For decades, people who want to end their life with the help of a doctor, and who have the means to do so, have travelled to a handful of countries, commonly Switzerland, for euthanasia.
But gradually, more countries around the world have begun to permit some form of assisted dying. Politicians in a number of others, including Ireland, Scotland and France, are now seriously debating it.
In Canada, where medical assistance in dying (Maid) became legal in 2016, the government intends to extend eligibility to people whose sole reason for ending their life is mental illness. But that planned expansion, now twice delayed, is deeply controversial.
In this episode of The Conversation Weekly podcast, we speak to a leading psychiatrist about the situation in Canada and why he’s a vocal opponent of the expansion.
When Karandeep Sonu Gaind began working as a psychiatrist more than 20 years ago, there were no assisted dying laws on the horizon in Canada. He never envisaged his role as a doctor would extend to helping patients end their life. “All of that changed quite recently, and in a relatively short space of time,” he said.
In 2016, Canada passed a law allowing medically assisted dying for people who were dying or terminally ill. Alongside his role at as a professor of psychiatry at the University of Toronto, Gaind was then chief-of-psychiatry at the city’s Humber River Hospital.
He became chair of the hospital’s Maid panel, setting up policies around the new law and initially having an oversight role of clinical cases. “I did believe there were some circumstances in which we could compassionately offer this pathway for people to avoid a painful death,” said Gaind. But he’s deeply concerned about the expansions that have happened since.
A court case led to the 2021 extension of Maid to those whose illness or disability is not necessarily fatal, but is incurable and causes unbearable suffering. Then the following year, the Canadian government announced plans to extend Maid to those suffering solely from mental illness, also known as psychiatric euthanasia.
The expansion was due to come into force in March 2023, but was delayed until March 2024. Then in February, a few weeks before the new provision was due to start, the government announced a delay until March 2027. If this is eventually happpens, Canada will join a handful of other countries – the Netherlands, Belgium and Switzerland – in permitting psychiatric euthanasia.
Those in favour of extending eligibility to those solely suffering from mental illness argue not to do so is a form of discrimination and restricts a person’s autonomy.
But Gaind says these arguments overlook what he believes are distinct differences between assisted dying for those suffering from physical and mental illness – for example, around whether a particular condition is irremediable, or whether the person has a medical condition that will not improve.
We need to be able to assess and predict for each patient whether or not they will get better from their medical condition. And unlike things like cancer [and] other medical conditions where, especially when they’re at an advanced stage, their outcome is far more predictable, for mental illnesses, all of the evidence across the world shows us we simply cannot make those predictions with any honesty.
In 2022, the last year for which numbers are available, more than 13,000 people ended their life through Maid, 4% of all deaths in Canada. (For comparison, in the Netherlands, where assisted dying has been legal in some form since 2002, it accounted for around 5% of all deaths in 2022.) Gaind believes Canada is already an outlier in the way its expanding eligibility, and he’s concerned about the reasons people are seeking to end their life.
It’s led to a situation where people are able to get Maid fuelled by all sorts of life suffering. And we’re seeing this, including things like poverty, including things like lack of access to care.
Listen to the full interview with Karandeep Sonu Gaind on The Conversation Weekly podcast, plus an introduction from Patricia Nicholson, health and medicine editor at The Conversation in Canada.
A transcript of this episode will be available shortly.
This episode of The Conversation Weekly was written by Gemma Ware and produced by Mend Mariwany and Katie Flood. Sound design was by Eloise Stevens, and our theme music is by Neeta Sarl. Stephen Khan is our global executive editor and Soraya Nandy does our transcripts.
Newsclips in this episode from Global News.
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