When Ross Douthat wrote about Canada’s love affair with the “holiness of euthanasia” in a December New York Times column, he hit a nerve. His primary argument is reductionist, facile, and oracular but correct in its essentials: “What if a society remains liberal but ceases to be civilized?” Is Canada, in truth, Douthat’s moral dystopia, the inexorable endpoint of a corrupting liberal trajectory? A cautionary tale for an American society caught in an embattled landscape of irreconcilable philosophies?
Yes and no.
What provokes Douthat is the pending law before the Canadian Parliament that will expand its Medical Assistance in Dying (MAiD) legislation. In 2016, medical assistance in dying became legal in Canada as long as certain conditions were met, including the restriction that only patients with terminal illness were eligible. Indeed, the natural death of the patient must be deemed as reasonably foreseeable and the suffering irremediable. In 2019, a Quebec judge ruled that this legal restriction was unconstitutional and that Parliament needed to amend the MAiD legislation to include adults who didn’t have a reasonably foreseeable death. In 2021, the revised MAiD came into force and almost immediately there were cries for even further amendments, including the right for those suffering from mental illness to elect their time of death. Parliament imposed a two-year study period before any further alterations, with new legislation to be debated and most likely enacted in March.
But this appears to be a step too far for many Canadians—liberal creatures that we are—and pushback has been formidable. The Association of Chairs of Psychiatry in Canada—the lead psychiatrists of Canada’s seventeen medical schools—called on the federal government to delay the expansion of assisted dying to people with mental illness. These psychiatrists, and many others in private practice, are especially vexed over the law’s irremediable condition clause, arguing that it is very difficult, if not impossible, to predict accurately who will and who will not recover from a mental disorder. The Chairs Association makes the point that experts will need to find some common ground on “operational definitions of irremediability for different mental disorders” because no such consensus currently exists. In addition, many psychiatrists are disturbed by the simple clinical reality that physicians might find it challenging to distinguish between a client who is suffering from acute suicidal ideation, and one who is rationally seeking an assisted death as the final remedy for unendurable pain.
It is important to acknowledge that the primary concern of the psychiatrists is not the law per se, but its expansion to include mental-health candidates without any kind of training regimen established for evaluating these candidates. Medical school curricula need to be upgraded, safeguards put in place, and the full airing of contentious issues around prognosis assured before any expansion of the legislation is enacted.