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Canada will delay providing medical assistance in dying to people with mental illness


The expansion of medical assistance in dying to people with mental illness has been delayed by Canada's Parliament for another year. The country already allows medically assisted death for some incurable illnesses. But as Emma Jacobs reports, mental health conditions are still up for debate. Please note, this story does include discussion of suicide.

EMMA JACOBS, BYLINE: For John Scully, life has literally become a living nightmare.

JOHN SCULLY: When I wake up, I go, oh, God, I've got to stop it. I've got to stop it. I must find a way to stop it.

JACOBS: Scully lives in Toronto. He was diagnosed with depression more than 30 years ago and suffers from work-related PTSD and anxiety. He says he has terrible, vivid nightmares.

SCULLY: There is no way to stop it. And because of that, I'm also permanently sleep deprived.

JACOBS: He has been watching the progress of the expansion of medical assistance in dying, known by its acronym, MAID, very closely.

SCULLY: I actually physically got the paperwork for MAID. I have it right here.

JACOBS: Canada's medical assistance in dying program was made legally available to some adults with terminal illness in 2016. In 2021, it was expanded to include those suffering with serious and chronic physical conditions. But for many, the plan to extend this to those suffering with solely mental illness raised concerns.

KWAME MCKENZIE: We don't have very good ways of defining incurability for mental health problems.

JACOBS: Kwame McKenzie, a professor of psychiatry at the University of Toronto, says these applicants raise a number of difficult questions for psychiatrists.

MCKENZIE: If the system's going to start getting into that business, before it offers people MAID, it must, in my mind, do everything it can to make sure that people get proper treatment and social support. And I think at the moment, our systems in Canada are not doing that.

JACOBS: But prior court decisions mean it's not a question of if the made expansion will happen, only when, points out psychiatrist Mona Gupta.

MONA GUPTA: Now we have a very different landscape, where all sorts of people with chronic medical conditions, who are not nearing the end of life, could make requests.

JACOBS: Gupta, who works at the research hospital of the University of Montreal, led a panel the Canadian government tasked with figuring out how MAID should be handled for applicants with mental disorders as their only conditions. The recommendations included additional funding for mental health and advice for clinicians assessing people who apply for MAID. Their conditions were based partly on the experience of European countries that already allow medical dying for people with mental conditions.

GUPTA: If we extrapolate from the European data, most people are turned away, actually, and the people who could actually reach that threshold ought to have had, will have had extensive histories of treatments.

JACOBS: In Toronto, John Scully feels that he has exhausted all available treatments. He had hoped to apply for MAID when it became open to those whose irremediable condition is a mental illness.

SCULLY: It offers a dignified death. It offers a peaceful death.

JACOBS: Government ministers say the delay will give more time to share information with practitioners throughout the health care system. Scully insists that in the meantime, he is being denied his right to control his death. For NPR News, I'm Emma Jacobs in Montreal.

CHANG: And if you or someone you know may be considering suicide or is in crisis, call or text 988 to reach the Suicide and Crisis Lifeline. Transcript provided by NPR, Copyright NPR.