From the age of 18, Kyle Thomson has struggled with depression and anxiety. “Where I live, quality help for mental illness is horrible,” claims Thomson, who resides in Brampton, Ont.. When he first found out about medical assistance in dying (MAID) in Canada, he was staying at St. Joseph’s Healthcare in Hamilton after checking himself in. He happened to come across an online article about assisted death and how it was going to be expanded to people solely afflicted with mental illnesses on March 17, 2023.
For Thomson, and many others suffering, it was a form of hope that didn’t exist before. “People don’t understand,” he says. “They don’t understand what it’s like. It was a form of extreme hope and some relief that there was an answer.”
Thomson, 49, attempted to end his life when he was 18 years old. He decided to commit suicide by taking an overdose of his mother’s schizophrenia pills while his family was out for the evening. This act left him in a coma for a week. When he saw both the reaction and the effect that it had on his family at the time, it deterred him from trying to take his life again. However, “It didn’t stop any of the below level awareness of my sadness. I feel like I’m a ghost inhabiting certain sections of people, but not really existing in the same place,” he explains.
Since then, Thomson has seen plenty of psychiatrists and doctors. He has gone through eight sessions of electroshock therapy, a treatment that uses electricity to induce seizures in the brain to alter mood and behavior. He has tried ayahuasca, a psychoactive and entheogenic brewed drink traditionally used ceremonially which causes psychedelic experiences, including visual hallucinations and altered perceptions of reality. Additionally, he has tried micro-dosing psilocybin, a hallucinogenic chemical in fungi known as magic mushrooms.
“I’ve done all the medications doctors have prescribed and nothing works. They will either mute the person you are, and you miss yourself, or they give you other issues like insomnia or tremors. My motivation is just gone,” said Thompson, who had hoped to take advantage of the updated law allowing people suffering from mental illness to seek assisted dying.
When Ottawa announced plans to delay the expansion of MAID until March 2024, Thomson said it was “traumatizing.” He doesn’t want to resort to taking his own life. Instead, he wants his last moments to be quiet and peaceful.
Medically Assisted Death in Canada
While some consider the practice to be an act of compassion, others argue that the system isn’t ready to grant those suffering from a mental illness access to medically assisted death. Canada’s MAID law was expected to change in March of this year, with the Liberal government set to introduce a new qualification — those suffering from mental illness. The senate voted to amend Bill C-7, the 2021 law which aligned MAID eligibility with court requirements to remove foreseeable deaths as a condition, in order to allow those who have grievous or irremediable mental illness and whose suffering is intolerable, to also access this procedure. The government agreed, but requested a two-year extension to prepare for implementation. The two years were set to expire in March 2023, however, the Liberal government introduced legislation in early 2023 to further delay the expansion.
Thomson says that politicians, or individuals in power “probably aren’t suffering to the point that others are. I just don’t think that they understand how low a human mind or soul can get.” He insists that the Expert Panel on MAID should include a person who has had experience with mental illness. “They need people in their circle that have experienced [mental illness] firsthand. That’s the biggest roadblock, I think. It’s like a blind person trying to explain the color orange — you can’t. They might get close to it, or have an idea of it, but they can’t.”
“These are people with longstanding mental disorders, with years, decades of treatment-resistant illnesses. It’s a small number of people [who wish to access medically assisted death], but they are people who are suffering similar to people with physical conditions.”
Sarah Dobec — Dying with Dignity Canada
Sarah Dobec, a Communications Specialist for Dying with Dignity Canada, says, “As an organization we were deeply disappointed by this delay. The reason people with mental illnesses were included in the first place is because it’s discrimination to exclude them from this legal right that every other Canadian has.”
Medically assisted death became legal in Canada in 2016. This came after the Supreme Court ruled that prohibiting assisted dying was a contravention of the Canadian Charter of Rights and Freedoms. Under the initial criteria, mentally capable, consenting adults whose deaths were reasonably foreseeable were able to apply for MAID. In March 2021, Bill C-7 was passed into law. Although this expanded access to MAID to include individuals whose deaths were not reasonably foreseeable, the update included a provision to temporarily exclude those whose sole underlying condition is a mental disorder from eligibility.
Some mental health advocates say that having the option of MAID would allow individuals suffering to die with dignity.
“These are people with longstanding mental disorders, with years, decades of treatment-resistant illnesses. It’s a small number of people [who wish to access medically assisted death], but they are people who are suffering similar to people with physical conditions,” explains Dobec.
Dying with Dignity Canada is a national human-rights charity committed to improving the quality of dying, protecting end-of-life rights, and helping Canadians avoid unwanted suffering. The advocacy group says that asking people who are in mental anguish to wait another year is extremely unfortunate.
“Denied the option of making an advance request for MAID, countless people across Canada live in fear of a possible catastrophic diagnosis, illness, accident or injury,” the organization’s website states. “This is cruel and inhumane — and wholly unnecessary.”
Others argue that the system simply isn’t ready to handle these changes, and that there aren’t clear enough guidelines or training available to ensure MAID is only offered to those who truly require it.
“To be honest, we could have gone forward with the original date,” Justice Minister David Lametti said at a news conference following the announcement of the further delay. “But we want to be sure, we want to be safe, we want everybody to be on the same page.”
An Extremely Complex Issue
According to the government, the one-year extension will provide additional time to prepare for the safe and consistent assessment and provision of MAID where the person’s sole medical condition is mental illness.
Jean-Yves Duclos, the federal Minister of Health states, “As MAID is a very personal and complex issue, the temporary exclusion would allow more time for regulators, clinicians, and others to better understand and implement guidelines and practices. This extension would play a crucial role in protecting the most vulnerable while supporting their autonomy, and ensuring assessors and providers are prepared and comfortable to support MAID for persons living with a mental illness, when it becomes available.”
While all parties supported the delay, the Conservatives are calling for the expansion to be scrapped altogether.
Pierre Poilievre, leader of the Conservative party, is against the use of MAID for cases of mental health stating that, “We don’t believe that medical assistance in dying for people whose only condition is mental health trouble. Experts tell us that depression and mental illness can come and go – that people can be suffering and desperate today, but a few months later be thankful that they still have their lives and their families. Our role should be to give them their hope, to help them get through the valley and back to the mountaintop.”
In May of 2022, the Government of Canada tabled the Expert Panel on MAID and Mental Illness’ final report in Parliament. The report sets out 19 recommendations for establishing a MAID regime that addresses questions that may arise in some MAID requests, and particularly where the person requesting MAID’s natural death is not reasonably foreseeable. This includes questions of incurability, irreversibility, capacity, suicidality, and the impact of structural vulnerabilities.
“Yes, there’s a fear of death. But there’s a companionship in it.”
KYLE TOMPSON
The Expert Panel on MAID and Mental Illness was formed in August 2021 to undertake a review respecting recommended protocols, guidance and safeguards to apply for requests for medical assistance in dying by persons who have a mental illness. The members of the Panel were chosen for their expertise in their fields and come from a broad range of disciplines, spanning clinical psychiatry, MAID assessment and provision, law, health professional training and regulation, mental health care services, as well as lived experience with mental illness.
Dr. Jeffrey Kirby resigned from the Expert Panel in April 2022. A retired professor in the Department of Bioethics, Faculty of Medicine at Dalhousie University, Dr. Kirby has experience in the direct delivery of mental health care services as a university-based physician-psychotherapist.
“I wasn’t comfortable,” said Kirby. “I couldn’t sign off in good conscience with recommendations that the panel had prepared because I didn’t agree with just soft recommendations.”
During his time on the panel, Dr. Kirby was advocating for one of the assessors in a case where the qualifying condition is mental health, to be an independent psychiatrist. He said, “This was an important recommendation from me, but in the end the report just wrote it as sort of a guidance recommendation.”
Dr. Kirby has published a set of academic papers in high-impact, international, bioethics journals on a variety of MAID-related topics that include medical assistance in dying for suffering arising from mental health disorders, and interpreting irremediability when a mental health disorder is the sole-qualifying medical condition for MAID.
Access to Services a Major Barrier
Other psychiatrists and mental health advocates see the expansion of MAID to include those suffering from a mental illness as a potentially dangerous overreach, and agree that the government needs to put in the work to provide vulnerable populations with the support needed to improve their daily lives.
“It’s no secret that our social support systems in Canada are lacking,” said Dobec. “Everybody deserves the support they need to thrive, whether it’s disability support, housing support, mental health support. COVID-19 has really shone a light on all the inadequacies in those systems, and everybody deserves a chance to try whatever they are interested in trying to address their mental illness.”
Dr. Kirby added, “[The government] should be putting in more effort and money into building up support services for persons with mental illness. In Belgium, when they introduced the euthanasia law in 2002 [which allowed euthanasia for adults who experience constant and unbearable physical or mental suffering that cannot be alleviated], they put an equal amount of money into all the structures that went around assisted dying. In this situation, we should put at least an equal amount of money and effort into improving mental health care services for individuals that can’t access it now.”
According to the World Health Organization, around 450 million people currently struggle with mental illness, making it the leading cause of disability worldwide. Here in Canada, it affects more than 6.7 million of us. While mental illness accounts for about 10 percent of the burden of disease in Ontario, it receives just seven percent of healthcare dollars.
While some may say that medically assisted death is the same as suicide, Thomson says that one is awful, and the other is quiet and mellow. He views the term “dying with dignity” as exactly what it is.
“Yes, there’s a fear of death. But there’s a companionship in it,” explains Thomson, who feels companionship is the last request of somebody screaming into the dark for a light.
“You hope that someone is there to turn on the light for you. I don’t want to die traumatically, at my own hand. I would rather it be peaceful, with somebody looking at me, whether it’s with compassion, or regret, or sadness. In the sadness there will be a thankful hope that whatever I’m getting will be what I want.”
