Leading experts involved in developing an expansion of Canada’s medically assisted dying regime for people whose only underlying condition is a mental disorder disagree on whether the expansion should be delayed.
One expert says a delay would ease pressure on the “rush process” of developing practice guidelines for complex cases, saying training modules for practitioners won’t be ready until the end of this year or early next year at the earliest. But another expert says there’s no need to wait any longer.
The system was slated to include such patients starting next March after a two-year sunset clause built into a 2021 update to the medical assistance in dying, or MAID, law.
Despite a panel of experts finding adequate safeguards in place, the federal government announced last week that it intends to legislate further delays. He has not indicated for how long.
“Not everyone is ready,” Justice Minister David Lametti said when he made the announcement.
Madeline Li, a cancer psychiatrist who sits on several MAID-related panels, says the Liberal government is still working on developing practice guidelines around cases with patients whose only underlying condition is a mental disorder.
She said she was pleased with the decision to delay the expansion, and that the delay will allow her and others to “properly develop” the guidelines.
What people are reading
“We didn’t really start preparing for this until relatively recently,” he said, adding that the government didn’t convene its panel to develop the guidelines until the fall. “They put it together very quickly. It was only a few months ago that this panel was convened to have a first draft.”
He said that as of last week, a draft of the guidelines was still under peer review.
“We needed to get everything ready by March, so it’s been a rushed process, but we haven’t really gone through the evidence-based rigor,” he said.
Experts disagree on whether the medically assisted dying system is ready for expansion in March. #CDNPoli #AssistedDeath #MAID
Once finalized, Li said the guidelines will be sent to provincial and territorial agencies for incorporation into regulations and then incorporated into professional practice through medical schools.
“All of that was supposed to be done before March, which would never have happened,” Li said. “Now we have time to do that.”
Li said that training modules for the expansion are still being developed.
He said a curriculum he is helping to develop would train doctors to consider the psychological factors that drive the desire to die and teach them how to assess vulnerable patients contemplating a medically assisted death, and how to focus their thinking on the equity and diversity.
“We’re probably going to finalize it in the spring for a soft launch,” he said. “It won’t be ready for hard launch until the end of the year or early next year at the earliest.”
Li said that once the curriculum is ready, it should be disseminated across the country among medical professionals “so that there is some consistency and practice across the country.”
“That would not have been done in March,” he said.
Jocelyn Downie, a law professor and medical ethicist at Dalhousie University, doesn’t think a delay is the right move.
She said readiness should not be determined by all physicians in Canada, indicating that they are prepared to provide medically assisted dying to people whose only existing conditions are mental disorders.
“Doctors who don’t think they’re ready to go have a professional obligation not to participate in MAID,” he said.
When the MAID laws first went into effect in 2016, he said not all doctors were ready. The protocols were still being developed. Drugs continued to be purchased.
“The doctors didn’t provide (CAMA), because they didn’t have all the things they needed to provide it,” he said. “There was no need for a delay in legislation to prevent that from happening. Physicians who weren’t trained weren’t providing MAID.”
Downie said he wants a rigorous system, but not one that holds people with mental disorders to a standard that no one else is forced to meet.
She said medical schools may have been ready for a spring expansion, technical briefings on standards of practice were already underway, and educational seminars with physicians were already on their agenda for March.
“What happens is people are getting ready, they’re also getting excited, and then the goalpost moves, because suddenly you’re not ready in other metrics,” he said.
This report by The Canadian Press was first published on December 23, 2022.