Pushing a message of death

NICK EICHER, HOST: Coming up next on The World and Everything in It: euthanasia in Canada.

On Thursday, Canada’s House of Commons voted to postpone expansion until 2027 of a law known as MAiD, an acronym for Medical Assistance in Dying. Here’s justice minister Arif Virani explaining the priorities of the Liberal Party government.

ARIF VIRANI: And what we understand as a government and as parliamentarians is that mental illness causes suffering and that suffering is equivalent to physical suffering.

Joining us now is Lia Milousis. She practices family law in the province of Ontario, and also serves as a human rights lawyer for the Acacia Group. She’s here to talk about what this means for vulnerable Canadians.

MARY REICHARD, HOST: Lia, good morning.

LIA MILOUSIS, GUEST: Good morning, Mary. Thanks for having me.

REICHARD: So Canada legalized euthanasia in 2016, but it was limited, and I’ll quote the law saying it’s reserved for those for whom “natural death has become reasonably foreseeable.” How did Canada get so far beyond that as we heard just moments ago where some in government are saying people should be able to end their lives if they have mental illness?

MILOUSIS: Yeah, that's a great question, Mary. And I would say the expansion has happened quite rapidly, so many Canadians aren't actually aware of what the steps have been.

So, back in 2015, the Supreme Court in the Carter v. Canada decision ruled that for individuals over the age of 18, who have a grievous and irremediable medical condition, where they have a condition that's in an advanced state of decline, and the suffering they experience is intolerable to them, they can consent to have a third party assist in ending their life. That then was codified in federal law, through Bill C-14. And as you said, you know, there was this requirement that death be reasonably foreseeable, and that that really was meant to capture the fact that the Supreme Court decision focused on a case where a woman had a terminal condition and was at the end of of her life.

Now, what happened, as inevitably happens when you start, you know, opening the door to something new as people fight over what the boundaries are. And so in 2019, there was a case in Quebec called the Truchon decision. And Nicole Gladu and Jean Truchon were two individuals who met all the other criteria except the end of life criteria. And so they had a condition that that they said was intolerable to them in terms of the suffering they experienced. And they argued that they should qualify, even though they were not near the end of their life. And the Court of First Instance concluded that that was the case that it was a violation of their Charter rights.

The issue was that that now MAiD, medical assistance in dying, is available to individuals with a mental illness. Because a mental illness is often a condition that, you know, it persists, it's a chronic condition that can cause intolerable suffering. And so there was a caveat added that this would not permit individuals whose sole underlying medical condition was a mental illness to qualify. So there was a kind of a safeguard built into the law. And then when that piece of legislation went to the Senate, the Senate disagreed. And so they recommended removing that and adjusting it. So that in 18 months, there would be the possibility for someone who has only a mental illness to qualify for medical assistance in dying. The federal government changed that to 24 months. And since then, there have been two different delays, two additional delays.

REICHARD: In that clip we played a moment ago, the member of parliament equated physical suffering and mental suffering, and the reasoning follows that therefore euthanasia should be available to people with both kinds of suffering. How would you respond to that argument?

MILOUSIS: Yeah, so I would agree, insofar as you know, I don't think it's appropriate for us to be telling people that their suffering isn't actually intolerable. We don't know. And so I, you know, having experienced a mental health issue myself, you know, frankly, I found it more intolerable than a physical condition would have been because I couldn't touch it. I couldn't see it. I couldn't, I couldn't point to anything that was actually the source of my suffering. It was this amorphous abstract pain. So I have immense empathy for people who experience mental health issues and experience psychological suffering.

The issue, though, is that there are actual differences between a mental illness and a physical illness. And one of the key ones from a medical perspective is the question of irremediability. And so the law requires that that the condition not be, there can't be a remedy–that things cannot improve. And the idea is that we're only going to be ending the lives of people that we cannot actually assist any further in living and recovering. And the issue with medical assistance and dying for mental illness as the only underlying condition is we don't actually know from a medical perspective, when a mental illness becomes irremediable or not.

When a doctor tries to evaluate based on certain criteria, whether someone's mental illness is going to never recover, that this will be the case for the rest of their life, we're only correct 47% of the time. So it's essentially a coin toss, whether we're going to be ending the life of someone who will never recover or whether we're going to be ending the life of someone who could have recovered with some additional treatment.

REICHARD: Last question: what’s the reason Canada is delaying expansion of MAiD?

MILOUSIS: The fact is that the medical community is not ready and is clear that there is not consensus on the irremediability of mental illnesses. And the fact is that we do not have the evidence to support this expansion. And I think the government has appropriately recognized that and is delaying. But really what it should have done, and I hope it still does do, is alter course entirely and abandon this idea of pushing a message of death when we really should be advocating for a message of hope. It frankly is unconscionable for a government to ever affirm the belief in an individual that their life has no meaning and no purpose anymore that is not within the purview of government authority. And our job as a society is to bring a message of hope and meaning and purpose when someone finds themselves in that place of despair and suffering.

REICHARD: Lia Milousis is a human rights lawyer for the Acacia Group in Ontario Canada.

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