Parliamentary Committee Recommends MAID Expansion; Expert Witnesses Respond with Concern & Criticism

In February, the Special Joint Committee on Medical Assistance in Dying (AMAD) issued its final report, Medical Assistance in Dying in Canada: Choices for Canadians. The report recommends significant and unprecedented expansion of medical assistance in dying (euthanasia and assisted suicide; “MAID”), including for children, by advance directive, and in support of MAID for incarcerated persons.

As others have noted, if the Committee’s recommendations are followed, it would make Canada’s euthanasia laws “among the broadest in the world.”

            …it would make Canada’s euthanasia laws “among the broadest in the world”

Shortly after, a group of 43 Expert Witnesses (Experts) issued a response to AMAD’s recommendations in a letter that can only be described as a scathing critique. The letter, entitled “Expert Witnesses Speak Out Against Bias in Medical Assistance in Dying Report” does not mince words. It rejects the Committee report on the basis that it “misconstrues, misrepresents, minimizes and completely ignores key evidence necessary to protect Canadians.”

Before we briefly canvas AMAD’s recommendations and the experts’ letter in response, here are a few reasons why these developments matter.

Why Does MAID Expansion Matter?

Awareness

First, as with many legal developments, Christian ministries need to be aware of proposed legislation that will impact the way they provide care, outreach and activities. For example, many of you, our members, serve the elderly, the incarcerated, those with mental illness, children and youth, people with disabilities, and those with illness and disease. It is important to understand the legislative changes that will have a life and death impact on the communities and individuals you serve.

Viewpoint

Second, and more specifically, if your organization has a particular religious or conscientious view on MAID that would, for example, impact membership or board composition (a matter discussed in past CCCC publications), it is important that those views be appropriately reflected in various documents. Depending on the nature of your organization those documents could include bylaws, policies and procedures, statements of faith, or otherwise.

Engagement

Third, depending on your charity’s purpose(s), you may want to engage with the public and/or government on these issues. For example, your charity might be well positioned to provide information related to your charitable purpose to inform or persuade the public about policy, to advocate to oppose or change law or policies, make representations to government, or convene forums for discussion.

Needs

Fourth, it reinforces the urgent need for the care and support that charities like you, our members, provide. As others have set out in detail and courts have noted, “psychological suffering (either alone or in combination with physical suffering) ha[s] contributed to 94% of MAID cases in Quebec.” News reports tell heartbreaking stories of people applying for MAID due to fears of homelessness, lack of accessible housing, poverty and disability, and MAID being offered to veterans suffering with post-traumatic stress disorder. Whether your charity alleviates poverty, advances religion or has other purposes, support and care for those with disabilities, mental illness, those in poverty or homelessness, your work is needed. The support your charity provides can reduce social isolation, love and care for vulnerable, give hope, and nurture both psychological and spiritual well-being.

In sum, these proposed changes will have a significant and permanent impact on the social, charitable, cultural, medical, ethical and legal landscape in Canada. Let’s take a quick look at some of AMAD’s recommendations and the experts’ response letter.

The Special Joint Committee on Medical Assistance in Dying

The Committee was established in April 2021 to review the state of palliative care in Canada and to review MAID and mental illness, mature minors, advance requests, and the protection of Canadians with disabilities, as required by Bill C-14 and Bill C-7, respectively.

The Committee’s Report & Recommendations

The Committee’s Report 138-page report has 23 recommendations and was presented to Parliament on February 15, 2023. The Report also includes an important dissenting opinion (see page 105).

The recommendations include:

• Affirming MAID expansion for mental illness
• Directing additional study of proposed safeguards for MAID for mental illness
• Allowing advance requests for MAID
• Expand MAID to children and youth (“mature minors”)
• Limit parental involvement – “where appropriate” consult parents, but the will of the child prevails
• Study MAID for “mature minors” 5 years after it is legal
• Consult with minors about MAID
• Consider increasing funding for implementing the Action Plan on Palliative Care
• Support MAID for inmates

The Experts’ Response to the Committee

Here are some of the 43 Experts’ concerns and responses related to each issue reviewed by the Committee:

MAID for mental illness as the sole underlying medical condition

The Experts find AMAD’s recommendations “…deeply flawed and selectively ignore evidence while preferentially accepted personal opinions of witnesses ideologically favouring expansion.”

MAID expansion to youth and children

On this topic, the Experts concluded that “[t]he committee failed to act as mature adults who recognize that minors are a group with unique disadvantages arising inherent within human development, and thereby are dependent upon adult legislators to create laws that effectively protect minors from systemic abuses.” And further, that AMAD

• “…failed to draw attention to the fact that there is a paucity of evidence that assessment [for a minor’s decision-making capacity] are sufficiently rigorous or reliable” and

• “… paid lip service to the importance of safeguards, failing to provide any robust safeguards and undermining natural safeguards in the life of minors.”

Regarding the state of palliative care

The Experts felt that AMAD dismissed evidence from nationally and internationally recognized palliative care experts about why palliative care and MAID should remain separate and distinct, including that “palliative care holds as both a clinical and legal safeguard for MAID…”;

Regarding protections for Canadians with disabilities

While the letter outlines many critiques, two key critiques of AMAD’s recommendations were that:

• “The Report […] ignored, diminished and misrepresented the statements of disabled witnesses who were allotted 5 minutes to contextualize and explain MAID’s place in Canada’s history of eugenics and oppression of disabled people”;

• “Disabled people are the only people eligible for MAID. … All the language used in MAID legislation is a synonym for disability.” The experts “oppose in the strongest possible terms removing the word disability from legislation that specifically targets disabled lives. That is deception not destigmatization.”

Regarding MAID in prisons

The Experts found MAID in prisons particularly disconcerting: “Offering people an opportunity to leave prison – where they can spend time with their families – on condition that they sign up for MAID is enticement, especially where parole by exception is often not accessible.”

Regarding advance requests for MAID

Lastly, in regard to advance requests, the Experts letter concludes that AMAD

• failed to provide “solid evidence that prior consent remains valid”;
• did not hear sufficient evidence from “clinicians with expertise in caring for the elderly” as they “underrepresented” among the Committee witnesses;
• made a recommendation that “runs counter to the emphasis on ‘clear consent’” in the Carter decision;
• “…recommendations on MAID by advance request reflect the activism of witnesses and politicians, not the prudence and knowledge necessary in considering such a life and death matter.”

What’s Next?

As per usual, we can expect the government to issue a response to this, AMAD’s second report. AMAD’s first report was presented to Parliament in June, 2022 and the government’s response was presented in October, 2022. Following a similar timeline, the government has committed to responding to this second report by June 15, 2023.

What Can You Do?

If MAID expansion is a concern to you and/or your organization, our friends at the EFC have created an Action Kit to Halt Expansion of MAID to Include Mental Illness Alone. It includes a sample letter, background on MAID development and wording that helps explain why people are concerned.

Additional Links & Information

Christian Legal Fellowship blog post (22 February 2023); brief and background paper submitted to AMAD Committee (9 May 2022)

Government of Canada, Canada’s medical assistance in dying (MAID) law