Quebec to expand assisted death to mentally ill, but few expected to qualify

MONTREAL — Quebec plans to expand medical aid in dying to include people with severe, incurable mental illness, the province’s health minister says, with guidelines to be drawn up by the provincial college of physicians.

Health Minister Danielle McCann told a news conference Tuesday that people with mental health issues who aren’t responding to treatment would be able to ask for the procedure — but she stressed such cases would be exceptional.

The college of physicians also said it expects that few people would be affected.

“We don’t expect many of these patients will qualify, because one of the other criteria that remains is to suffer from a disease that is not curable, which is not necessarily the case of all mental health situations,” said Dr. Yves Robert, the college’s secretary. “It will really be an individual, case-by-case decision that will be done.”

On Tuesday, the Quebec government announced it would comply with a court ruling last year striking down part of its medical aid in dying legislation — specifically the requirement that someone seeking medically assisted death be “at the end of life.” The same Quebec Superior Court judgment invalidated the “reasonably foreseeable natural death” requirement of the federal Criminal Code.

To comply with the provincial law, prospective recipients would still have to be 18 years old or older, have the mental capacity to make their own decisions about medical care, suffer from a serious and incurable illness and be in constant and unbearable physical or psychological pain that can’t be relieved.

Speaking to reporters, McCann confirmed that severely mentally ill patients could qualify.

“The guide will be modified to include safeguards, elements that allow (for) medical aid in dying for people who have severe mental disorders and who are resistant to any treatment,” McCann said.

She spoke of possible additional criteria for the mentally ill —  a psychiatrist would need to be consulted — and said the delay before medical aid in dying is given would be longer.

The proposed changes follow Quebec Superior Court Justice Christine Baudouin’s ruling in September in a case brought by two Quebec residents who suffered from incurable degenerative diseases but did not meet the criteria for assisted death.

The judge declared unconstitutional the “reasonably foreseeable natural death” requirement of the Criminal Code and the section of the Quebec law stating people must “be at the end of life.”

The federal government has said it accepts the Quebec court’s ruling and will amend the federal law accordingly, launching public consultations on how to implement the necessary changes.

Those consultations will look at issues including whether those suffering from mental illness and “mature minors” should be eligible, as well as whether those who fear losing mental capacity and being unable to provide consent should be allowed to make advance requests for medical assistance in dying. A parliamentary review of the law is to begin this summer.

Critics have said that assisted death for those whose only condition is mental illness raises complex moral and ethical issues. Some have argued there’s a lack of evidence that mental illness is an incurable condition, and others have said more should be invested into treatment and resources for those suffering from mental illness.

Robert said that in jurisdictions such as Belgium and the Netherlands that brought in euthanasia legislation before Canada, mental health cases have been a minority of overall cases.

The college is just beginning its reflection on the mental health matter and will take time to consult groups and determine who would qualify.

“We are approaching a no-man’s land, where nobody else was before, so to be prudent and to take the time to have a good reflection and to do one step at a time and do it in a spirit of serenity and wisdom is probably the best way to handle and treat these very delicate and complicated issues,” Robert said.

This report by The Canadian Press was first published Jan. 22, 2020.

Sidhartha Banerjee, The Canadian Press