Canada Suspends Expanding Medical Aid In Dying To Mental Illness

The policy is debated in terms of structure, funding, and institutional design. What is not debated, and what would have determined the policy’s success or failure, is the character of the people who were to carry it out. The Government of Canada has now suspended indefinitely its plan to extend medical assistance in dying to persons whose sole condition is a mental illness, a change once fixed for March 2027. The official language will speak of readiness, of safeguards, of systems not yet prepared. I would put the matter more plainly. The country discovered it had not yet formed the people to whom it meant to hand this responsibility, and, to its credit, it stopped.

Consider what the expansion asked of a psychiatrist. Her whole training, if it was any good, taught her a particular discipline of hope. She learned to sit with a patient who believes nothing will ever improve and to treat that belief as a symptom rather than a verdict. She learned that the illness speaks in the patient’s own voice, and that her task is to hear the person beneath it. The expansion would have asked the same woman, at the same desk, to certify that this suffering is beyond remedy. It placed two forms in front of her. One is a referral to further treatment. The other is a signature that ends the need for any.

No regulation can resolve that conflict, because it is not a conflict between rules. It lives inside the practitioner. A clinician formed in the habit of perseverance cannot comfortably keep both forms on her desk. A clinician who can is no longer formed in that habit. The question was never whether Canada could write adequate safeguards. It was what kind of physician the safeguards would gradually produce.

The strongest objection deserves a full hearing. A person with a long and grievous mental illness is still a person, with a mind and a will. To deny that person a choice granted to the cancer patient looks like the old condescension that treats the mentally ill as children. Many reformers in my own day suffered from this condescension. Those of us who taught the poor to read were told they could not be trusted with books. I do not dismiss the charge lightly.

But the objection mistakes whose character is under audit. The question is not whether the sufferer is capable of choosing. It is whether the society offering the choice has earned the right to offer it. A patient who has waited a long season for treatment, who has been passed from one overstretched clinic to another, and who has never had steady care from anyone who knew her name, does not choose death freely if she chooses it. She chooses it from inside a neglect that others arranged. Autonomy exercised in a room the community has emptied is not liberty. It is the community’s abdication signed in the patient’s handwriting.

So the suspension is only as good as what is done with it, and here I fear the usual vice of governments. A delay is easily mistaken for an achievement. Ministers will feel the relief of a crisis postponed, and the long work the postponement was supposed to purchase will go undone. That work is the formation of clinicians willing to stay with hard cases for years, and of nurses, chaplains, social workers, and neighbours who know how to keep company with a despairing person without either fleeing or flattering her. None of it fits in a press release. It takes a generation, which is why it is neglected and why it is the only thing that works.

I would judge Canada’s decision by a practical test. When the question returns, as it will, will the country have produced better people to answer it, or only a more elaborate set of forms? If the psychiatrist of the future has been trained in more forms and less patience, the suspension will have bought nothing but time to perfect the paperwork.

The fruits of any system are its citizens. A country that has learned to sit up through the night with a person who wants to die has formed something precious. Such a country might one day be trusted with harder questions. A country that has only learned to process the request has formed something else. Picture the woman in the waiting room with her coat still on. Whoever opens the door to her, the next time, should come to her with more help than paperwork.