Resource Canada won't become a suicide tourism destination in 2023

[Rounded Apathy]

It's still four months away, but I'm already seeing an uptick in posts wondering about the changes in the Medical Assistance in Dying (MAiD) law in Canada that will open the eligibility criteria to those suffering from mental ailments. I answered two posts about it today alone with a lot of sourced info about why this does not mean you will be able to just show up and get euthanized once it happens - and maybe dispel some other myths of the fabled Perfect Canadian Healthcare System. After the amount of work I put into them, I figured I might as well collate them because this is just going to become more of a hot topic as the time draws closer. I seriously hope people find and spread this around; might as well save folks the time and effort wondering and researching this. I've already sunk my own life hours into it - sharing is caring. Have fun doing something else with your time.

For starters - there's a good chance whatever condition you think would make you eligible will not. There is still no list of accepted conditions, even physical ones. The section of the federal MAiD page on eligibility states that one must have a:

Grievous and irremediable medical condition​

To be considered as having a grievous and irremediable medical condition, you must meet all of the following criteria. You must:​

• have a serious illness, disease or disability (excluding a mental illness until March 17, 2023)
• be in an advanced state of decline that cannot be reversed
• experience unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable

The community of medical practitioners here is not even uniformly in favour of this change in legislation, so right off the bat the numbers are working against you. Moreover, you need not one, but two independent physicians or nurse practitioners to sign off on your request. Save for those who have some personal passion for this - moral, financial, or whatever else - the truth is it's also extra work, and most physicians here are at the end of their ropes already. This article discusses the sobering reality.

Given the long-standing indoctrination (see what I did there?) of "doing no harm" in medicine, I also expect nothing short of advanced cases of things like C-PTSD, dementia, schizophrenia, personality disorders, treatment-resistant depression, and eating disorders (the latter only because there has already been at least one successful application) will be getting the green light for this. Your life may feel like (and legitimately be) a living hell, but this is merely a change in legislation - the system has been teaching for decades that mental illnesses are not something to end life over. Even if it is legal, thought processes and moral alignment of those whose authorization you'll need won't be automatically flipping come March.

Round all this out with the fact that this nation's health care system is not the golden goose it's hyped up to be: a huge proportion of Canadians either don't have a family doctor, despite actively looking, and an even larger number are in the combined boat of being without a doctor or unable to get an appointment with theirs when necessary. Unlike the US, it's also an extremely bureaucratic system - any specialist covered by public health insurance can only be seen on referral from a GP/PCP, so after all the waiting you've done to be connected with a doctor (who hopefully doesn't suck btw), and all the waiting you've done to be able to actually have that appointment with them, guess what: GET READY TO WAIT SOME MORE! Average wait time from referral by a general practitioner to consultation with a specialist was 11.1 weeks in 2021, on top of which, from the consultation with a specialist to the point at which the patient receives treatment took another 14.5 weeks. For those keeping tabs, from referral to treatment, that's half a year, folks. Of course, all this god damn waiting may not apply if you just wanna be offed by a white coat, but it may - you might not be forced into unacceptable treatment, but when the gears move this slowly for something as innocuous as a procedure like a knee replacement, you'd better believe assisted suicide won't be moving at light speed.

Names of practitioners who are generally willing to get involved in this are going to circulate fast - everyone and their dog is gonna be trying to connect with them. It's be unheard of if any walk-in doctor vouched for something like this. So just like with everything else regarding accessing health"care" here, there's going to be an eternal wait for it. The following article just came out a couple of days ago; haven't read it but looks worthwhile, exploring the complex nature of the reality of bringing this legislation into effect:

Canada will soon allow medically assisted dying for mental illness. Has there been enough time to get it right?

With doctors divided and federal guidelines still in development, Canadians have questions about who will qualify for MAID next year – and whether it’s a good idea to give the most vulnerable an easier way to die

www.theglobeandmail.com

For a second though, let's imagine that none of the above would be an issue. You fit the eligibility profile perfectly and for some reason could be fasttracked through the purgatory that is Canadian health"care". Well, there's another major hurdle (I'll assume you didn't comprehensively read every link I've already embedded, but if you have, this won't be news): in order to be eligible for medical assistance in dying, you must be eligible for health services funded by the federal government, or a province or territory (or during the applicable minimum period of residence or waiting period for eligibility) - generally, visitors to Canada are not eligible for medical assistance in dying.

If you're reeaally determined, you CAN decide to go for the long haul and do what it takes to fulfill this criterion, but systems like this are designed to dissuade people from just dropping in and start getting publicly-funded medical support when they have no intention of sticking around. Dying is no exception, and, well, you won't be sticking around.

Generally, provinces administer their own healthcare programs, and as such there is variation between the requirements for enrolling in them, though there is a lot of commonality. Overall, you need to prove you live there, will continue to live there, and have lived there for some time. Some examples of key criteria from just three provinces, with links to the sources and more detail:

Ontario - To meet the minimum qualifications you must:

• be physically in Ontario for 153 days in any 12‑month period
• be physically in Ontario for at least 153 days of the first 183 days immediately after you began living in the province
• make Ontario your primary residence

You must also meet at least one of the following additional requirements. You:​

• are in Ontario on a valid work permit and are working full-time in Ontario, for an Ontario employer, for at least six months
• have a Temporary Resident Permit (only certain case types, e.g. 86 through 95) [link is useless though]

British Columbia - A resident is a person who meets all of the following conditions:

• A citizen of Canada or lawfully admitted to Canada for permanent residence
• Makes their home in B.C.
• Physically present in B.C. at least six months in a calendar year

Study and work permit holders​

Certain other individuals, such as some holders of Study and/or Work Permits, or Work Permits on Working Holiday Programs, which are issued under the federal Immigration and Refugee Protection Act and are valid for a period of six or more months, may be deemed residents.​

Alberta - Eligible residents You are eligible for Alberta Health Care Insurance Plan (AHCIP) coverage if you are:

• legally entitled to be in and remain in Canada and make your permanent home in Alberta
• committed to being physically present in Alberta for at least 183 days in any 12-month period
• not claiming residency or obtaining benefits under a claim of residency in another province, territory or country
• any other person deemed by the regulations to be a resident or temporary resident, not including a tourist, transient or visitor to Alberta

If you are moving, immigrating, or returning to Alberta from outside Canada, you might be eligible for coverage from the date you established residency. If you have an immigration document from Immigration, Refugee and Citizenship Canada, you might be eligible for AHCIP coverage. Your eligibility depends on:​

• the type of entry document you have
• any restrictions listed on the document
• the length of time allowed in Canada
• your commitment to live in Alberta for 12 consecutive months

If you are a student from outside Canada, you may be eligible for AHCIP coverage.​

• Students who have a 12-month study permit (valid for an Alberta educational institute) and who will reside in Alberta for 12 months or more are eligible for AHCIP coverage and should apply.
• Students with study permits valid for less than 12 months, may be eligible for AHCIP coverage if their application is accompanied by a letter from the student confirming their intent to reside in Alberta for at least 12 months.

Temporary workers from outside Canada - If you come to Alberta on a work permit you must intend to stay in Alberta for 12 months. To qualify for AHCIP, the minimum acceptable work permit length is 6 months.​

​

(Let it be known that I also tried to get this info summary for Quebec cause while they can be pretty freaking xenophobic, they are also sometimes hyper progressive with things in the same vein as MAiD - sadly, their eligibility page is a god damn click-through survey based on circumstances. Knock yourself out if you wanna look.)

So, as you can see from my hopefully-not-depths-of-the-night-impaired writeup, this isn't gonna be the magical out many of y'all may be wishing it will. Honestly, the amount of stress, time, effort, and money that would have to be sunk into this would probably be better spent on a plane ticket to Switzerland and the fees for Pegasos. But hey, this is all new here in the Great White North - maybe in a couple of years when the economy is really in the shitter, and the horrible Premier of Ontario has totally gutted the public health system to the point of getting away with introducing a mirror private one, things will be different. The Wild West of MAiD. Let this thread be a repository for revisions, changes, and whatever else to the new frontier upon which we are embarking.

*I made a bunch of random edits and additions to this after posting and probably destroyed the flow and cohesion in the process, given it's now past 6:30am. Sorry.

 

[lachrymost]

The "funniest" part about all this is the hysteria from those opposed to the expansion, who seem convinced that doctors are coercing depressed teenagers into getting MAiD left and right. I keep seeing memes about how the Canadian government can't wait to off the mentally ill as an alternative to providing support, when in reality we will get neither.

 

[Lawliet]

thank you for the extensive labor of this thread. it baffles me though, that people even imagined that you can just walk into canada and have this done?? i'm in the usa and the healthcare is shit, but i don't have the wait THAT long for a doctor (and im on medicaid).

you should get paid to write an article like this lmao

 

[Rounded Apathy]

The "funniest" part about all this is the hysteria from those opposed to the expansion, who seem convinced that doctors are coercing depressed teenagers into getting MAiD left and right. I keep seeing memes about how the Canadian government can't wait to off the mentally ill as an alternative to providing support, when in reality we will get neither.

I use no social media (well, unless you count this place...) for many reasons, trash like this being one of them. But really, to expect anything more from someone with a cross in their handle would be a fool's errand.

thank you for the extensive labor of this thread. it baffles me though, that people even imagined that you can just walk into canada and have this done?? i'm in the usa and the healthcare is shit, but i don't have the wait THAT long for a doctor (and im on medicaid).

you should get paid to write an article like this lmao

Thank you! Once upon a time I actually made (some) money from writing, and tend to forget I actually enjoy it when about an important subject and there are no constraints on the process. I've gotten a lot from this community and hope with this I will be able to give back into the future. Maybe I should set up a crypto donation thing hah.

I guess given how, as I understand, you can basically do that in Switzerland, people just figure Canada might be introducing a similarly lenient system. It's funny, lots of press is saying the new laws here will be the "most lax in the world", but all you seem to need in Switzerland is the money.

Speaking of which, I'm wondering if that's why even Medicaid is generally faster - though again, this point illuminates another misconception of our system: everything in Canada to do with institutional medicine is still 100% run by money, it just goes through the intermediary of government. In general, doctors (and hospital CEOs) still get paid obscene amounts, and as such have a financial incentive to blast through as many patients as possible because quality of care has no impact on salary. Not sure I agree, but once heard an interesting take that in the US, there may be a more ingrained sense of accountability to the patient as they pay physicians directly instead of their cheque coming magically from the ether; and given that to some extent one is more free to "shop around" for a physician, reputation matters more.

 

[Rounded Apathy]

Well, here's even more evidence that even for Canadians, they will be on their toes about people like us...not news, but just happened upon it now. From the following source, in the section on MAiD & suicidality:

www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html#a223

​

"In these high-stakes clinical situations the clinician must undertake three actions simultaneously: 1. consider a person's capacity to give informed consent to make such decisions; 2. consider whether or not suicide prevention interventions should be activated, including against the will of the person if necessary;Footnote27​ and, 3. consider what other types of interventions could be helpful to the person including non-intervention. Even though decision-making capacity is presumed for all healthcare decisions, if clinicians have reasons to doubt capacity (and a decision that will lead to death often raises doubts about capacity) then it must be assessed in light of the decision being made. Invoking measures of suicide prevention, particularly involuntary ones, tends to occur when a person has a history of suicide attempts, a history of a mental disorder, and/or is in a state of crisis or other reversible circumstance. The third action, offering and negotiating therapeutic options, is always part of the care plan and continues in parallel whether or not voluntary or involuntary suicide prevention measures are in play.​

​

Clinicians do not prevent people (including those with mental disorders) from making life-ending decisions in all cases. In situations where there is no acute crisis and the person is capable to make the decision, clinicians encourage preservation of life through all therapeutic mechanisms available, but do not go so far as to prevent a person from making a potentially fatal decision in every situation. This approach is consistent with existing legal and ethical norms concerning informed consent, decision-making capacity, and involuntary hospitalization for mental disorders.​

​

In addition to non-MAiD situations of high-stakes decision-making, people with mental disorders and coexisting physical disorders are potentially eligible for MAiD at present. Individualized suicide assessments that take into consideration the above elements are already part of current MAiD assessment practices as are suicide prevention efforts when these are warranted.Footnote28"​​

 

[whitefeather]

It's still four months away, but I'm already seeing an uptick in posts wondering about the changes in the Medical Assistance in Dying (MAiD) law in Canada that will open the eligibility criteria to those suffering from mental ailments. I answered two posts about it today alone with a lot of sourced info about why this does not mean you will be able to just show up and get euthanized once it happens - and maybe dispel some other myths of the fabled Perfect Canadian Healthcare System. After the amount of work I put into them, I figured I might as well collate them because this is just going to become more of a hot topic as the time draws closer. I seriously hope people find and spread this around; might as well save folks the time and effort wondering and researching this. I've already sunk my own life hours into it - sharing is caring. Have fun doing something else with your time.

For starters - there's a good chance whatever condition you think would make you eligible will not. There is still no list of accepted conditions, even physical ones. The section of the federal MAiD page on eligibility states that one must have a:

Grievous and irremediable medical condition​

To be considered as having a grievous and irremediable medical condition, you must meet all of the following criteria. You must:​

• have a serious illness, disease or disability (excluding a mental illness until March 17, 2023)
• be in an advanced state of decline that cannot be reversed
• experience unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable

The community of medical practitioners here is not even uniformly in favour of this change in legislation, so right off the bat the numbers are working against you. Moreover, you need not one, but two independent physicians or nurse practitioners to sign off on your request. Save for those who have some personal passion for this - moral, financial, or whatever else - the truth is it's also extra work, and most physicians here are at the end of their ropes already. This article discusses the sobering reality.

Given the long-standing indoctrination (see what I did there?) of "doing no harm" in medicine, I also expect nothing short of advanced cases of things like C-PTSD, dementia, schizophrenia, personality disorders, treatment-resistant depression, and eating disorders (the latter only because there has already been at least one successful application) will be getting the green light for this. Your life may feel like (and legitimately be) a living hell, but this is merely a change in legislation - the system has been teaching for decades that mental illnesses are not something to end life over. Even if it is legal, thought processes and moral alignment of those whose authorization you'll need won't be automatically flipping come March.

Round all this out with the fact that this nation's health care system is not the golden goose it's hyped up to be: a huge proportion of Canadians either don't have a family doctor, despite actively looking, and an even larger number are in the combined boat of being without a doctor or unable to get an appointment with theirs when necessary. Unlike the US, it's also an extremely bureaucratic system - any specialist covered by public health insurance can only be seen on referral from a GP/PCP, so after all the waiting you've done to be connected with a doctor (who hopefully doesn't suck btw), and all the waiting you've done to be able to actually have that appointment with them, guess what: GET READY TO WAIT SOME MORE! Average wait time from referral by a general practitioner to consultation with a specialist was 11.1 weeks in 2021, on top of which, from the consultation with a specialist to the point at which the patient receives treatment took another 14.5 weeks. For those keeping tabs, from referral to treatment, that's half a year, folks. Of course, all this god damn waiting may not apply if you just wanna be offed by a white coat, but it may - you might not be forced into unacceptable treatment, but when the gears move this slowly for something as innocuous as a procedure like a knee replacement, you'd better believe assisted suicide won't be moving at light speed.

Names of practitioners who are generally willing to get involved in this are going to circulate fast - everyone and their dog is gonna be trying to connect with them. It's be unheard of if any walk-in doctor vouched for something like this. So just like with everything else regarding accessing health"care" here, there's going to be an eternal wait for it. The following article just came out a couple of days ago; haven't read it but looks worthwhile, exploring the complex nature of the reality of bringing this legislation into effect:

Canada will soon allow medically assisted dying for mental illness. Has there been enough time to get it right?

With doctors divided and federal guidelines still in development, Canadians have questions about who will qualify for MAID next year – and whether it’s a good idea to give the most vulnerable an easier way to die

www.theglobeandmail.com

For a second though, let's imagine that none of the above would be an issue. You fit the eligibility profile perfectly and for some reason could be fasttracked through the purgatory that is Canadian health"care". Well, there's another major hurdle (I'll assume you didn't comprehensively read every link I've already embedded, but if you have, this won't be news): in order to be eligible for medical assistance in dying, you must be eligible for health services funded by the federal government, or a province or territory (or during the applicable minimum period of residence or waiting period for eligibility) - generally, visitors to Canada are not eligible for medical assistance in dying.

If you're reeaally determined, you CAN decide to go for the long haul and do what it takes to fulfill this criterion, but systems like this are designed to dissuade people from just dropping in and start getting publicly-funded medical support when they have no intention of sticking around. Dying is no exception, and, well, you won't be sticking around.

Generally, provinces administer their own healthcare programs, and as such there is variation between the requirements for enrolling in them, though there is a lot of commonality. Overall, you need to prove you live there, will continue to live there, and have lived there for some time. Some examples of key criteria from just three provinces, with links to the sources and more detail:

Ontario - To meet the minimum qualifications you must:

• be physically in Ontario for 153 days in any 12‑month period
• be physically in Ontario for at least 153 days of the first 183 days immediately after you began living in the province
• make Ontario your primary residence

You must also meet at least one of the following additional requirements. You:​

• are in Ontario on a valid work permit and are working full-time in Ontario, for an Ontario employer, for at least six months
• have a Temporary Resident Permit (only certain case types, e.g. 86 through 95) [link is useless though]

British Columbia - A resident is a person who meets all of the following conditions:

• A citizen of Canada or lawfully admitted to Canada for permanent residence
• Makes their home in B.C.
• Physically present in B.C. at least six months in a calendar year

Study and work permit holders​

Certain other individuals, such as some holders of Study and/or Work Permits, or Work Permits on Working Holiday Programs, which are issued under the federal Immigration and Refugee Protection Act and are valid for a period of six or more months, may be deemed residents.​

Alberta - Eligible residents You are eligible for Alberta Health Care Insurance Plan (AHCIP) coverage if you are:

• legally entitled to be in and remain in Canada and make your permanent home in Alberta
• committed to being physically present in Alberta for at least 183 days in any 12-month period
• not claiming residency or obtaining benefits under a claim of residency in another province, territory or country
• any other person deemed by the regulations to be a resident or temporary resident, not including a tourist, transient or visitor to Alberta

If you are moving, immigrating, or returning to Alberta from outside Canada, you might be eligible for coverage from the date you established residency. If you have an immigration document from Immigration, Refugee and Citizenship Canada, you might be eligible for AHCIP coverage. Your eligibility depends on:​

• the type of entry document you have
• any restrictions listed on the document
• the length of time allowed in Canada
• your commitment to live in Alberta for 12 consecutive months

If you are a student from outside Canada, you may be eligible for AHCIP coverage.​

• Students who have a 12-month study permit (valid for an Alberta educational institute) and who will reside in Alberta for 12 months or more are eligible for AHCIP coverage and should apply.
• Students with study permits valid for less than 12 months, may be eligible for AHCIP coverage if their application is accompanied by a letter from the student confirming their intent to reside in Alberta for at least 12 months.

Temporary workers from outside Canada - If you come to Alberta on a work permit you must intend to stay in Alberta for 12 months. To qualify for AHCIP, the minimum acceptable work permit length is 6 months.​

​

(Let it be known that I also tried to get this info summary for Quebec cause while they can be pretty freaking xenophobic, they are also sometimes hyper progressive with things in the same vein as MAiD - sadly, their eligibility page is a god damn click-through survey based on circumstances. Knock yourself out if you wanna look.)

So, as you can see from my hopefully-not-depths-of-the-night-impaired writeup, this isn't gonna be the magical out many of y'all may be wishing it will. Honestly, the amount of stress, time, effort, and money that would have to be sunk into this would probably be better spent on a plane ticket to Switzerland and the fees for Pegasos. But hey, this is all new here in the Great White North - maybe in a couple of years when the economy is really in the shitter, and the horrible Premier of Ontario has totally gutted the public health system to the point of getting away with introducing a mirror private one, things will be different. The Wild West of MAiD. Let this thread be a repository for revisions, changes, and whatever else to the new frontier upon which we are embarking.

*I made a bunch of random edits and additions to this after posting and probably destroyed the flow