Most of the changes in this “Update” reflect the addition of historical information referencing the 2019 Truchon case and the passage of Bill C7 (of note, despite knowing since September 2019 that the Truchon ruling would lead to expansion of MAiD to non-dying disabled by removal of the reasonably foreseeable death safeguard, CPA leadership did not reference Truchon in its initial March 2020 Position Statement on MAiD, nor did it reference Truchon or provide this context in its October 2020 member survey…it is only now, 2 years after Truchon, and 8 months after the passage of Bill C7 in March 2021, which expanded MAiD and introduced the sunset clause to ensure MAiD for mental illness will be provided by 2023, that CPA leadership is mentioning the impact of the Truchon ruling to members).

Remarkably, like the initial 2020 Position Statement, the 2021 “Update” continues to lack any evidence-based guidance and continues to fail to cite a single clinical or evidence-based reference whatsoever. Even more remarkably, despite repeated concern being raised about CPA’s lack of mention or cautions regarding potential suicidality and mental illnesses in public policy consultations on mental illness and death, CPA leadership continues to refuse to include any cautions regarding mental illness related suicide risk, the importance of suicide prevention, or even use any word related to “suicidality” in its Position Statement “Update”.

Declaration 2 of CPA Statement: The “Update” continues to make no mention of evidence regarding predicting, or being able to predict, irremediability in mental illnesses, while still maintaining that “Patients with a psychiatric illness … should have available the same options regarding MAiD as available to all patients…”, and adds the phrase “…where eligibility requirements are determined to be met.” By never raising the issue of the need for evidence in determining whether mental illnesses can be predicted to be irremediable, while saying it is discriminatory for patients not to be able to get MAiD for mental illness and now explicitly implying eligibility requirements (including determination of predicting irremediability of mental illness) can be met, CPA leadership has taken a position, notwithstanding the disingenuous claim in the “Update” that “CPA did not and does not take a position on the legality or morality of MAiD”.

Declaration 4 of CPA Statement: This declaration previously stated that psychiatrists must provide “information regarding available MAiD resources and the referral process.” CPA leadership has changed this to require psychiatrists to provide “an effective referral.” Given many members have expressed concern about the continued lack of evidence in being able to predict irremediability in mental illnesses, it is unclear what the ethical and legal tensions will be when psychiatrists are forced to provide “effective referrals” when they know those will go to other psychiatrists who unscientifically and wrongly think they are able to predict irremediability of mental illness.

Declaration 5 of CPA Statement: Previously this Declaration stated that, as part of the eligibility assessment, psychiatrists were to be rigorous in “…identifying symptoms of mental disorder that are likely to affect decision-making”. The “Update” released by CPA leadership removes the caution about assessing whether symptoms of mental disorder are impacting decision-making, and replaces it with a requirement to identify “treatable symptoms of mental disorder”. While most psychiatrists would consider it common sense and obviously important to identify treatable symptoms, it is important to remember that Canada is the only jurisdiction in the world where patients can get MAiD even if standard practice treatments have not been tried. And given that patients can qualify for MAiD even if their suffering could be relieved by standard treatments, but the patient does not consider them “acceptable”, and further given that our patients’ decision-making can be impacted by symptoms of mental disorder even while they retain legal capacity, CPA leadership’s conscious decision to remove the specific expectation of needing to identify mental illness symptoms that are likely to affect decision-making is both puzzling and disturbing.

No.

First, it is disingenuous to say you “do not take a position” while repeatedly claiming it is discrimination not to provide MAiD for mental illness, all while failing to issue a single evidence-based caution about known suicide risks to vulnerable and marginalized populations suffering from mental illness.

Second, as the articles below suggest, claiming to be “neutral” on this issue while failing to offer evidence-based guidance is not really being neutral, but oftentimes can serve as a “dogwhistle” indicating tacit support for expansion. CPA leadership knows full well that public and policy makers have taken the CPA Position as supporting MAiD for mental illness.

[click on links below to read articles]

“First, Take No Stand: On assisted suicide, the medical profession ducks behind “neutrality.””

“Physician-Assisted Suicide: Why Neutrality by Organized Medicine Is Neither Neutral Nor Appropriate”