On March 17th, 2023, the mentally ill in Canada will be able to qualify for medical assistance in dying (MAiD), or medical assisted suicide. This comes as a result of the passing of Bill C-7 in March of 2021, which modified the previous criteria set in place by Bill C-14, the original bill that instituted MAiD, to exclude the portion that required those seeking MAiD to have a “reasonably foreseeable” death.
After Bill C-7 passed, many disability activists bravely spoke up against the bill stating that the expansion could easily be used to exploit the disabled community (which it already has) including the mentally ill, and they were right. Let’s dive deeper to explore why.
Though I personally agree with the concept of MAiD, I do not support the recent expansion to include the mentally ill (as well as the disabled). Especially, when there are no current safeguards in place to protect those who are most vulnerable, such as the homeless, precariously housed, and/or impoverished.
The Mentally Ill and MAiD
Those living with serious mental health illnesses disproportionately live in poverty. 1 in 5 Canadians will struggle with a mental illness in a given year, and 45% of those who are homeless either have a mental illness or disability in Canada. 35% of those on the Ontario Disability Support Program (ODSP) have a diagnosed mental illness. In 2014, 23% of Canadians classified as disabled were low income and, according to the Homeless Hub, “people living with disabilities, both mental and physical, are twice as likely to live below the poverty line”. The mental illnesses that will qualify for MAiD are: bipolar disorder, post-traumatic stress disorder (PTSD), depression, schizophrenia, and personality disorders. It is unclear what other mental illnesses will qualify, as of now.
These statistics raise red flags as cost of living struggles are often amplified by those living with mental illness or a disability. ODSP’s highest rate of income per month, in 2020, for a single person, was $1169. 1169 is less than rent in most regions of Ontario ($1027 – $1635), before even considering food, electricity, transit, and other necessities. Further, contrary to popular belief, ODSP excludes certain treatment expenses; like certain pharmaceuticals (particularly name brand) or medicinal cannabis, furthering the struggle of those on ODSP.
As a result, the current ODSP plan legislates both enforced poverty and suffering on the disabled in Ontario.Since 1 in 3 of those on ODSP have a mental illness, the mentally ill on ODSP are at a greater risk of being pressured into accepting MAiD when they can no longer afford to live with dignity.
A devastating case study
Recently, a Toronto woman named Sophia, with multiple chemical sensitivities (a disability), partook in MAiD. Sophia attributed this in part to her miserable living environment, saying it contributed to her condition. After 2-years of fighting for assistance from “all levels of government” to help in improving her living conditions. Peris, a worker from an organisation who assists people with multiple chemical sensitivities and who interacted with Sophia, stated that “it’s not that she didn’t want to live – she couldn’t live that way” (CTV News).
Disability activist Sarah Colero called the case heartbreaking, saying; “Along with remembering her, we need to remember that her death was 100% preventable had it not been for systemic ableism failing her. For the few stories that are told, there are hundreds of untold stories being written. That’s why Sophia’s words & story are so impactful. We need to honor Sophia by learning from her story, not by having it be repeated due to the same systemic failures.”
During a CTV News interview about the case, Dr. Claudia Miller, a board certified allergist/immunologist from the University of Texas San Antonio, said: “It’s a sad statement. …people are so desperate they do want to die — I think that’s completely an indication of a huge failure…a societal failure. It’s …..such a bad statement about not just Canadian government, but any government that allows that to occur”.
Those who are mentally ill, but not on disability, can still struggle to pay for their pharmaceuticals and therapy for condition management. According to the Toronto Star, 1 in 5 Canadians “either did not have prescription drug insurance or had inadequate insurance to cover their medication needs” and 1 in 4 “Canadian households were having difficulty finding money to buy their medicines”. Wait times for therapy can also be incredibly long, taking between 1 to 4 months to access counselling (as of and 2020).
Real World Scenario
If an individual with schizophrenia is unable to afford their antipsychotic medication, their symptoms will likely return. If that same individual goes to the hospital, where they are treated and then discharged, but still not able to afford to take their anti-psychotics, they could end up back in the hospital. If this continues to happen over an extended period of time, this individual may be pushed into considering MAiD as they are deemed “unable” to control their condition. Though they could apply for ODSP, their medication may not be covered, which would continue the cycle. Ultimately, being forced to live in a state of poverty may push these individuals suffering with serious mental illnesses to seek MAiD as they can not afford to live in an environment that promotes wellbeing.
What Should Have Been Done
Before expanding MAiD to include the mentally ill, the federal government should have worked with the provinces to implement other measures that would have safeguarded against the misuse of MAiD, before expanding it. Such policy measurements include universal pharmacare, true universal mental health therapy andcare, universal housing and significant increases to disability payments.
Disability payments are a core component of any solutions – they ensure that the mentally ill would be given a chance to be successfully treated for their condition and be able to live a life benefitting their mental wellbeing, before considering MAiD.
The federal government had the chance to begin the process of implementing a universal pharmacare system (Bill C-213, a private members bill brought forth by the NDP) in 2021, a policy favoured by 86% of Canadians according to a poll by the Angus Reid Institute. It was voted down by other parties. Only a month later, in 2021, Bill C-7 would pass, which opened the door to include the mentally ill in MAiD.
In the end, it should be of the utmost importance to protect the most vulnerable within our society rather than absolving ourselves by incentivizing MAiD for people who have been failed by their government. Certain measurements should be in place to ensure that the mentally ill are given the opportunity to be treated, before given the option to end their own life.
A study from 2017, by Rousseau et al., shows that even Canadian psychiatrists disagree with the thought of including the mentally ill in MAiD, with 70.6% rejecting such a notion. Dr. Mark Sinyor, a psychiatrist from Sunnybrook Health Sciences Centre, stated in response to the potentiality of including the mentally ill in MAiD: “how many Canadians who will access this treatment may have suffering that could be remediated with adequate treatment? Without research, no one can say. Proceeding without testing that question is unconscionable and fundamentally anti-scientific. The only rational response for psychiatrists is to refuse to participate until and unless evidence clearly shows that this practice is safe and that the potential benefits outweigh the harms”.
Thank you to disability activist Sarah Colero for being a consultant for this article.