any better, you're still talking about erasing the person I've already been for forty-six years. But apparently that's FINE. PERFECTLY acceptable to kill the existing me in favour of having someone more agreeable and acceptable in my body, as long as it's not ME controlling my life and death.

I'm in the US, so this specific situation doesn't affect me directly, but I've been thinking about some sort of tangentially-related things because they're passing SO many laws here to make the lives of the poor and disabled as difficult as possible (in my state they've already decided they're going to put even more restrictions both on what I can buy with my SNAP "benefits", because as an unemployed, chronically-ill adult, I can't be trusted to make decisions for myself and I don't deserve the luxury of a glass of juice instead of water anyway, and potentially where I can even use them). And they just SO clearly want people like me to not even exist, but they won't actually allow me to die unless it's on THEIR terms (as drawn-out and miserable as possible). And, just, WHY? Like, I see people saying that it's about wage slavery (and I'm sure that is a factor in some cases), but someone like me, who's been disabled their entire life, never worked, never contributed in any meaningful way*, what possible benefit is there to forcibly keeping me alive other than pure sadism?

*(To be clear, I don't think that the disabled are nothing but dregs on society or anything; this is just me making a point about myself. I don't even feel guilty about "not contributing" because it's not my fault. I just don't GET it.)

 

[Hystearical]

I wish all those people who spoke against the extension would take a look through even a tenth of people like FC's content here, let alone the whole thing.

How could anyone on the planet who is opposed do that and still reach the same conclusions they had before?

(At least the idea that that kind of premature exit can't be the right course of action for some people. The involvement of other parties IS a thorny issue to be certain, but people can't even see that first point to begin with.)

 

[lachrymost]

I saw this linked in a pro-MAiD article and looked through it the other day: Canadian Guidance on Medical Assistance in Dying (MAID): Evaluating the "Grievous and Irremediable" Eligibility Criterion in Persons with Mental Disorders who Request MAID and Managing Suicide Risk during the Process for All MAID Eligibility Requests from the Canadian Psychiatric Association.

I'm not going to bother finding the exact wording, but in this they say that "incurable" (and therefore "irremediable") means that the assessors think there are no more acceptable treatment options available. They can decide that the remaining treatment options are unacceptable because of side effects or something specific to the patient's concerns or circumstance. One concern of mine with ever getting the law to stick was that it's much harder to view mental illness as irremediable because the illness can be defined by the mental suffering itself, which can always just randomly subside in a way that seems incomparable to, say, a brain tumour. But if it's about the treatments available for it, then it's on par with physical illness. Even if we consider time itself as a treatment, it's a treatment assessors could find unacceptable like any other. I haven't watched the full committee hearings or anything, so has anyone made this argument there? CPA didn't get to talk? Cool, cool. All I've heard when people are challenged on the irremediable point is a whole lot of nothing, but this is something. Would be nice if something actually meant something.

 

[_Gollum_]

And they just SO clearly want people like me to not even exist, but they won't actually allow me to die unless it's on THEIR terms (as drawn-out and miserable as possible). And, just, WHY? Like, I see people saying that it's about wage slavery (and I'm sure that is a factor in some cases), but someone like me, who's been disabled their entire life, never worked, never contributed in any meaningful way*, what possible benefit is there to forcibly keeping me alive other than pure sadism?

I've thought about this too, like what's their motive for keeping people alive at all costs? For forcing people to continue living when they've expressed a clear desire to die? I find it so hard to square with any secular notion of morality. We even kill beloved pets when their quality of life declines too steeply, and yet we can't let humans take their own life when they've arrived at that same conclusion? Sadism is the perfect term because it amounts to a fetishization of suffering.

That's how I feel, anyway. But being charitable, I think their real motive is just that they truly believe that life is a good thing -- the best thing, even. A gift of unparalleled proportions. They enjoy their lives, and they feel horror at the thought of dying, and they feel horror at the thought of their loved ones dying, so by extension that must mean that death is bad and life is good. This is a socially beneficial belief, so it gets entrenched in society. It's in the very air we breathe. I can't fault most people for never questioning it when their own instincts align so perfectly with it.

I saw this linked in a pro-MAiD article and looked through it the other day: Canadian Guidance on Medical Assistance in Dying (MAID): Evaluating the "Grievous and Irremediable" Eligibility Criterion in Persons with Mental Disorders who Request MAID and Managing Suicide Risk during the Process for All MAID Eligibility Requests from the Canadian Psychiatric Association.

I'm not going to bother finding the exact wording, but in this they say that "incurable" (and therefore "irremediable") means that the assessors think there are no more acceptable treatment options available. They can decide that the remaining treatment options are unacceptable because of side effects or something specific to the patient's concerns or circumstance. One concern of mine with ever getting the law to stick was that it's much harder to view mental illness as irremediable because the illness can be defined by the mental suffering itself, which can always just randomly subside in a way that seems incomparable to, say, a brain tumour. But if it's about the treatments available for it, then it's on par with physical illness. Even if we consider time itself as a treatment, it's a treatment assessors could find unacceptable like any other. I haven't watched the full committee hearings or anything, so has anyone made this argument there? CPA didn't get to talk? Cool, cool. All I've heard when people are challenged on the irremediable point is a whole lot of nothing, but this is something. Would be nice if something actually meant something.

Thanks for the link, interesting read. "Symptom" of the disorder versus "consequence" of the disorder also comes up with their bizarre criteria about suicidal ideation. They divide it into three groups:

• Impulsive suicidality: temporary, related to emotional events, symptom of the disorder;
• Chronic suicidality: persistent, frequently occurring, symptom of the disorder; and
• Well-considered, persistent wish to die: persistent, unrelated to events, consequence of the disorder.

But it's not clear to me why "well-considered, persistent wish to die" is a consequence of the disorder whereas chronic suicidality is a symptom.