Medically assisted deaths for people with mental illnesses? It depends on the election result
Warning: Story contains discussion of suicide.
John Scully says he regularly wakes up screaming from his brutal" nightmares, a result of his post-traumatic stress disorder.
Sometimes they're about the numerous war zones he's been to throughout his career as a journalist: the street violence, guns, flying bullets.
Other times, they're about the daily stress familiar to so many journalists - pressure to make decisions, fear of getting the story wrong, too many assignments at one time.
Often they're just horror," said Scully, 80, in an interview.
Along with PTSD, Scully says he has severe depression and anxiety, but no treatment or medication over the decades have helped alleviate his suffering.
I've been to literally dozens of psychiatrists, dozens of psychologists, I've been admitted to CAMH six or seven times on a long-term basis," he said. I've been through all the therapies, including 19 shock therapies, behavioural therapy. My bete noire is group therapy.
There's no drug I haven't tried."
What Scully wants, and the reason the Toronto man has been speaking publicly about his conditions, is to die.
He has become an advocate for medical assistance in dying (MAID) on the sole basis of mental illness - set to become legal in Canada in two years following the passage this year of the Liberal government's Bill C-7.
I have a human right to have the same rights of treatment as a person with a physical illness, including MAID," he said.
That expansion of the MAID regime is now at a crossroads given the ongoing federal election, and could end up coming to a halt depending on the outcome at the polls.
The Conservatives have promised to repeal the mental illness expansion, and re-impose some of the rules on accessing MAID that were lifted by C-7.
The Liberals announced a 12-member expert panel just two days before the writ drop to come up with safeguards by next March for MAID on the basis of a mental illness.
The issue is an emotional one that cuts to the core of deeply held personal beliefs for many Canadians. Underpinning much of the debate is a fundamental question: In what circumstances can someone's mental illness be deemed incurable and their suffering intolerable so as to allow a medically assisted death?
Scully, who has attempted suicide in the past, said MAID would allow for time to plan with his family, who he says are supportive of his wishes. And it would avoid the physical and emotional pain stemming from a suicide attempt, he said.
There's a doctor who will administer a proper dose of the right medication, that will offer you a peaceful, dignified death," he said.
An Ipsos poll conducted in February on behalf of advocacy group Dying with Dignity Canada found that 65 per cent of Canadians support expanding MAID on the basis of a mental illness, as long as the person has capacity to consent and the other eligibility criteria is met - that the illness is incurable and the person's suffering is intolerable.
The government initially banned MAID for mental illness in C-7, but accepted a Senate amendment that would make it legal down the road. Senators in favour had argued that banning individuals with mental illnesses was discriminatory and likely unconstitutional.
The bill allows individuals whose natural deaths are not reasonably foreseeable to apply for MAID. The Conservatives say C-7 went too far, and that the government failed to listen to organizations representing people with disabilities who said C-7 could push individuals to seek MAID due to lack of supports and services.
The mental illness expert panel's formation comes at an unfortunate time" given the ongoing election, said member Dr. Donna Stewart.
Politics may play a bigger role in this than one would like it to, with various parties deciding that they need to take a position at the extreme ends of the spectrum, whereas most people are somewhere along that spectrum," said Stewart, not commenting on the work of the panel itself.
Opening up MAID to those with mental illnesses has divided advocates and experts. Some argue that it can't be done safely, and could lead to marginalized individuals with lack of supports to apply for the procedure.
Experts in favour argue it would only apply to a very small number of individuals, who would be thoroughly assessed after having lived with their symptoms for years and gone through a number of treatments that failed to alleviate their suffering.
An important part of the expert panel's work will likely look at how to determine that a mental illness is irremediable" - incurable - one of the criteria required to access MAID in Canada.
I think that one has to accept that not all psychiatric treatments work," said Stewart, a professor at the University of Toronto and psychiatrist at University Health Network, where she conducts MAID assessments.
Some of those patients will learn to live with their severe symptoms, and others will not and will request MAID. And I think that one cannot say that they cannot be considered because perhaps sometime in the future something will be found that will perhaps treat it."
Stewart said she hopes the panel will consider safeguards proposed by a range of authorities, including the Canadian Psychiatric Association and a report on MAID by the Council of Canadian Academies, as well as draw from Dutch and Belgian experiences.
These potential safeguards include at least one psychiatric consultation, special training for practitioners who would consult on these cases, longer wait times between application for MAID and the procedure being carried out, a minimum number of years of having lived with a mental illness, and mandatory reporting and reviewing of all such MAID cases.
Dr. Sonu Gaind, a professor of psychiatry at the University of Toronto and former president of the Canadian Psychiatric Association, opposes the expansion.
The fundamental foot in the door is that it's supposed to be an irremediable medical condition," he said. We simply cannot make any responsible predictions of irremediability for any person with mental illness."
Gaind decried the lack of thorough parliamentary debate on the issue, noting it was added as a Senate amendment toward the tail end of the bill's legislative journey.
Another concern that has been raised is around the capacity of those with mental illnesses asking for MAID. The Council of Canadian Academies report - in which Gaind took part - noted that it may be difficult in some cases to ensure that the person is capable and making an autonomous decision" for MAID.
Some psychiatrists have countered that evaluating decision-making capacity is a core part of the job, and done all the time during MAID assessments on the basis of physical illnesses. (Individuals with mental illnesses are eligible to apply for MAID now if they have a physical illness that meets the eligibility criteria.)
The vast majority of people with psychiatric illnesses are indeed competent," said psychiatrist Dr. Derryck Smith, a former board member of Dying with Dignity Canada.
He said he believes that part of the opposition to expanding MAID is related to the stigma that continues to surround mental illness. We somehow presume that people with a psychiatric illness aren't competent to make decisions for themselves and that society has to look after them."
Scully said it would be abhorrent" if the Conservatives removed the possibility of MAID on the basis of mental illness. He said he also doesn't have faith in a re-elected Liberal government to ensure the procedure actually becomes legal in two years.
While he lives with the psychological scars of his decades-long career, mainly in television journalism - disease, civil unrest and wars around the world - he says he has no regrets about going into the profession. I regard it as a duty, as a calling if you can do it," he said.
His focus now is to speak up on an issue that, he finds, hears far too often from medical professionals and academics and far less from people like him, those who live with severe mental illness and want MAID. What are the decision-makers afraid of, he wonders.
To shut us out is an abdication of moral responsibility," he said. How dare they make decisions on my behalf without hearing my voice."
If you are thinking of suicide or think someone else may be, there is help. Call your local crisis line or go to the emergency room of your local hospital. Resources are available through the government of Canada. You can connect to a national network of distress lines at 1-833-456-4566 and Kids Help Phone at 1-800-668-6868.