Whenever and wherever the issue of euthanasia and assisted suicide has been debated over the past few decades, two things are a given.
The first is its supporter’s objections to the use of the terms “euthanasia” and “assisted suicide,” preferring instead such vague and neutered descriptions like ‘medical aid in dying’ or ‘voluntary assisted dying’.
The second is their dismissal of the slippery slope argument.
Professor Margaret Somerville, internationally known bioethicist and Professor of Bioethics at the University of Notre Dame Australia’s school of medicine, certainly knows the slippery slope exists. She has spent over four decades researching and writing on the issue and her latest essay outlines the well-traversed playbook of euthanasia activists around the world in this time. It always begins with claims that if legalised, euthanasia will only be rarely used and only as a last resort. Secondly they claim that it will not open up slippery slopes.
“The normalisation of euthanasia and its frequent use, also opens up the unavoidable ‘logical slippery slope’, that is, once euthanasia is legalised, the situations in which it is available rapidly expand,” Professor Somerville writes.
Nowhere is this more evident than in Canada, where the practice was first legalised in September 2016. It has now evolved from originally allowing people with a grievous and irremediable medical condition, whose death was reasonably foreseeable, to request euthanasia or assisted suicide.
This law was amended in 2021 to remove the requirement that death be reasonably foreseeable, and as of March 2023, people whose suffering is caused solely by mental illness will be able to apply as well. This new frontier – which allows people with mental illnesses only – to access euthanasia and assisted suicide, calls into question the role of those who clinically care for people with mental illnesses. Until now it could be argued the entire reason for the existence of their profession was to prevent suicides; to provide patients with mental health problems a holistic care that best met their mental health and emotional needs.
The American Psychiatric Association issued a position statement in 2016:
“A psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.”
Mark Komrad MD, a leading psychiatrist at Johns Hopkins University, has questioned how the profession can simultaneously be preventing suicides and, under the new laws in Canada, also facilitating them?
“This is a profound change in the trajectory of the euthanasia law and the practice of psychiatry for Canada, which is now the largest nation that will soon allow MAID for psychiatric conditions,” Dr Komrad said.
“Bill C-7 and similar laws would represent a terrible shift in the deep ethos of psychiatry. Psychiatrists would have to decide which suicides should be prevented and which should be abetted.”
Dr Komrad examines other jurisdictions that allow euthanasia for mental illness only:
“Currently, several countries, such as Belgium, the Netherlands, Luxembourg and Switzerland, allow patients who are suicidal to receive death by either lethal injection (euthanasia) or a self-administered prescription for lethal medication (assisted suicide). In 2002 Belgium, the Netherlands, and Luxembourg legalised both these practices.
“Laws in those countries permitted voluntary death for patients whose physical or psychological suffering was unbearable and could not be effectively treated by means that were acceptable to them. A terminal condition was not a necessary criterion.”
“This opened the door for some patients with psychiatric illness to have suicide provided for them, rather than prevented. Now between 100 and 200 patients are euthanized upon request annually between Belgium and the Netherlands.”
Indeed, these same countries are now debating extending their euthanasia regimes to those who feel they have a “completed life” or who are just “tired of living”.
The Canadian amendments were the result of intense lobbying by different interest groups, who argued that the exclusion of people with mental illness was discriminatory. These groups declared that, in the interests of parity, “patients with a psychiatric illness should not be discriminated against solely on the basis of their disability, and should have available the same options regarding MAID as available to all patients.”
Dr Komrad is correct to sound the alarm. The proposed laws are irresponsible in the extreme and will place people suffering from mental illness in Canada at great risk of wrongful death. It is evidence indeed of a slippery slope. And each Australian state that adopts assisted suicide and euthanasia combs the world to glean what it deems as best practice.
How long before the Canadian precedents are imported to our shores?