The Calendar Was Never the Patient

The administrator at a mid-sized clinic in, let us say, Sudbury had printed the information sheet three times. The first said March 2023. The second said March 2024. The third, which had survived long enough to acquire a coffee ring and a drawing pin through the “2” of 2027, now had to come down too. She did not print a fourth. There is a point at which a date stops being information and becomes a kind of weather report for a country that does not exist.*

*The Government of Canada has now suspended indefinitely its plan to extend medical assistance in dying to people whose sole underlying condition is a mental illness. “Indefinitely” is a word governments use when they want the effect of “no” without having to stand next to it.

The case for the suspension deserves to be heard properly, because it is a serious case and the people making it are not fools. Psychiatrists do not agree on whether any mental illness can be called irremediable. Depression lies, and it lies most convincingly about the future. A system that cannot reliably tell a disease that will not lift from a disease that has not lifted yet should not be putting its signature on the difference. If you are going to make a mistake, the argument runs, make the one you can take back. That is a respectable position. Reasonable people hold it, and some of them have sat across from patients who were certain in January and alive and glad of it by June.

The difficulty is not the caution. The difficulty is what the caution has been standing in for.

The expansion was never really Parliament’s idea. It was a court ruling, in Quebec, that first pushed the law wider. Parliament then wrote the mental-illness provision in with a delay attached, the legislative equivalent of agreeing to go to a party and immediately checking what time the last bus leaves. Each postponement was justified by the need for the system to be “ready”, meaning trained assessors, clear standards and adequate safeguards. These are sensible things to want. But consider what “ready” would actually require. It would require that a person asking to die of their illness had first been offered real treatment for it: a psychiatrist seen this season rather than next year, a bed that did not involve a corridor, a therapist who was not leaving for a better-paid job. A safeguard is only as strong as the alternative it guards towards.

That is the thing the delays kept almost saying. Every time Ottawa looked at the provincial mental health systems and asked whether they could support a careful, humane assisted-dying process for the mentally ill, the honest answer was that they could not reliably support a careful, humane living process for them either. The state discovered that it had become more confident about the paperwork for the end than about the appointment for the middle.**

**This is the real finding of the whole affair, and nobody will announce it, because “we suspended the policy because we noticed what the waiting lists were doing” is not a sentence any minister wishes to read out at a press conference.

Which brings us to the second thing “indefinitely” does. A deadline forces Parliament to decide. Its absence passes the decision on to someone else, and in Canada that someone else has form. Somewhere a person with a long, well-documented illness and a very good lawyer will take this to court under the Charter. A judge will then do the deciding that elected members preferred not to do, and the politicians will be able to say, with real relief, that their hands were tied. Institutions are very good at arranging to have their hands tied. It is one of the few knots they reliably learn.

None of this tells you whether the expansion was right. Writers who are sure of that, either way, have not been sitting in the right waiting rooms. It does tell you that the question being argued in public, about whether death should be available, was mostly a way of not asking the question underneath it, which is whether help is. One costs a statute. The other costs psychiatrists, and psychiatrists cannot be legislated into existence before a long weekend.

Back in Sudbury, the administrator has taken the sheet down and left the drawing pin in the corkboard, where it holds nothing in particular. Beside it, still current and still laminated, is the notice that has been there longest of all, the one nobody ever thought to suspend: Psychiatric referrals: current estimated wait, please ask at desk. People do ask. She tells them. They nod and sit down, and the clock on the wall carries on doing the only job in the building that has never once been postponed.