Controversy continues to swirl around Canada’s permissive Medical Assistance in Dying laws, as a new Canadian government report recommends that within the next five years lawmakers there should look at extending medically assisted death to young people, starting with those who have terminal illnesses, but eventually extending it to children who want to die for other reasons.

The report also recommends that Canadians should be allowed to request assisted suicide solely for mental health reasons starting next year.

The Special Joint Committee on Medical Assistance in Dying presented an extensive 138-page report to the Canadian Parliament on Feb. 15. In the report, members of the committee offered recommendations on medically assisted death as it relates to people with disabilities, “mature minors” and people with mental illnesses.

“Mature minors” is a category of underage children that isn’t strictly defined in Canadian law. It’s loosely understood to mean any child who doctors believe can consent to their own medical decisions.

The report stated that within the next five years, the government of Canada should review the criminal code as it pertains to assisted suicide and mature minors.

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Who is eligible for assisted death in Canada?

When it passed in 2016, Canadian law permitted adults who have a terminal illness to apply for medically assisted death. Later in 2021, the law was expanded to adults who choose to die for other reasons.

In practice, the law seems to have been interpreted broadly. The Associated Press reported that 61-year-old Canadian Alan Nichols submitted his application for medically assisted death and listed only hearing loss as his reason for requesting to die.

Rupa Subramanya reported for The Free Press that a Canadian woman named Margaret Marsilla found out that her 23-year-old son Kiano Vafaeian was scheduled to die from medically assisted death. After making the discovery, Marsilla contacted her son’s doctor under the guise of pursuing her own death and was told Canada’s law allows people to apply for medically assisted death if they have a condition that is “intolerable to them.”

Reports have also suggested that at times the poor in Canada are choosing medically assisted death because they see no other option.

This permissive law led Marie-Claude Landry, head of the Humans Rights Commission, to say that medically assisted death “cannot be a default for Canada’s failure to fulfill its human rights obligations.”

Canada’s 5-year plan with mature minors and medically assisted death

After Subramanya’s article appeared, alongside similar articles, commentators raised questions about the laws, especially with regards to the country’s decision to consider expanding access to medically assisted death to “mature minors.”

The report recommends that the Canadian government examine extending access to medically assisted death to children with a caveat — the children would have to have a terminal illness.

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In the report, Dr. Gordon Gubitz is quoted as saying “that the Canadian public may not be ready for track two MAID for minors, and recommended, along with others, a cautious, stepped approach.” But attorney Bryan Salte is said to have questioned whether or not the Canadian constitution allows the government to prevent broader access to medically assisted death.

“Track one” refers to people who have terminal illnesses, while “track two” includes people who do not have a terminal illness.

Other medical practitioners and members of the committee recommended that the country offer only track one medically assisted death to minors, “at least initially.”

Ultimately, the committee recommended that the Canadian government should provide funding to pursue further research on medically assisted death for mature minors and that they amend the criminal code to include access for minors within the next five years.

In their dissenting report, members of Canada’s Conservative Party said they do not support expanding medically assisted suicide to include mature minors. Dr. Maria Alisha Montes, a pediatrician, questioned the capacity of minors to consent to assisted suicide, especially given that their brains have not fully matured.

When concluding their section of the report, Conservatives said: “The Liberals’ rushed and reckless approach to Canada’s MAID regime has put the lives of vulnerable Canadians at risk.”

People with disabilities and medically assisted death

The report also contained information about the high percentage of people with disabilities who access medically assisted death.

The previously released third annual report on medically assisted suicide revealed that 3.3% of the deaths in Canada in 2021, or 10,064 people, were because of MAID. Of those who die in this way, 43% were people who needed disability support services. This means that more than 4,000 people with disabilities accessed medically assisted death.

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The Associated Press reported that a man named Roger Foley, who had a degenerative brain disease, said he was pressured by a hospital ethics director to use medically assisted death due to the high cost of his care. He said that he felt like the director was using “coercion.” Disability advocacy groups have expressed fear that the medically assisted death system would disproportionately burden people with disabilities.

The report acknowledged that people with disabilities “might see MAID as a way to relieve suffering due to poverty and lack of services.” The committee recommended that the government support people with disabilities, but they disagreed on what further policies or amendments may be needed. Some members of the committee felt like under the current structure, there was “systematic coercion” and people with disabilities couldn’t make meaningful choices. Conversely, others felt like people with disabilities needed to have their ability to access medically assisted death protected.

According to the report, witnesses told the committee the government had failed to adequately consult with people who have disabilities on MAID policy. The committee recommended that the government create a panel to do this.

Canada’s disability rights collective has criticized the country’s laws. Forbes reported that the committee issued a statement saying, “The very existence of the current law is a threat to the lives of people with disabilities and their families.”

Delaying medically assisted death for people with mental illnesses to 2024

Previously, Canada had planned to expand medically assisted death to people with mental illness in March 2023. During an expansion of the law in 2021 when the requirement for terminal illness was removed, the law also specifically stated that mental illness could not be the sole reason. The restriction regarding mental illness was set to be repealed in 2023, but officials recently delayed that change.

After consideration, the committee recommended that the expansion of MAID to people who list mental health conditions as their sole reason be delayed until March 2024. The committee said it remained in support of the expansion, but believes that it needs more time to set up eligibility requirements and regulations.

But a new poll from Cardus, a nonpartisan Canadian think tank, found that 51% of Canadians oppose medically assisted death for people with mental illnesses. The policy has support from fewer than one-third of the Canadian population.

Of those polled, 55% said that they believe expanding medically assisted death in this way would lead to a replacement of social services for those with mental illness. Rebecca Vachon, health program director at Cardus, said that the government should expand mental health services for people with mental illnesses before even considering expanding medically assisted death.