By Lisa Blumberg

This spring, eligibility under Canada’s assisted suicide/euthanasia law is scheduled to expand to include people who are deemed to suffer from “untreatable mental illnesses.” The implementation of the expansion has been delayed before and will hopefully be delayed again due to stiff opposition to it. A recent New York Times article, “Death by Doctor May Soon Be Available to the Mentally Ill in Canada”, tries to describe both sides of this controversary.

It quotes two psychiatric survivors who both have made multiple suicide attempts and who feel they would benefit from the option of having a medically caused death. It also quotes an Ontario psychiatrist who explains his opposition by stating, “What does it mean for the role of the physician, as healer, as bringer of hope, to be offering death? And what does it mean in practice?… [P]sychiatrists are no better at identifying who’s not going to get better.”

The piece misses the mark though. It devotes few words to shortcomings in the health care system. It omits the views of disability rights activists and does not question whether Canada should have legalized assisted suicide for any patient group in the first place.

Canada is a textbook case in mission creep. Its original assisted suicide law enacted in 2016 applied only to the terminally ill but it now applies as well to people with chronic conditions or physical disabilities if they are seen as suffering. The person must request death but there is no requirement that lethal drugs be self-administered.

Some people with physical disabilities using the law have been quite explicit that it was because they could not receive funding to hire the in-home help they needed to avoid a nursing home. A woman with multiple chemical sensitivities died under the law because she could not find safe and affordable housing. These Canadians have accepted – not chosen – state sponsored death because the failings of society had made their lives as disabled persons feel intolerable. If the law is expanded to include people presumed to have long standing mental health problems, it can be expected that more people will die because they cannot access the right type of care or support.

As Dr. Ira Byock, an American palliative care specialist and opponent of assisted suicide has stated, “When doctor-induced death becomes an accepted response to the suffering of dying people,….extensions grease the slippery slope.” Indeed, the article quotes Dr. Alexandra McPherson, a psychiatry professor at the University of Alberta and assisted death provider who states that she treats a small number of patients “with severe disabling mental health disorders who suffer equally to the patients that I see in cancer care.” In other words, if death can be a good thing for folks with cancer, it can be a good thing for “the mentally ill”. Her use of the term “disabling” of course harks to “better dead than disabled” prejudices.

In America, the states which have legalized assisted suicide still purportedly limit eligibility to those with terminal illness – as porous as that term is – and a six month prognosis, although some states have made expansions in other areas such as reducing the waiting periods and authorizing non-physician prescribers of lethal drugs. It seems to be the strategy of proponents of assisted suicide to get the laws initially enacted by promoting their supposed safeguards. However, pieces have begun to appear in the mainstream press suggesting that assisted suicide should be available to the chronically ill. As described in a previous Not Dead Yet blog, a lawyer writing in the New York Law Journal asserts that assisted suicide should be available to both the chronically ill and those deemed to be in cognitive decline and that a self-administration requirement is discriminatory. A Connecticut legislator supports passing an assisted suicide law in its “restricted” version because that “would open the door to evaluation and expansion.” If an assisted suicide law is in effect in any state ten years from now, it may well rival Canada’s.

The New York Times piece fails because it considers whether Canada should amend its assisted suicide/euthanasia law to include so-called mental illness as a discreet issue, unique to the presumed characteristics of psychiatric survivors, an issue where psychiatrists can disagree. Instead, it should have considered whether Canada’s pending expansion of its law is just one more object lesson as to why an assisted suicide law enacted in any form imperils everyone.