Report and Recommendations
Click here to Download the full EAG “Canada at a Crossroads” report on MAiD and Mental Disorders
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Canada is at a crossroads as we strive to find the most appropriate balance of medical assistance in dying (MAiD) laws and policies. The Expert Advisory Group’s (EAG) Canada at a Crossroads report provides an evidence-based review and recommendations to guide policy regarding MAiD and mental disorders. The EAG also felt the need to urgently respond to the recent Institute for Research on Public Policy (IRPP) Halifax Group’s Report during a crucial time when national and provincial policies with profound social and ethical implications are being formed. EAG members have deep concern that the conclusions and many recommendations reached in the Halifax Group’s report are flawed, and based on incomplete or selective review and interpretation of existing evidence.
A central message of the final report of the Council of Canadian Academies (CCA) Medical Assistance in Dying where a Mental Disorder is the Sole Underlying Medical Condition (MAiD MD-SUMC) expert panel was that there was no agreement on whether MAiD MD-SUMC could be safely introduced without unduly risking the lives of vulnerable persons. Based on a fulsome review of evidence and key differences between mental disorders and other progressive medical conditions informing evolving MAiD policy, as Canada envisions rescinding the “reasonably foreseeable natural death” criterion, the EAG makes a core recommendation regarding MAiD MD-SUMC, that to avoid further stigmatization and discrimination against those with mental disorders:
Core Recommendation
MAiD policy and legislation should explicitly acknowledge that determinations of irremediability and irreversible decline cannot be made for mental illnesses at this time, and therefore applications for MAiD for the sole underlying medical condition of a mental disorder cannot fulfill MAiD eligibility requirements.
Ancillary Recommendation 1
A non-ambivalence criterion should be required for MAiD in situations when death is not reasonably foreseeable.
Ancillary Recommendation 2
A “lack of reasonable alternative” criterion should be required prior to being eligible for MAiD in situations when death is not reasonably foreseeable.*
*NB: For reasons articulated in the EAG report, the EAG supports a “lack of reasonable alternative” criterion for all MAiD applications, as is required elsewhere in the world except in Canada. However, this criterion is particularly essential to introduce as current policies change and the “reasonably foreseeable natural death” criterion is rescinded, which is the focus of this critique.
