Canada’s medical assistance in dying review was biased and ignored us, expert witnesses say

OTTAWA — Dozens of experts who testified before the parliamentary committee reviewing Canada’s medical assistance in dying (MAID) system are blasting what they say was a biased process.

In a scathing 11-page letter sent to government and medical officials as well as the committee itself, witnesses said they were “routinely talked over, ignored, argued with and at times openly disparaged by committee members in favour of amplifying the ideology of MAID expansionists and pro-MAID lobby groups.”

The final report of the Special Joint Committee on Medical Assistance in Dying “misconstrues, misrepresents, minimizes and completely ignores key evidence necessary to protect Canadians,” said the letter, signed by more than 40 physicians, people with direct personal experience with MAID programs, advocates and others.

Their alarm bells are the latest to be set off about Canada’s MAID regime. One planned expansion — allowing those with a mental illness as their sole condition to be eligible — has already drawn considerable criticism, while what the committee is recommending would expand access even further to covet certain minors, along with others.

While the federal government hasn’t committed to that, MAID opponents — and even many who are in favour of it in limited circumstances — have long raised concerns that expanding access will cause difficult issues down the road.

“I think we’re beyond anywhere where we thought we would get to,” said Dr. Sonu Gaind, one of the architects of the letter.

“We’re already there, and going further.”

Gaind, the chief of psychiatry at Sunnybrook hospital and a former physician chair of the Humber River Hospital MAID team, stresses that he is far from a “conscientious objector” to allowing some access to medical assistance in dying.

He said the impetus for the letter was a concern not just that the committee process was flawed, but that not enough Canadians are aware of the scope of the proposed changes — and the potential damage they could do.

“It’s been artificially presented that, ‘Oh, this is just about your autonomy to have a death with dignity,’” he said.

“Well, as we’re expanding it further, it goes way, way beyond that. It actually shifts from people seeking death with dignity to people seeking death to avoid having had a life that society hasn’t let them live with dignity.”

At this point in the debate, Gaind said Canadians should be concerned about why the government is expanding access to MAID.

“It’s not coming from a legal mandate, it’s not coming from public opinion and it’s not coming from evidence,” he said.

“What is left is ideology.”

Marc Garneau, the Liberal MP who co-chaired the committee, said it should be expected that some people won’t agree when recommendations are made about an issue as complex as MAID.

“Our job as a committee was to hear from witnesses and experts, weigh their testimony, whether they appeared before the committee or submitted a written brief and then make a set of well-considered recommendations to Parliament,” Garneau said in an email.

“I believe the committee did its job conscientiously.”

Canada’s MAID regime dates back to a 2015 Supreme Court decision, which struck down criminal provisions related to aiding suicide as a violation of Charter rights.

A parliamentary committee was the government’s response. It has since helped shape the legislative framework for physician-assisted deaths, starting with the first bill, known as C-14.

In 2019, a Quebec Superior Court ruled the original restrictions on access to MAID for those whose deaths were reasonably foreseeable were too narrow; from that flowed the first expansion, a law known as C-7.

Although the government had not originally intended for C-7 to allow those with a mental illness as their sole condition to be eligible for MAID, it bowed to pressure from senators who believed such an exclusion would be unconstitutional.

A two-year delay was imposed before the mental illness provision was to be made available. The clock was supposed to run out this month, but the government is now pushing that deadline back by a year.

The letter castigates the committee for how it addressed the mental illness question, claiming the government ignored evidence about the distinction between suicidal ideation and people with a psychiatric illness who want to access MAID.

Speaking in the Senate on Tuesday, Sen. Stan Kutcher said there has been a “tsunami” of misinformation around the mental health provisions, and that it is incorrect that someone who is suicidal can request MAID and receive it.

“A competent person with a mental disorder who is suffering terribly and persistently should be able to decide how they will choose to proceed with their life,” he said.

“To deny them this right while permitting it for people whose illness is not a mental disorder is not just stigmatizing, it is exclusionary.”

Correction — March 8, 2023:Speaking in the Senate on Tuesday, Sen. Stan Kutcher said it isincorrect that someone who is suicidal can request MAID and receive it. A previous verison of this article erroneously said Kutcher said a suicidal person should be able to request MAID.

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