The Waiting Room Has No Exit

The suspended reform addressed the suffering of people whose only diagnosis is a mental illness, and it offered them a door marked death, while leaving the hall around them untouched: the waiting lists, the rented rooms, the disability cheques that do not cover the rent. This is not an oversight. It is the function of reform. And now that the Government of Canada has shelved the March 2027 expansion indefinitely, we should be clear about what was actually decided. Ottawa did not choose between life and death. It chose to keep the hall exactly as it is and to lock the one door it had been building.

Liberal commentators will call this prudence, and the strongest case against it deserves a hearing. A person with a chronic, treatment-resistant depression is a citizen, not a ward. To tell her that a cancer patient may decide the end of her own life but she may not, because her suffering lives in the mind rather than the body, is to declare her judgement defective by category. The disability movement knows this argument well: “for your own protection” has excused every asylum ever built. If freedom means anything, it must include the freedom of the one whose reasoning the authorities distrust.

I accept every word of that, and it is exactly why the expansion was never the emancipation its defenders claimed. A choice is free only when the alternatives are real. A woman in Hamilton sits in a clinic corridor, her referral letter softening in her hands, and is told the psychiatrist can see her in the spring. She lives on a provincial disability payment that leaves her choosing between groceries and the bus fare to that appointment. The state that would have offered her a dignified death by 2027 has not offered her a dignified Tuesday. When one option is funded, administered and delivered on schedule, and the other is a queue, the market has already voted, and it has voted with her body.

Here the comedy of the bourgeois state shows itself, because neither the expansion nor its suspension costs the treasury anything. Assisted death is cheap. Housing is expensive, and so are psychiatric beds, community clinics and income supports set above the poverty line. The suspension is cheaper still, since it costs nothing at all. Parliament has discovered an arrangement in which it can debate the gravest question a society can ask, earn credit for moral seriousness from both sides, and spend not one additional dollar on the conditions that made the question urgent. The only commodity being rationed is permission. Permission has no budget line.

Who was consulted? Committees of physicians, ethicists and provincial health ministers have argued over whether mental illness can be deemed irremediable, and they will go on arguing now that “indefinitely” has replaced a date. These are serious people, and some of them are right. But the people actually living with these illnesses appear in this process mainly as case studies, the subject of clinical criteria rather than authors of policy. A movement of psychiatric patients and disabled workers demanding to set the terms of their own care, including the funding, the housing and the right to refuse treatment, would frighten Ottawa far more than either the expansion or its reversal. Whether to permit death is a question the state is comfortable answering on their behalf. What life would have to cost before death stopped looking reasonable is a question it will not let them ask.

So the suspension is a genuine reform, in the narrow sense. It removes a danger: that poverty and neglect would be dressed in the language of autonomy and processed as consent. That danger was real, and its removal is not nothing. But it removes the danger by withdrawing a choice rather than by changing the conditions of choosing, and so it leaves everything that produced the danger perfectly intact, ready for the next government to revive the proposal when the corridor is longer and the cheques are thinner. Then the people in that corridor will be told, once again, that they are finally being treated as free.

The woman in Hamilton has not heard about any of this. She is still holding the letter. Spring is still the earliest appointment. The only thing that changed in Ottawa this year is the sign on the door at the end of her hall, which used to say Opening 2027 and now says nothing at all.