Resource Update: Canada MAiD law changing in 2023

[wljourney]

QUICK RECAP:
Since MAID (medical assistance in dying) was legalized 6 years ago in Canada it is considered a healthcare option.
It is a voluntary choice of treatment with a number of safeguards in place.

It is not available to people who don't live in Canada (to prevent suicide tourism!)

Right now people who suffer from a "grievous and irremediable" illness can apply for MAID, they do not have to be terminally ill.

However, people who suffer solely from mental health conditions are excepted until March 2023.

UPDATE:
the government has created a working group to provide guidelines on HOW TO ASSESS patients with mental illness come March 2023.

They were supposed to publish their report this spring (2022).

Yesterday the government announced that the report of the working group is delayed and has been given an extension to publish their final report until October 2022.

The working group must publish an interim report by June 23, 2022.

These reports will tell us what exactly the eligibility criteria will be. I.e. how many assessors have to sign off, how many treatments must the patient have tried, how severe the disability due to mental illness has to be, how doctors can assess the "suffering" of a person, how to make sure the patient is competent and able to make this decision, etc.

WHAT DOES THIS MEAN FOR PATIENTS:
Doctors who assess patients and have to decide if they are eligible for MAID likely wont know early enough what the legal requirements are.

They will need checklists, forms and follow a procedure that likely wont be set up by March 2023.

It is very likely that there will be a delay in accessing MAID for patients with MH illness as a result.

If you are interested in accessing MAID in Canada be prepared, start the conversation with your doctor, but also assume that this will not happen immediately and there are many legal and administrative hurdles to overcome before anything happens.

 

[wljourney]

Another interesting thing I learned:

You do not need the support of your current treating physician to apply for an assessment for MAID.

If your doctor is "consciously objecting" MAID in general they are legally required to transfer your care to another doctor/specialist who is not a conscious objector. (This will get very very interesting since there are currently not enough doctors available as needed and wait times may be extremely long)

Also: once you think you are eligible, you can call a provincial intake hotline and they will go through a basic questionnaire to make sure you fulfill the basic eligibility criteria as required by law (over 18, resident in Canada, eligible for provincially funded healthcare, what kind of illness/disability, etc).

Then an assessor is assigned and the process begins.

While supporting letters from your physicians are helpful, they are not required.

However medical records will have to be requested by patients and can't always be transferred from doctor to doctor, so there is a bit of administrative legwork involved.

 

[vk1699]

Have you written in support of expansion?

https://www.parl.ca/Committees/en/AMAD/StudyActivity?studyActivityId=11625215

 

[Capsaicin78]

It is not available to people who don't live in Canada (to prevent suicide tourism!)

Well, this is what we call "unlucky" my guys.

 

[wljourney]

UPDATE (May 2022):

The good news: the much awaited recommendations of the Expert Panel on MAID and mental health has been published.

It's a bit of a read, but essentially they came up with 13 recommendations to make sure that people who suffer from mental health illnesses can be properly assessed, get access to MAID if they qualify and are denied if they turn out not to fulfill the criteria required in the law.

Next step is for federal and provincial agencies to work together with medical professionals and come up with practical guidelines that would cover questions like:

- when is a condition considered to be "irreversible"?
- when is an illness considered "irreversible"?
- what is considered "intolerable suffering"?
- when is a patient's functioning severely limited?
- how many different treatments must a patient have tried unsuccessfully?
- how to distinguish between suicidality and a rational wish for MAID?
- would additional social support (housing, Financial aid) be available and has the patient been offered reasonable support?
- How to assess that a patient is capable of making the request?
- How to assess if the patient has been influenced by others or coerced?

So… now we wait.

 

[intelatedtojimmi]

QUICK RECAP:
Since MAID (medical assistance in dying) was legalized 6 years ago in Canada it is considered a healthcare option.
It is a voluntary choice of treatment with a number of safeguards in place.

It is not available to people who don't live in Canada (to prevent suicide tourism!)

Right now people who suffer from a "grievous and irremediable" illness can apply for MAID, they do not have to be terminally ill.

However, people who suffer solely from mental health conditions are excepted until March 2023.

UPDATE:
the government has created a working group to provide guidelines on HOW TO ASSESS patients with mental illness come March 2023.

They were supposed to publish their report this spring (2022).

Yesterday the government announced that the report of the working group is delayed and has been given an extension to publish their final report until October 2022.

The working group must publish an interim report by June 23, 2022.

These reports will tell us what exactly the eligibility criteria will be. I.e. how many assessors have to sign off, how many treatments must the patient have tried, how severe the disability due to mental illness has to be, how doctors can assess the "suffering" of a person, how to make sure the patient is competent and able to make this decision, etc.

WHAT DOES THIS MEAN FOR PATIENTS:
Doctors who assess patients and have to decide if they are eligible for MAID likely wont know early enough what the legal requirements are.

They will need checklists, forms and follow a procedure that likely wont be set up by March 2023.

It is very likely that there will be a delay in accessing MAID for patients with MH illness as a result.

If you are interested in accessing MAID in Canada be prepared, start the conversation with your doctor, but also assume that this will not happen immediately and there are many legal and administrative hurdles to overcome before anything happens.

I am so excited for this! We should have a choice. Also, people won't take unnecessary risks as much or go through unnecessary pain. All in all it's to end the pain. And some of us have suffered far too long. I've suffered since I was 8 with anxiety and depression. To be free of pain ! Aaaah how exciting

 

[WorthlessTrash]

I wish us citizens could apply.

 

[wljourney]

I am so excited for this! We should have a choice. Also, people won't take unnecessary risks as much or go through unnecessary pain. All in all it's to end the pain. And some of us have suffered far too long. I've suffered since I was 8 with anxiety and depression. To be free of pain ! Aaaah how exciting

Yes, on the one hand I am too.
On the other: it is extremely difficult to find supportive healthcare providers.
My experience over the last few months has shown that most HC workers don't understand the new law. They don't understand the process itself and they don't understand the difference between "suicidal" and "well thought out wish for MAID".

I've spent hours to educate and advocate for the right of a peaceful death and the result:
- social worker tells me to call the crisis line if I'm suicidal
- therapist quit and referred to someone else (starting all over again)
- psychiatrist is a conscientious objector and freaked out, now wants me to try ECT or Ketamine.

Honestly. I am questioning if it's worth going through all of this just to access a (soon to be) legal healthcare option.

It's extremely (!!) exhausting and frustrating dealing with these people and DIY CTB seems MUCH easier.

All I was hoping for was not having to die alone.

 

[intelatedtojimmi]

We could move there. I'm willing for painless freedom

 

[ayb]

Just a reminder that the conservative party has vowed to repeal this law if they come into power in Canada. Vote accordingly in the future.

This is why I hope the supreme court rules it as a right for the mentally ill as well so they'd be unable to.

 

[Alex6216]

It would also be nice if having N in your possession wasn't illegal.

 

[wljourney]

Just a reminder that the conservative party has vowed to repeal this law if they come into power in Canada. Vote accordingly in the future.

This is why I hope the supreme court rules it as a right for the mentally ill as well so they'd be unable to.

Do you mean the Canadian Supreme Court? Because they have already ruled on this (Bill C14 and Bill C7) and that's why MAiD laws are changing right now and are extended to mental illness next March.

But yes. I agree that people have to stop voting against their own best interests. Conservatives would very likely try to overturn this new legislation.

It would also be nice if having N in your possession wasn't illegal.

BC is starting to allow possession of hard drugs, but only in very small quantities. It's still illegal, but they are having a go at decriminalization.
Not a bad move IMO. More is needed.

We could move there. I'm willing for painless freedom

You can't just move to a foreign country and be eligible for public healthcare without qualifying for a visa/work permit/permanent residency.

MAiD is only available to those who are also eligible for public healthcare.

 

[ayb]

Do you mean the Canadian Supreme Court? Because they have already ruled on this (Bill C14 and Bill C7) and that's why MAiD laws are changing right now and are extended to mental illness next March.

But yes. I agree that people have to stop voting against their own best interests. Conservatives would very likely try to overturn this new legislation.

BC is starting to allow possession of hard drugs, but only in very small quantities. It's still illegal, but they are having a go at decriminalization.
Not a bad move IMO. More is needed.

You can't just move to a foreign country and be eligible for public healthcare without qualifying for a visa/work permit/permanent residency.

MAiD is only available to those who are also eligible for public healthcare.

Yes I mean the supreme court in Canada. Right now they've ruled that MAID is a right for people with terminal illnesses, alongside those with severe irremediable physical, and neurodegenerative conditions. The government has also included severe-refractory mental illness as an eligible criteria because excluding it would very much likely be unconstitutional.

What I wish for however is a case to go before the supreme court regarding severe-refractory mental illness and MAID eligibility. That way they can explicitly rule it as a right for that category of people as well. If they do that then even if the conservative party were to gain power, and also hold a majority in parliament they wouldn't be able to pass a law impinging on that right for eligible people because it'd be a violation of the charter of rights and freedoms.

 

[wljourney]

Yes I mean the supreme court in Canada. Right now they've ruled that MAID is a right for people with terminal illnesses, alongside those with severe irremediable physical, and neurodegenerative conditions. The government has also included severe-refractory mental illness as an eligible criteria because excluding it would very much likely be unconstitutional.

What I wish for however is a case to go before the supreme court regarding severe-refractory mental illness and MAID eligibility. That way they can explicitly rule it as a right for that category of people as well. If they do that then even if the conservative party were to gain power, and also hold a majority in parliament they wouldn't be able to pass a law impinging on that right for eligible people because it'd be a violation of the charter of rights and freedoms.

That decision has already been made by the Superior Court of Quebec (Truchon decision) and has been signed into law by Bill C7. You don't need another Court decision since it's already been decided that it would be against the charter to exclude people with mental illness.

The law now specifically includes people whose sole medical condition is a mental illness, but they added a 2 yr wait period to figure out how to practically implement this.

That exclusion is automatically repealed come March 2023.

Bill C7 and Truchon decision

Legislative Background: Bill C-7: Government of Canada’s Legislative Response to the Superior Court of Québec Truchon Decision

Department of Justice Canada's Internet site

www.justice.gc.ca

Government Bill (House of Commons) C-7 (43-2) - Royal Assent - An Act to amend the Criminal Code (medical assistance in dying) - Parliament of Canada

Government Bill (House of Commons) C-7 (43-2) - Royal Assent - An Act to amend the Criminal Code (medical assistance in dying) - Parliament of Canada

parl.ca

 

[Deleted Member 4048]

Yes, on the one hand I am too.
On the other: it is extremely difficult to find supportive healthcare providers.
My experience over the last few months has shown that most HC workers don't understand the new law. They don't understand the process itself and they don't understand the difference between "suicidal" and "well thought out wish for MAID".

I've spent hours to educate and advocate for the right of a peaceful death and the result:
- social worker tells me to call the crisis line if I'm suicidal
- therapist quit and referred to someone else (starting all over again)
- psychiatrist is a conscientious objector and freaked out, now wants me to try ECT or Ketamine.

Honestly. I am questioning if it's worth going through all of this just to access a (soon to be) legal healthcare option.

It's extremely (!!) exhausting and frustrating dealing with these people and DIY CTB seems MUCH easier.

All I was hoping for was not having to die alone.

Oh my god, that's terrible hearing even these "professionals" gaslight, avoid the subject, and try to treat you like a patient rather than have a normal, rational conversation. Whenever I hear about professionals who say they are going to have an open-dialogue I roll my eyes and seriously doubt that they even engage in good faith. It's not in good faith as they have a purpose to treat whoever discusses such topics as someone to be treated and a patient first rather than just someone who wishes to have an honest, good faith discussion about the topic.

I wouldn't even think about approaching such actions in the US where not only are these professionals just as bad in various ways, but with the added consequence of hospital and medical bills for temporary psych holds and what not. It makes me rather angry and sad that this is the state of affairs and another chip into the bucket of reasons to CTB (amongst many others).

 

[wljourney]

Oh my god, that's terrible hearing even these "professionals" gaslight, avoid the subject, and try to treat you like a patient rather than have a normal, rational conversation. Whenever I hear about professionals who say they are going to have an open-dialogue I roll my eyes and seriously doubt that they even engage in good faith. It's not in good faith as they have a purpose to treat whoever discusses such topics as someone to be treated and a patient first rather than just someone who wishes to have an honest, good faith discussion about the topic.

I wouldn't even think about approaching such actions in the US where not only are these professionals just as bad in various ways, but with the added consequence of hospital and medical bills for temporary psych holds and what not. It makes me rather angry and sad that this is the state of affairs and another chip into the bucket of reasons to CTB (amongst many others).

I agree.

Of course approaching this topic in a country that doesn't offer legal MAiD is quite different compared to countries that do.

That's why it is quite frustrating, because d/t the change in law Canadian healthcare professionals now have to LEARN how to have these conversations.

Just because we now have MAiD as a legal healthcare option doesn't mean the people who are supposed to offer this healthcare option (or refer you to someone who does) know how to deal with it.

They have to learn how to distinguish between suicidality vs. well-reasoned wish for MAiD.

The one doctor who actually reacted surprisingly professionally, calm and open was my GP. So there is hope.

It's going to be a very long way not only for patients but also for healthcare providers to learn how to deal with this.

And I don't think I have the patience to advocate and educate people for years to come.

 

[Deleted Member 4048]

I agree.

Of course approaching this topic in a country that doesn't offer legal MAiD is quite different compared to countries that do.

That's why it is quite frustrating, because d/t the change in law Canadian healthcare professionals now have to LEARN how to have these conversations.

Just because we now have MAiD as a legal healthcare option doesn't mean the people who are supposed to offer this healthcare option (or refer you to someone who does) know how to deal with it.

They have to learn how to distinguish between suicidality vs. well-reasoned wish for MAiD.

The one doctor who actually reacted surprisingly professionally, calm and open was my GP. So there is hope.

It's going to be a very long way not only for patients but also for healthcare providers to learn how to deal with this.

And I don't think I have the patience to advocate and educate people for years to come.

Hmm, so it seems even if migrating to Canada anytime soon won't necessarily mean that one gets access to MAiD (for mental health conditions)?

Not that I have any plans to migrate as doing so and uprooting one's current existence is a lot of effort and not everyone (including myself) have the resources to do that.

 

[wljourney]

Hmm, so it seems even if migrating to Canada anytime soon won't necessarily mean that one gets access to MAiD (for mental health conditions)?

Not that I have any plans to migrate as doing so and uprooting one's current existence is a lot of effort and not everyone (including myself) have the resources to do that.

The estimated timeline for applications is based on experience from the Netherlands/Belgium and about 10 months. So from the day one applies it will still take almost a year to actually get MAiD.

Anyone thinking about "moving" to Canada: forget it!
You can't simply "move" to a foreign country and expect access to healthcare and eligibility for a work visa without fulfilling very stringent requirements for immigration.

Getting a work visa is HARD.
Don't have a college degree?
Don't have years of specialized work experience?
Don't fit in (very restricted!) refugee classifications?
Forget it!

And even if you do, there is a FULL medical you need to pass.

And just as you said: it's expensive!!
Not just the application fees ($2-3k) and the moving costs (a few grand), but in order to immigrate you have to prove that you have the funds to establish a life here. That's a minimum $7k on top.

 

[ayb]

T

That decision has already been made by the Superior Court of Quebec (Truchon decision) and has been signed into law by Bill C7. You don't need another Court decision since it's already been decided that it would be against the charter to exclude people with mental illness.

The law now specifically includes people whose sole medical condition is a mental illness, but they added a 2 yr wait period to figure out how to practically implement this.

That exclusion is automatically repealed come March 2023.

Bill C7 and Truchon decision

Legislative Background: Bill C-7: Government of Canada’s Legislative Response to the Superior Court of Québec Truchon Decision

Department of Justice Canada's Internet site

www.justice.gc.ca

Government Bill (House of Commons) C-7 (43-2) - Royal Assent - An Act to amend the Criminal Code (medical assistance in dying) - Parliament of Canada

Government Bill (House of Commons) C-7 (43-2) - Royal Assent - An Act to amend the Criminal Code (medical assistance in dying) - Parliament of Canada

parl.ca

The issue is that the Superior Court of Quebec is not the Supreme Court of Canada. Like I said, I fully anticipate the conservatives passing legislation to ban it once in power, or pull some other bullshit. Hence why I hope Dying With Dignity Canada manages to get the Supreme Court to rule it as a right for the mentally ill as well. That way the bible-humpers wouldn't be able to do anything but pound sand.

 

[CoalmineCanary]

 

[lachrymost]

I have a hard to Google question: Would previous ctb attempts render one ineligible for MAID? Or even, could one be granted MAID if their given reason for applying is disabilities incurred through ctb attempts?

 

[wljourney]

I have a hard to Google question: Would previous ctb attempts render one ineligible for MAID? Or even, could one be granted MAID if their given reason for applying is disabilities incurred through ctb attempts?

The short answer: We don't know yet.

The long answer:
Right now the Guidelines are being written on how to assess a patient who suffers solely from mental illness.
We should know more about the details by end of October 2022. But it's likely that this will be delayed.

These guidelines that are being written to help healthcare providers assess MAID applicants are based on a number of recommendations that came out of the commission that discussed this question.

Link to the final report here: https://www.canada.ca/en/health-can...rt-expert-panel-maid-mental-illness.html#a223

Under Number 2 the issue of "Suicidality" is being discussed.

"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."

As far as I understand it a previous suicide attempt should NOT exclude you now, if you are CURRENTLY considered to be capable of making the decision, you are not in crisis, you are not currently hospitalized for mental health issues, you are able to make an informed decision and you are able to understand the consequences of the decision you are making.

This assessment (if the patient is suicidal/in crisis) will likely be done multiple times throughout the application process (expected to take about 10 months from referral to actual date of MAID provision). Potentially every time you talk to the MAID assessor.

Generally I would advise against telling the assessor that you are a member of SaSu. That would likely lead to an assessment that considers you as "chronically suicidal". I would also suggest not to mention financial difficulties such as the severe poverty people are forced to live in, when they depend on disability pension in Canada.

Both of those would be exclusion criteria and arguments against providing MAID.

I have a hard to Google question: Would previous ctb attempts render one ineligible for MAID? Or even, could one be granted MAID if their given reason for applying is disabilities incurred through ctb attempts?

Further to your question it may be important to add this:

The governmental commission has made 19 recommendations that will go into these new guidelines for healthcare professionals.

Recommendation #5 mentions CAPACITY.
Recommendation #9 mentions INVOLUNTARINESS

Final Report of the Expert Panel on MAiD and Mental Illness - Canada.ca

The final report of the Expert Panel on MAiD and Mental Illness

www.canada.ca

I expect there will be some sort of "special rule" for people who are repeatedly admitted to involuntary 72 hr holds ("formed"). Potentially with an additional wait time to make sure the crisis situation has passed or a requirement that one hasn't been formed within the last 12 months (or something like that).

"Recommendation 9: Situations of Involuntariness
Persons in situations of involuntariness for periods shorter than six months should be assessed following this period to minimize the potential contribution of the involuntariness on the request for MAiD. For those who are repeatedly or continuously in situations of involuntariness, (e.g., six months or longer, or repeated periods of less than six months), the institutions responsible for the person should ensure that assessments for MAiD are performed by assessors who do not work within or are associated with the institution."


+++
EDIT:

Now, THIS part of your question is a bit harder to answer.
@lachrymost

"Or even, could one be granted MAID if their given reason for applying is disabilities incurred through ctb attempts?"

I assume that this would be covered by the capacity/involuntariness sections.

If you continually try to CTB and incur longterm health issues from said attempts, you would likely be considered "chronically suicidal". On top of that, if you are being formed (involuntary hold for 72 hrs after CTB attempt) repeatedly, you would likely at some point be excluded from being eligible for MAID.

I don't think it matters if you have kidney failure from repeated drug overdoses or are quadriplegic after jumping from a bridge.
In both cases you would be assessed based on your current state of mind.
You would have to be able to show that you are not currently suicidal, in crisis or otherwise impaired in making an informed decision.

 

[Banshee]

I really don't understand how so many people on here think that they'll easily receive MAID here in Canada. There is lots of people with horribly painful and crippling terminal illnesses that are still being denied.

My ex-girlfriend's terminally ill and bedridden uncle tried to get accepted here in Canada but was denied multiple times. Luckily he was a dual citizen (originally from The Netherlands) because he ended up having to fly back home to have a doctor assisted suicide. He was in such pain that the family had to charter a private jet to fly him home as he wasn't able to walk. He was literally gurnied on to the plane.

 

[LaVieEnRose]

I really don't understand how so many people on here think that they'll easily receive MAID here in Canada. There is lots of people with horribly painful and crippling terminal illnesses that are still being denied.

My ex-girlfriend's terminally ill and bedridden uncle tried to get accepted here in Canada but was denied multiple times. Luckily he was a dual citizen (originally from The Netherlands) because he ended up having to fly back home to have a doctor assisted suicide. He was in such pain that the family had to charter a private jet to fly him home as he wasn't able to walk. He was literally gurnied on to the plane.

Surprising they would deny someone terminally ill. There shouldn't be any controversy about that.