Opinion: Why I resigned from the Federal Expert Panel on Physician-Assisted Dying

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Ellen Cohen is the National Coordinator of the National Network for Mental Health.

In August 2021, I was nominated to serve on the federal government’s Expert Panel on Physician-Assisted Dying and Mental Illness. The panel was created to support Ottawa “in developing its approach to providing safe access to MAID for people with mental illness.” I had been asked to speak about the intersection of mental illness and disability, and the many challenges faced by those affected by such conditions.

This work is important because in March, Canada will legalize MAID for people whose only underlying medical condition is a mental health disorder. I believe that this extension of the MAID law would be a serious error. Establishing policies around it requires special attention.

In my work on this panel, I have shared my own lived experience with mental illness, my experience as a family member of people with mental illness, and my expertise in my work. I talked about the number of people with disabilities and mental illnesses who don’t get the help they need because the health care system doesn’t understand how to meet their needs. I spoke about the lack of social and economic support for people living with mental illness and how this can lead people to consider MAID.

I entered the panel with an open mind. In Canada, the psychiatric system is the only part of the medical system that legally allows physicians to detain and treat patients against their will. This is permitted under provincial and territorial mental health legislation.

The psychiatric consumer-survivor movement, which began in the 1960s when people began to challenge some of the harmful and coercive effects of psychiatry, including forced treatment, stigma and discrimination, opposes this practice. . But disability communities are diverse, and I know that consumer-survivors are divided on the issue of MAID and mental health.

I also knew that the panel was not authorized or designed to reject MAID for mental illness. We were supposed to consider how do it safely before march. But to do our job effectively, we had to seriously grapple with complex issues around decision-making, consent and capacity, privilege and vulnerability, and accountability and oversight. In my experience, the committee failed to do so.

MAID requires a person to consent voluntarily, but how do we understand consent for people with mental illnesses who may be forcibly confined and treated against their will? Do we need a special set of safeguards in these situations?

Persons with disabilities have already requested and obtained MAID because they are living in poverty, do not have appropriate lodging or cannot get the health care they need – reasons that are supposed to be outside the scope of MAID laws. How do we ensure that this does not happen when MAID is extended to people whose only underlying condition is mental illness? How do you ensure their stories are told? The report recommended that people be informed of “the widest possible range of social supports” that could alleviate their suffering, but there is no guarantee that these supports will be available.

I do not believe that the panel took these issues seriously. For example, they recommended that if a person is continuously “involuntarily” for more than six months, they should still be allowed to seek MAID and be assessed from inside a psychiatric facility. Involuntary situations would include being in and out of a mental institution, or being locked up in the criminal justice system.

As a panel member, I had proposed changes to provincial and territorial mental health legislation, as well as fair funding for best practices such as peer support, psychiatric screening, better monitoring and team assessments.

But it seemed to me that the members of the panel simply did not want to offer serious safeguards that would require changing the law. I also often felt like I was treated like I didn’t know what I was talking about and was ashamed to suggest protective measures. Thus, it was as if the recommendations of the committee had already been established before the work had even begun. Disability accommodations for recordings or notes that I had requested for the panel were also denied.

I felt so much shame, but also so much responsibility. I started having panic attacks in the middle of the night, thinking about my family and my communities.

And so after serving on the panel for five months, I made the difficult decision to step down in December 2021. I could not legitimize the process, nor could I condone the findings of the panel, which were rreleased in may. (The terms of my appointment provided that there would be no compensation for my participation and that I would sign a confidentiality agreement, which has now expired.)

In my opinion, the Expert Panel on MAID and Mental Illness has not truly fulfilled its responsibilities. On such important matters of life and death, we all deserve better.

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