By Lisa Blumberg
The broadening of eligibility under the Canada’s euthanasia law to include people who are deemed to suffer from “untreatable mental illnesses” has been delayed once again. The expansion had been scheduled to take effect in March. According to the New York Times, the postponement occurred because a parliamentary committee concluded that there are not enough doctors, particularly psychiatrists, in the country to assess patients with mental illnesses who want to end their lives and to help them do so. The Canadian Health Minister Mark Holland stated that “the system is not ready, and we need more time.” He did not give any new effective date for the expansion, although a committee member expressed the hope that the delay would be indefinite.
Shortly before the delay was announced but when there were already signs that the Canadian Government was having “second thoughts”, the Editorial Board of the Washington Post wrote a sharply worded piece opposing voluntary euthanasia for psychiatric survivors in Canada and elsewhere. The importance of a major newspaper taking such a stand cannot be overestimated.
It is true that the editorial seems to assume that euthanasia and assisted suicide are more acceptable for those with life-threatening physical conditions than for psychiatric survivors. It does not attack the type of assisted suicide laws enacted in several states in this country. Yet, every argument that the editorial makes against legalizing euthanasia for psychiatric survivors also mitigates against permitting assisted suicide for any group. Indeed, down to its use of the phrase “second thoughts,” the editorial reverberates with arguments that disability rights advocates have made in opposing assisted suicide in general. (Note: The piece does use some terminology regarding psychiatric survivors that activists would avoid.)
The editorial states, “Many in the grips of psychiatric distress view, temporarily, suicide as their only way out, only to later be grateful they did not kill themselves in the depths of their suffering.” This is equally true of people initially demoralized by physical disabilities and illnesses struggling to get the support they need. The heart of the lawsuit brought by two disabled Californians (joined by several advocacy groups) challenging the constitutionality of the state’s assisted suicide law is the fear that if they become suicidal, they will not be given the suicide prevention services available to the general California public but instead be approved for a lethal drug prescription.
Disability rights activists have long pointed out that assisted suicide is less about patient choice and personal autonomy and more about what health care providers should or should not be able to do. Health care providers are the designated gatekeepers in the statutory scheme. They can make eligibility determinations based on incomplete knowledge of the patient, errors in prognosis or implicit bias. Along these lines, the editorial stated, “There might, indeed, be mentally ill patients suffering from symptoms so debilitating and intractable that their options are uniformly dismal. But designing a system to distinguish them reliably from others in mental distress, who would benefit from treatment, is at least extremely hard, if not impossible. Certainly, Canada’s system is not up to the task.” Health Minister Holland said virtually the same thing when he announced the postponement of the expansion.
The Canadian system is not up to the task. The American system is not up to the task. No health care system is up to the task because what a euthanasia or assisted suicide law expects health providers to do is to determine, based on health status, that a person’s continued existence is so irredeemable and lacking in value that they are eligible for state sanctioned death. No one has the capacity to do that. In Canada, finding eligibility seems to be the default position – only 3.5 percent of written requests for euthanasia were denied in 2022.
Lastly, the Post takes on the issue of “safeguards.” Noting that Quebec’s top end-of-life care regulator has decried rampant noncompliance with the rules in that province, the editorial states that although proponents may have “high confidence in the procedures they’ve developed to control psychiatric euthanasia. They need to remember that no procedural protections are perfect…Good intentions tend to have unintended consequences. In the United States, Americans need to keep a close eye on their neighbor’s experience and learn from it.”
We could not have said it better ourselves. Thank you, Washington Post! However, given all that you have said, you should join us in opposing assisted suicide in any iteration.
