Montreal – As a result of a recent court decision in Quebec, many more persons with physical disabilities and chronic conditions could have access to MAiD, including persons with mental disorders as their sole underlying medical condition, says a new report from the Institute for Research on Public Policy.

In 2017, Jean Truchon and Nicole Gladu launched a court challenge against the federal MAiD legislation’s criterion that, for them to be eligible, their natural death had to be “reasonably foreseeable,” and the Quebec Act concerning end of life care criterion that they had to be at the “end of life.” In September 2019, a Quebec Superior Court judge struck down both of these provisions within the province, to come into effect on March 11, 2020. Both the federal and Quebec governments committed to not appeal the decision, and the federal government pledged to create a consistent solution across the country.

As Jocelyn Downie and her coauthors point out, “with these provisions gone, the issue of MAiD for persons with a mental disorder as their sole underlying medical condition has landed squarely and unavoidably on the desks of the federal Parliament and Quebec National Assembly.”

While the federal and Quebec governments’ first instinct may be to simply exclude cases like this outright, a blanket exclusion of all persons with mental disorders would be to further stigmatize and discriminate on the basis of mental illness. Such a response also discounts the very real suffering of these persons. Rather than excluding access to MAiD for all persons with MD-SUMC, the authors recommend making the eligibility criteria and oversight processes more robust. This would entail improving professional competencies for MAiD clinical assessments and establishing a new post hoc oversight process for complex cases, among other things. In particular, they recommend that:

• The federal and Quebec governments mandate that a person’s decision to request MAiD be “well-considered,” and that the assessment be of the decision-making process, not the quality of an individual’s decision;
• Health professions’ regulators establish explicit standards for clinical assessments of cases of persons with MD-SUMC, and that better training be provided to improve the eligibility-assessment skills of MAiD assessors and providers for these cases;
• The federal government establish a five-year consultation service to assist MAiD providers, assessors, and patients on request, as well as a five-year post hoc peer review process for all requests outside Quebec in cases where the person did not have a diagnosis of a lethal condition; and
• Governments significantly improve access to mental health services and social supports across Canada, particularly for those with chronic, difficult-to-treat mental disorders.

MAiD Legislation at a Crossroads: Persons Living with Mental Disorders as Their Sole Underlying Medical Condition, by Jocelyn Downie et al. (the Halifax Group), can be downloaded from the Institute’s website (irpp.org).

The Institute for Research on Public Policy is an independent, national, bilingual, not-for-profit organization based in Montreal. To receive updates from the IRPP, please subscribe to our e-mail list.

Media contact: Graham Fox, tel. 514-518-0775, gfox@nullirpp.org