Everyone knows the tragic Shakespeare tale of how Juliet awakens from her “death” to discover that her love Romeo had taken his life, believing that Juliet had really died. Juliet, in her own state of sorrow, stabs herself with a dagger and is joined forever with her love Romeo.
This week, it was announced that the former Dutch Prime Minister, Dries van Agt and his wife Eugenie van Agt-Krekelberg passed away hand in hand by euthanasia at the age of 93. Together for more than 70 years, both Dries and Eugenie had been dealing with deteriorating health over recent years.
In Canada, under current law, those wishing to use medical assistance in dying (“MAID”) must satisfy all of the eligibility set out below:
- be eligible for publicly funded health care services;
- be 18 years of age or older;
- be capable of making health care decisions;
- voluntarily request medical assistance in dying;
- be able to provide informed consent, which means that you have given permission after you have received all of the information you need to make your decision;
- have a grievous and irremediable medical condition, which means you:
- have a serious and incurable illness, disease or disability;
- are in an advanced state of irreversible decline in capability; and
- are enduring physical or psychological suffering caused by the medical condition or the state of decline, that is intolerable and cannot be relieved.
To determine if a person qualifies, a doctor or nurse practitioner will review his/her eligibility. If the person is eligible, then a second doctor or nurse practitioner will be required to complete a second assessment.
In 2022, there were 13,241 medically assisted deaths in Canada. I was surprised to read that there was a growth rate of medically assisted deaths of 31.2% in 2022 over 2021. Since MAID was introduced in 2016, there have been 44,958 medically assisted deaths in Canada.
MAID and Mental Health Illness
Currently, those suffering solely from a mental illness are not entitled to die by way of MAID (MAID MD-SUMC[1]).
Former Bill C-7[2], which was passed in March 2021, revised the eligibility criteria for obtaining MAID and the process of assessment. It also, temporarily excluded those who were suffering solely from mental illness from being eligible to participate in MAID for a period of 24 months. The delay was meant to provide the provinces and territories the opportunity to prepare for the ability for an individual who was solely suffering from mental illness to be eligible for MAID, by ensuring the proper protections were in place.
This period was extended to March 2023 and then subsequently delayed again until March 2024. The purpose of these delays was to provide additional time to study how MAID can be provided to those suffering from a mental illness and to ensure that necessary and appropriate safeguards can be introduced to protect these individuals.
In January 2024, a Special Joint Committee on Medical Assistance in Dying (the “AMAD”) released a final report recommending a further delay[3]. AMAD’s recommendation was that MAID not be made available to those suffering solely from a mental illness until Canada’s health care system can adequately and safely provide for MAID in these cases.
On February 1, 2024, the Government of Canada tabled legislation (Bill C-62[4]) to delay eligibility for MAID when suffering solely from a mental illness until March 17, 2027[5]. Unless Bill C-62[6] is passed by Parliament and receives Royal Assent, the exclusion of those suffering from a mental illness wishing to die by medically assisted death will be repealed on March 17, 2024.
Stay turned for the evolving changes in the area of MAID and in particular MAID for those suffering solely from a mental illness. In the meantime, if you are interested in reading more about MAID, Dr. Shulman has written some great blogs on MAID which can be found at:
https://www.allaboutestates.ca/evaluation-capacity-consent-maid/
https://www.allaboutestates.ca/update-amendment-capacity-maid/
https://www.allaboutestates.ca/capacity-consent-maid-suggestion/
Gillian Fournie also wrote a blog on former Bill C-7 which can be found at https://www.allaboutestates.ca/maid-update-bill-c-7/
While from 2021, my colleague Tamar Silverbrook wrote a great blog reviewing the history of MAID, which can be found at https://www.allaboutestates.ca/medical-assistance-in-dying-maid-an-update/
[1] MAID MD-SUMC is medical assistance in dying for individuals whose sole underlying medical condition is a mental health illness.
[2] https://www.justice.gc.ca/eng/csj-sjc/pl/charter-charte/c7.html
[3] https://www.parl.ca/DocumentViewer/en/44-1/AMAD/report-3/
[4] C-62 – An Act to amend the Criminal Code (medical assistance in dying), No. 2 https://www.parl.ca/legisinfo/en/bill/44-1/c-62
[5] https://www.canada.ca/en/health-canada/news/2024/02/the-government-of-canada-introduces-legislation-to-delay-medical-assistance-in-dying-expansion-by-3-years.html
[6] This is currently at the Second Reading in Senate, having completed the First Reading on February 1, 2024, the Second Reading, Consideration in Committee and Report Stage on February 14, 2024 and the Third Reading in Parliament on February 15, 2024. The First Reading in Senate was completed on February 15, 2024.
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