Canada at a Crossroads: Recommendations on Medical Assistance in Dying and Persons with a Mental Disorder: An Evidence-Based Critique of the Halifax Group IRPP Report

(Toronto, Expert Advisory Group on Medical Assistance in Dying, 2020), 34 pages

34 Pages Posted: 21 Apr 2020 Last revised: 31 Oct 2021

See all articles by K. Sonu Gaind

K. Sonu Gaind

University of Toronto; University of Toronto

Allison Crawford

University of Toronto - Department of Psychiatry

Rose Geist

University of Toronto - Department of Psychiatry

Mark Henick

affiliation not provided to SSRN

Scott Y. Kim

National Institutes of Health; University of Michigan at Ann Arbor

Trudo Lemmens

University of Toronto - Faculty of Law

Brian Mishara

University of Quebec at Montreal (UQAM) - Faculty of Human Sciences

Harvey Schipper

University of Toronto - Faculty of Medicine

Tom Shakespeare

London School of Hygiene & Tropical Medicine

Sandy Simpson

University of Toronto - Department of Psychiatry

Timothy Stainton

affiliation not provided to SSRN

Georgia Vrakas

University of Quebec at Trois Rivieres

Date Written: March 26, 2020

Abstract

In the wake of a Quebec lower court decision that invalidated the restriction in Canada's Medical Assistance in Dying Law (MAID) to situations where a person's natural death is "reasonably foreseeable," and the federal government's failure to appeal that decision, Canada is debating potential expansion of its MAID law. The MAID 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 responds directly to a recent Institute for Research on Public Policy (IRPP) Report by the so-called Halifax group, which recommended to explicitly legalize the provision of life-ending interventions by physicians for people whose sole underlying condition is a mental disorder. This EAG report puts forward why the conclusions and several recommendations reached in the Halifax Group’s report are flawed, and why that report reflects incomplete or selective review and interpretation of existing evidence. Based on a fulsome review of evidence and on an identification of key differences between mental disorders and other progressive medical conditions, the EAG makes a core recommendation regarding MAiD MD-SUMC: to avoid further stigmatization and discrimination against those with mental disorders, the report recommends, MAiD policy and legislation should explicitly acknowledge that a priori 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. The report further emphasizes the need to impose a non-ambivalence criterion for MAiD in situations when death is not reasonably foreseeable; and the need to require a “lack of reasonable alternative” criterion for MAID, which is currently not part of Canadian MAID law. The report also discusses the concern that the proposed expansion of Canadian MAID law outside the end-of-life context, if implemented, would result in a direct promotion and perhaps even imposition of physician involvement in the provision of sub-standard care.

Keywords: Medical Assistance in Dying, Euthanasia, Physician Assisted Suicide, End of Life, Criminal law, constitutional law, vulnerability, mental health, human rights, autonomy

Suggested Citation

Gaind, K. Sonu and Crawford, Allison and Geist, Rose and Henick, Mark and Kim, Scott Y. and Lemmens, Trudo and Mishara, Brian and Schipper, Harvey and Shakespeare, Tom and Simpson, Sandy and Stainton, Timothy and Vrakas, Georgia, Canada at a Crossroads: Recommendations on Medical Assistance in Dying and Persons with a Mental Disorder: An Evidence-Based Critique of the Halifax Group IRPP Report (March 26, 2020). (Toronto, Expert Advisory Group on Medical Assistance in Dying, 2020), 34 pages, Available at SSRN: https://ssrn.com/abstract=3561601

K. Sonu Gaind

University of Toronto ( email )

Toronto, Ontario M5S 3G8
Canada

University of Toronto ( email )

Toronto, Ontario M5S 3G8
Canada

Allison Crawford

University of Toronto - Department of Psychiatry ( email )

Toronto
Canada

Rose Geist

University of Toronto - Department of Psychiatry ( email )

Toronto
Canada

Mark Henick

affiliation not provided to SSRN

Scott Y. Kim

National Institutes of Health ( email )

Warren G. Magnuson Clinical Center
Bethesda, MD 20895-1156
United States

University of Michigan at Ann Arbor ( email )

500 S. State Street
Ann Arbor, MI 48109
United States

Trudo Lemmens (Contact Author)

University of Toronto - Faculty of Law ( email )

78 and 84 Queen's Park
Toronto, Ontario M5S 2C5
Canada

Brian Mishara

University of Quebec at Montreal (UQAM) - Faculty of Human Sciences ( email )

320, rue Sainte-Catherine Est
Pavillon J.-A.-DeSève, local DS-1900
Montréal, Québec H2X 1L7
Canada

Harvey Schipper

University of Toronto - Faculty of Medicine ( email )

Toronto
Canada

Tom Shakespeare

London School of Hygiene & Tropical Medicine ( email )

Keppel Street
London, WC1E 7HT
United Kingdom

Sandy Simpson

University of Toronto - Department of Psychiatry ( email )

Toronto
Canada

Timothy Stainton

affiliation not provided to SSRN

Georgia Vrakas

University of Quebec at Trois Rivieres ( email )

POBox 500
Trois-Rivières, Québec G9A 5H7
Canada

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