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Daniel Zekveld: Ring the alarm—Canada is failing to safeguard those with mental illness from MAID

Commentary

Parliament voted in 2021 to legalize “medical assistance in dying” (MAID) for people whose sole underlying condition is mental illness. But after wrestling with the ethical and practical complications of MAID for mental illness, parliamentarians have delayed the coming into force of that law until 2027. 

Patients eligible for MAID in Canada are separated into “track 1” and “track 2,” which require slightly different processes and safeguards. Track 1 is for those whose natural death is reasonably foreseeable, while track 2 is for those who have an irremediable medical condition but are not nearing death. 

MAID deaths overall were relatively equal between men (51.4 percent) and women (48.6 percent) in 2022. However, track 2 MAID cases have a significantly skewed gender ratio. In 2022, 59 percent of those who received track 2 MAID were women and 41 percent were men. Why would there be such a disparity? A key possible answer is that Canada is already euthanizing people with mental illness who disproportionately tend to be women.

The gender gap

Consider euthanasia and assisted suicide (EAS) in the Netherlands, for comparison. Overall, rates of men and women receiving EAS in the Netherlands in 2022 were nearly equal, at 50.6 percent male and 49.4 percent female, which is similar to Canadian rates for MAID overall. When it comes to EAS for psychiatric conditions, however, the rates become drastically unequal. One study found that between 2012 and 2018, 65 percent of those granted psychiatric EAS in the Netherlands were female and 35 percent were male. Another study found that women make up between 69 and 77 percent of all those who request and receive psychiatric EAS in Belgium and the Netherlands. 

The gender disparity for psychiatric MAID in the few nations where it has been legalized mirrors the ratio of female-male suicide attempts. Although male suicide attempts are lethal at twice the rate of female attempts, women attempt suicide at twice the rate of men. The British Journal of Psychiatry notes that women are less likely than men to cause themselves pain or violence. In China, for example, high female suicide rates into the early 2000s, particularly in rural areas, were attributed to relatively easy access to non-violent means. Another group of researchers concludes “that the availability of EAS in the Netherlands may render more effective the wish to die of women whose suffering from mental illness is unbearable.”  

Canada must grapple with this evidence as the legalization of MAID for mental illness looms. But gender disparity in MAID is already a reality in Canada, particularly within track 2 which lacks effective safeguards to prevent patients with mental illness from using MAID as a means of suicide. Canadians should be raising the alarm that track 2 may also be simply “render[ing] more effective the wish to die of women whose suffering from mental illness is unbearable.”  

Lack of safeguards in track 2

Canada’s current MAID law excludes MAID for mental illness as the sole underlying medical condition. But our law does not exclude MAID for mental illness entirely. Even if a MAID request is related to a patient’s mental illness, they may still receive MAID provided they have another irremediable condition that causes intolerable physical or psychological suffering. 

For example, an able-bodied patient who is depressed is not eligible for MAID. But a person with a serious disability caused by a major accident may be, even if they are not nearing natural death. That same patient might ultimately request MAID because of their depression but be approved because of their disability. In fact, it may be that more patients dying by track 2 MAID suffer from mental illness. As Dr. Sonu Gaind explained about “suicidality”: “On the face of it, even if you look at what the word means, when somebody wants to die and they’re not dying, of course that means that they’re suicidal.”

In Canada, a patient might be offered counselling to help relieve suffering, but there is no requirement to address mental illness prior to providing MAID. The patient must be informed of “means available to relieve their suffering” and the patient and medical practitioner must agree “that the person has given serious consideration to those means.”See Criminal Code ss. 241.2(3.1)(g)(h)) Even so, it can be challenging to determine what means might relieve one’s suffering. 

Minister of Health Mark Holland, centre, Women and Gender Equality and Youth Minister Marci Ien, left, and Deputy Prime Minister and Minister of Finance Chrystia Freeland, right, participate in a news conference to announce a new youth mental health fund at the National Press Theatre in Ottawa on Tuesday, April 9, 2024. Patrick Doyle/The Canadian Press.

In the State of Oregon, by contrast, if one of two physicians assessing a patient believes that judgment may be impaired by a psychiatric or psychological disorder or depression, the physician must refer the patient for counselling and cannot prescribe MAID medication until it is determined the patient’s judgment is not impaired. Even this safeguard, however, is complicated by an inevitable element of physician subjectivity in assessing a patient’s capacity to choose MAID. 

One research paper on psychiatric EAS in the Netherlands notes that granting requests “appears to involve considerable physician judgment, usually involving multiple physicians who do not always agree (and sometimes without independent psychiatric input).” 

In Canada, while there is a requirement for two physicians or nurse practitioners to approve a request, there is no requirement for a psychiatrist to be involved. Further, if one physician deems a patient ineligible, the patient may look for another doctor who believes otherwise. As a result, patients are currently being approved for MAID due to mental illness. 

Take, for instance, the story of Donna Duncan. Duncan was in a car accident in 2020, following which she suffered from post-concussion syndrome and various mental health problems. Duncan was approved for MAID by two physicians in October 2021 and euthanized shortly thereafter. Duncan’s daughters believed she would have recovered with proper treatment for depression, stating that “it took a year to get treatment but it could only take four days to die.” 

In 2022, 23-year-old Kiano Vafaeian had reportedly been approved for MAID. His only physical disabilities were diabetes and loss of vision in one eye, but he was also depressed. He was approved for MAID. Vafaeian’s mother found out about his scheduled MAID death and began posting about the situation on social media, stating “the doctor literally has given him the gun to kill himself.” Because of Kiano’s mother’s advocacy, the doctor decided not to go through with providing MAID. 

The failure of track 2 MAID

The problems with track 2 MAID continue, including stories of people who access MAID instead of the necessary supports, an issue that the Canadian Human Rights Commissioner recently urged the government to thoroughly examine. Beyond that, track 2 is providing MAID for those who are not dying, some of whom are suffering from mental illness. 

Canadian MAID data does not separate mental illness from other MAID requests as the Netherlands does. But the lack of safeguards, stories of Canadians being approved for MAID despite mental illness, and of course the gender disparity in track 2 MAID, are alarming. At the very least, track 2 MAID needs more effective safeguards. Rather than consider further expansion of MAID, the federal government ought to focus on resolving existing problems and refuse to provide a fail-proof means of suicide to Canadians who are not dying. 

Joanna Baron: It’s time to stop giving the pro-Palestine protestors the benefit of the doubt

Commentary

At a scrum on Monday morning, Deputy Prime Minister Chrystia Freeland was asked about the protests on Parliament Hill over the weekend where pro-Palestine protestors chanted “Long live October 7” and “October 7 is proof that we are almost free.” As Jews were preparing to celebrate our liberation from slavery at the Seder table, and with over 130 hostages snatched by Hamas still unaccounted for, Freeland could not muster a clear condemnation of those who would celebrate their murder, torture, rape, and kidnapping. “I wasn’t in Ottawa over the weekend,” she demurred. 

A few hours later, after gathering her talking points, Freeland issued a statement expressing “shock and disgust” at the protests. But the fact that she needed time to consult with her comms staff before doing so is evocative of a much bigger problem. Imagine a crowd cheering in approval of the lynchings of Black people. Can there be any doubt that Freeland wouldn’t have found herself similarly muzzled in her response?

As protestors were jubilantly celebrating the October 7 pogroms as proof of their imminent freedom in Ottawa, campuses in the United States have been similarly roiled with increasingly tense pro-Palestine encampments. The campus groups are nominally asking for amnesty for students who had been suspended for earlier protests, divestment from certain Israel bonds, and disclosure of how the university invests its billions in endowments.

Some of the happenings at the Yale and Columbia encampments seemed like standard university tactics. There were exhortations to bring toothpaste, dance shows, and zine workshops. There were Shabbat services led by anti-Zionist Jewish student groups and Muslim prayers. I have to admit, as someone who hasn’t studied on a university campus for over a decade, I have a wistfulness for both youthful idealism and the meaning-making impulse to join up with a cause bigger than one’s self.

But erstwhile defenders of the youth simply expressing noble, if somewhat naive, pacificism, are missing the clear lust for violence on display at these protests. As much as I support free expression, the level of support for terrorist tactics like October 7 at these protests is a threat to liberal democracies that cannot be dismissed as mere peaceful protests by naïve youth.

There were cut-and-dry legal wrongs being committed: assault, including where Jewish students and faculty who merely committed the sin of being visibly Jewish were encircled with human chains and physically blocked. There was a young masked blonde woman who carried a sign menacing a group of pro-Israel counter-protestors as “AL-QASM’s NEXT TARGETS,” referring to the armed wing of Hamas that led the October 7th attacks and arguably a direct incitement to violence and clear grounds for expulsion under Columbia’s code of conduct. A Jewish woman, Sahar Tartak, was poked in the eye with a Palestinian flag and had to go to hospital.

But the most loathsome aspect of the weekend’s horror shows on both sides of the border was the unanimity with which pro-war, pro-eradication of Jewish and Israeli life, and pro-terror slogans were embraced by the crowds. The whole crowd joined in on chants of “Go back to Poland,” and “Burn Tel Aviv to the ground.” 

Two weeks ago in downtown Toronto, a “ceasefire now” pro-Palestine protest let its mask slip when, upon hearing a loudspeaker announcement that the Islamic Republic of Iran had sent 300 drones and missiles to Israel, virtually all those present, including children, hooted and cheered in delight. 

And, of course, in Ottawa, practically the whole crowd went along with gleeful chants in support of October 7. 

These protestors are not for peace, they are for violence— seemingly even beyond the borders of Israel and Palestine. When they say death to America and death to Israel, I believe they mean it.

This truth which is apparent to anybody with eyes and 30 seconds to watch a social media clip is frequently being downplayed as a few bad apples. Special Representative on Combatting Islamophobia Amira Elghawaby tweeted that the “problematic speech” of a “few individual protesters” is unacceptable and contrary to our shared values but then added she was concerned about “deliberate efforts to smear all protesters with one brush. It’s difficult to square Elghawaby’s assertion that it was only a “few individual protestors” when clearly the hateful chants were coming from the whole crowd on Parliament Hill.

Pro-Palestine protestors take part in a demonstration on Parliament Hill in Ottawa, Sunday, Oct. 22, 2023. THE CANADIAN PRESS/Spencer Colby

Moreover, the pro-Palestine movement has repeatedly failed to purge itself from its continually prominent hateful elements. Not every Columbia student might have been onside with marking Jewish students as the Hamas Al-Qassam Brigade’s next targets, but there has been no public disavowal of this conduct, nor of violence against Jews and Israelis generally. As Bret Stephens noted in the New York Times a few weeks ago, “The mark of a morally serious movement lies in its determination to weed out its worst members and stamp out its worst ideas. What we’ve too often seen from the ‘Free Palestine’ crowd is precisely the opposite.”

This is no accident. It follows from the ideological foundations of the movement which are plain for anyone to see. The main student organization behind the campus protests, Students for Justice in Palestine, issued this statement after October 7th:

Today, we witness a historic win for the Palestinian resistance: across land, air, and sea, our people have broken down the artificial barriers of the Zionist entity, taking with it the facade of an impenetrable settler colony and reminding each of us that total return and liberation to Palestine is near.

In the settler-colonialism ideology, which was spoon-fed to the students at the same elite institutions now scrambling to contain its fruits, any critical assessment of the colonized’s means of resistance—apparently, up to and including rape and torture, and slaughter of innocents—is an unacceptable imposition of white colonizer standards.

Alarmingly, this ideological framework also extends to rejecting the basic premises of a free society governed by laws. Yesterday, Students for Justice in Palestine tweeted out “WE REFUSE TO BE SUBSUMED INTO A LIBERAL FIRST AMENDMENT FRAMEWORK!”

What they mean is that they don’t want to be accommodated within a liberal society, they want to burn it to the ground. We’d best listen and act accordingly.