Ottawa seeks to delay expansion of MAID to treat mental disorders

Dr. Madeline Li, a psychiatrist at the Princess Margaret Cancer Care Center in Toronto, said the expansion of MAID will allow physician training to revolve around best practice standards that are still being developed.Christopher Kasarov/The Globe and Mail

The federal government will ask parliament to delay an extension to assisted dying for mental disorders after many leading psychiatrists and mental health advocates argue that appropriate safeguards are not yet in place and the healthcare system is not ready for the controversial changes.

“At the end of the day, we’re going to be careful, we’re going to be gradual so we don’t make mistakes,” Attorney General David Lametti announced at a news conference Thursday.He said provinces, territories and health care Professionals have made it clear that more time is needed.

“We know we need to get this right to protect those who are vulnerable,” he said.

The new law, currently set to take effect on March 17 next year, will making Canada one of the few In a world where mental illness assisted death is allowed.

Delaying the expansion will require new legislation to be passed by parliament, which is now adjourned until the end of January. The government will have less than two months to change the law, although Mr Lametti said discussions were already underway.

It was unclear how much extra time the government would ask for, but Mr Lametti stressed it was only a delay and the government still considered expanding MAID a priority. “We plan to take the next step,” he said. “We are committed to ensuring our laws protect everyone, while supporting the autonomy and freedom of choice that are at the heart of Canada’s maid system.”

when End of life medical assistance It became legal in 2016, following a Supreme Court ruling that only terminally ill patients are eligible to participate. In late 2019, a Quebec judge ruled that the legal limit was unconstitutional, and parliament amended MAID legislation to include adults without reasonably foreseeable deaths.

The change is effective immediately for Canadians with medical conditions, but is on hold For cases based solely on mental disorders, more time is given to investigate the issue. The two-year study period will officially end next March.

The decision to extend MAID to mental disorders has Questions That Divide Among Psychiatrists, and the focus of polarizing testimony to a parliamentary committee examining the issue this year. Over the past few months, groups such as the Canadian Medical Faculty’s chair of psychiatry and the Ontario Psychiatric Association have called for a delay to allow more time to develop standards and best practice and to conduct a closer review of existing science.

For example, the Maid Act required that a person must have an incurable disease to qualify. But experts say it’s challenging — if not impossible — for psychiatrists to reliably predict who will recover from mental illness. Researchers are also concerned that it may be difficult to identify suicidal patients among those who make legitimate euthanasia requests.

Critics worry that the standards of care are not complete enough to guide doctors and hospitals in applying the law consistently. Federally funded physician training has not been completed. The law would also expand at a time when the health care system is paralyzed by the fallout of the pandemic and overwhelmed by increased patient demand and strained resources.

“I’m relieved and grateful that the government will give us the time to do this,” said Madeleine Lee, a psychiatrist at the Princess Margaret Cancer Care Center in Toronto and scientific lead of a government-funded course on euthanasia for doctors. .

The delay will allow physician training to revolve around best practice standards that are still being developed, and give healthcare organizations more time to develop clear processes for staff handling complex MAID requests, Dr. Lee said.

“This allows for thoughtful consideration of gaps in existing legislation and challenges of implementation,” said Jack Haggarty, chair of the Department of Psychiatry at the Northern Ontario Medical School.

One issue that needs more discussion, he said, is how patients seeking MAID will access treatments that may help them, and how issues such as poverty and housing issues will be properly considered in decision-making.

However, Mona Gupta, a psychiatrist at the University of Montreal and chair of the Federal Panel of Maids and Mental Illness, sees no need for a delay and the system should have been ready to process new eligibility in March. She said the decision amounted to a “continued violation” of the rights of the patient group that the court had said should have access to MAID.

“If we’re going to disenfranchise people, then we have to be very clear about what we’re going to do to make sure people can exercise their rights,” Dr Gupta said. “Otherwise, it can always be argued that we are not in a state of full readiness.”

Sonu Gaind, director of psychiatry at Humber River Hospital, who has been an outspoken critic of MAID’s expansion, said he hoped the delay would allow more consultations to take place and the potential risks to marginalized and vulnerable patients carefully considered. Dr Gaind said that without clear, Evidence-based guidelines, “This is not where you jump out of the abyss”. “To subject people to arbitrary death would be the height of discrimination.”

Mr Rametti said that while some experts, such as Dr Gupta, believed doctors were prepared to deal with cases of maids with mental disorders, the government’s decision “was to make sure everyone was prepared”.

He also said the delay would give the government time to fully consider the recommendations of the parliamentary committee, which just concluded hearings at the end of November and is now due to deliver its final report in mid-February.

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