From: Ministerial Correspondence Unit – Mailout <Ministerial.CorrespondenceUnit-Mailout@justice.gc.ca>
Sent: Monday, February 26, 2024 12:24 PM
To: Pathways SMIS <info@pathwayssmi.org>
Subject: Correspondence from the Minister of Justice and Attorney General of Canada
Dear Ms. Chan:
Thank you for your correspondence, sent on behalf of Pathways Serious Mental Illness Society, concerning medical assistance in dying. Please excuse the delay in responding.
The Government of Canada understands that medical assistance in dying is a complex and deeply personal issue. We are committed to ensuring that our laws reflect Canadians’ evolving needs, support autonomy and freedom of choice, and protect those who may be vulnerable.
As you may know, An Act to amend the Criminal Code (medical assistance in dying) (former Bill C‑7) came into force on March 17, 2021. This legislation was informed by consultations with Canadians, the provinces and territories, Indigenous partners, key stakeholders, legal experts, academics, organizations involved in regulating health care, and medical practitioners.
In accordance with the Superior Court of Quebec’s 2019 Truchon decision, the Act amended the medical assistance in dying provisions of the Criminal Code to, among other things, remove the requirement for a person’s natural death to be reasonably foreseeable in order to be eligible for medical assistance in dying. It created two sets of procedural safeguards to be followed in assessing a request: one set for persons whose natural death is reasonably foreseeable, and another more robust set for persons whose natural death is not reasonably foreseeable. One of the requirements of the second set of safeguards is a minimum 90‑day assessment period to ensure that adequate time and expertise are devoted to the eligibility assessment of persons whose natural death is not reasonably foreseeable. Furthermore, practitioners must take steps to ensure that such persons have been informed of any available and appropriate options that could help relieve their suffering and have been offered consultations with relevant professionals who provide those services or care.
This legislation also amended the Criminal Code to allow persons who have been assessed and found eligible for medical assistance in dying, and whose natural death is reasonably foreseeable, to enter into a written arrangement with their practitioner to waive the requirement for final consent should they risk losing capacity before their chosen date to receive medical assistance in dying. Allowing the waiver of final consent for persons in these circumstances, often referred to as “Audrey’s Amendment,” responds to the concerns that were raised by Audrey Parker, who chose to receive medical assistance in dying earlier than she wanted to out of fear of losing decision-making capacity before her preferred date.
Moreover, the Act temporarily excluded, until March 17, 2023, persons suffering solely from a mental illness (i.e., a condition primarily treated within the domain of psychiatry, such as depression and personality disorders) from eligibility for medical assistance in dying. However, on February 2, 2023, the Government introduced in the House of Commons Bill C‑39, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), which received Royal Assent on March 9, 2023. This legislation extended this temporary exclusion until March 17, 2024, to provide more time for the dissemination and uptake of key resources by the medical and nursing communities.
The Government of Canada recognizes that mental illness can cause the same level of suffering as that of physical illnesses, and important progress has been made to prepare for medical assistance in dying eligibility for persons whose sole medical condition is a mental illness. Nonetheless, in its consultations with the provinces, territories, medical professionals, people with lived experience, and other stakeholders, the Government of Canada has heard and agrees that the health system is not yet ready for this expansion.
On February 1, 2024, my colleague the Honourable Mark Holland, Minister of Health, introduced in the House of Commons Bill C‑62, An Act to amend An Act to amend the Criminal Code (medical assistance in dying), No. 2, to further extend the temporary exclusion for three years until March 17, 2027. This extension would provide more time for the provinces and territories to prepare their health care systems, including the development of policies, standards, guidance, and additional resources to assess and provide medical assistance in dying in situations where a person’s sole underlying condition is a mental illness. It would also provide practitioners with more time to participate in training and become familiar with available supports, guidelines, and standards.
This delay is in line with the recommendations of the third report of the Special Joint Committee on Medical Assistance in Dying, which was tabled in the House of Commons on January 29, 2024. While the Committee acknowledged that considerable progress has been made in preparing for the expansion of eligibility for persons suffering solely from a mental illness, it recommended that medical assistance in dying in these cases not be made available until the health care system can safely and adequately provide it.
The Bill provides that, within two years of Royal Assent, a joint parliamentary committee must undertake a comprehensive review relating to the eligibility of persons whose sole underlying medical condition is a mental illness and table a report in Parliament. This would allow the Government to further examine progress made by provinces, territories, and partners in achieving overall readiness in the health care system.
The Government has supported the release of the Model Practice Standard for Medical Assistance in Dying, the development of a nationally accredited medical assistance in dying curriculum, and a series of workshops to support the development of additional clinician assessment tools. These resources aim to assist practitioners in assessing complex requests for medical assistance in dying, including those where the sole underlying medical condition is a mental illness.
The Government of Canada is committed to a measured, thoughtful, and compassionate approach to help ensure our medical assistance in dying system meets the needs of Canadians, protects those who may be vulnerable, and supports autonomy and freedom of choice of individuals. We will continue to work closely with the provinces and territories, medical professionals, people with lived experiences, and other stakeholders to support safe implementation of medical assistance in dying, with appropriate safeguards in place, to affirm and protect the inherent and equal value of every person’s life.
Thank you again for writing.
Sincerely,
The Honourable Arif Virani, P.C., M.P.
Minister of Justice and Attorney General of Canada
—
See also:
