Canada at a Crossroads: Recommendations on Medical Assistance in Dying and Persons with a Mental Disorder: An Evidence-Based Critique of the Halifax Group IRPP Report

In the wake of a Quebec lower court decision that invalidated the restriction in Canada's Medical Assistance in Dying Law (MAID) to situations where a person's natural death is "reasonably foreseeable," and the federal government's failure to appeal that decision, Canada is debating potential expansion of its MAID law. The MAID Expert Advisory Group’s (EAG) Canada at a Crossroads report provides an evidence-based review and recommendations to guide policy regarding MAiD and mental disorders. The EAG responds directly to a recent Institute for Research on Public Policy (IRPP) Report by the so-called Halifax group, which recommended to explicitly legalize the provision of life-ending interventions by physicians for people whose sole underlying condition is a mental disorder. This EAG report puts forward why the conclusions and several recommendations reached in the Halifax Group’s report are flawed, and why that report reflects incomplete or selective review and interpretation of existing evidence. Based on a fulsome review of evidence and on an identification of key differences between mental disorders and other progressive medical conditions, the EAG makes a core recommendation regarding MAiD MD-SUMC: to avoid further stigmatization and discrimination against those with mental disorders, the report recommends, MAiD policy and legislation should explicitly acknowledge that a priori determinations of irremediability and irreversible decline cannot be made for mental illnesses at this time, and therefore applications for MAiD for the sole underlying medical condition of a mental disorder cannot fulfill MAiD eligibility requirements. The report further emphasizes the need to impose a non-ambivalence criterion for MAiD in situations when death is not reasonably foreseeable; and the need to require a “lack of reasonable alternative” criterion for MAID, which is currently not part of Canadian MAID law. The report also discusses the concern that the proposed expansion of Canadian MAID law outside the end-of-life context, if implemented, would result in a direct promotion and perhaps even imposition of physician involvement in the provision of sub-standard care.