Rory Leishman:

Time and again, the Liberal government of Prime Minister Justin Trudeau has pledged that as of March 17, 2024, physicians and nurse practitioners in Canada will be authorized to kill suicidal patients who are suffering solely from a mental illness. What can account for this appalling prospect?

The Criminal Code of Canada clearly and unambiguously states in sections 14 and 241(b): (1) “No person is entitled to consent to have death inflicted on them” and (2) “Everyone is guilty of an indictable offence and liable to imprisonment for a term of not more than 14 years who, whether suicide ensues or not, (a) counsels a person to die by suicide or abets a person in dying by suicide; or (b) aids a person to die by suicide.”

This law is still in effect and used to apply to all Canadians with no exemption for physicians, nurse practitioners or anyone else. That changed when the Supreme Court of Canada arbitrarily decreed in Carter v. Canada (2015) that the right to “life, liberty and security of the person” in section 7 of the Canadian Charter of Rights and Freedoms confers upon Canadians the right to death by physician-assisted suicide provided the patient is a medically competent adult and “has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual.”

On the face of it, this far-fetched interpretation of the Charter makes no sense. Yet, instead of invoking the notwithstanding clause of the Charter to contest the precedent-shattering ruling, the Justin Trudeau Liberals kowtowed to the Court by introducing the Medical Assistance in Dying (MAID) ACT of 2016 which legalized physician-assisted suicide under the conditions dictated by the Court, subject only to the additional proviso that the death of the suicidal patient must be “reasonably foreseeable.”

Three years later, in response to the ruling by the Superior Court of Québec in Truchon (2019), Parliament expanded MAID to include persons whose death is not reasonably foreseeable. What will be next: Legalization of physician-assisted death for mentally incompetent patients who cannot give informed consent to the death-dealing procedure?

That is a distinct possibility. In a letter sent on June to the Special Joint Committee of the Parliament of Canada on Medical Assistance in Dying, Jean-Yves Duclos and David Lametti, then respectively the federal ministers of Health and Justice, conceded that many medical practitioners have expressed concerns about legalizing MAID for patients who once signed an advance consent to euthanasia or physician-assisted suicide while they were mentally competent, but are “unable to reconfirm their desire for MAID immediately before administration.” However, instead of pledging to uphold the existing ban on euthanasia or physician-assisted suicide for any mentally incompetent person, Duclos and Lametti said the Trudeau government considers that legalizing advance directives for MAID is a “complex issue” requiring “significant work, including further consultation and study.”

Note that the Criminal Code still provides that only patients who are suffering from “a grievous and irremediable medical condition” are entitled to MAiD. That raises a crucial question: How can a physician be sure beyond a reasonable doubt that a patient is afflicted with an irremediable condition?

In the case of persons whose death is not “reasonably foreseeable,” such certainty is clearly impossible. Have the judicial and political proponents of expanded MAID never heard about a patient afflicted with a most grievous medical condition who was blessed with a seemingly miraculous cure?

Determining the competence of the medically ill to give informed consent to MAID is also fraught with difficulty. In a recent article advising against physician-assisted death (PAD) for the mentally ill published in World Psychiatry: The Official Journal of the World Psychiatric Association, Dr. Paul S. Applebaum, Past President of the American Psychiatric Association, observed: “Even the most skilled of psychiatric evaluators will find it difficult to ascertain the extent to which the patient is making a judgment independent of the influence of the psychiatric disorder itself.”

In summation, wrote Applebaum: “There appear to be ample reasons to conclude that adoption of PAD for psychiatric disorders is likely to yield more harm than good.” Therefore, the American Psychiatric Association takes the position that “a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.’”

Regardless of all such advice and warnings, our federal and provincial rulers in Canada are determined to sanction MAID for persons who are suffering solely from a mental illness. In cities across the country, we will soon have the sorry spectacle of some psychiatrists helping patients to commit suicide, while other psychiatrists strive to assure their most vulnerable patients get the care and treatment they urgently need to safeguard their lives.