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Liberals table bill delaying medically assisted dying expansion to March 2024

OTTAWA — The federal government is delaying the expansion of its medically assisted dying regime to people whose sole condition is a mental disorder for another year because it says more time is needed to prepare health-care practitioners and systems
Justice Minister and Attorney General of Canada David Lametti speaks during a news conference, Thursday, February 2, 2023 in Ottawa. THE CANADIAN PRESS/Adrian Wyld

OTTAWA — The federal government is delaying the expansion of its medically assisted dying regime to people whose sole condition is a mental disorder for another year because it says more time is needed to prepare health-care practitioners and systems across the country. 

On Thursday, Justice Minister David Lametti introduced the bill seeking to delay extending the eligibility until March 17, 2024.

"We need to be prudent. We need to move step by step, making sure that people within the profession, Canadian society at large, has internalized this step," Lametti told reporters.

"To be honest, we could have gone forward with the original date, but we want to be sure. We want to be safe. We want everybody to be on the same page."

The Liberal government agreed to expand eligibility in its 2021 update to the assisted dying law after senators amended the bill. The senators argued that excluding people with mental illness would violate their rights.

That law put a two-year deadline on the expansion that is set to expire on March 17. 

The Liberals now have six weeks to pass the new legislation.

Carolyn Bennett, the federal minister for mental health and addictions, said the "extra time" would help ensure the people assessing these cases, and the practitioners carrying out the assisted dying process, "to know that they have done it in exactly the way that the experts and the patients deserve."

She said certain provinces had also indicated they weren't ready.

Madeline Li, a psychiatrist who sits on several assisted dying-related panels, said the delay is a "reasonably foreseeable" amount of time. 

"It's really about preparing health-care providers to more carefully assess patients, and the way we do that is by rolling out training, in terms of how to assess patients with mental disorders, how to properly evaluate capacity, how to consider vulnerability factors," she said. 

She added that the process of developing that training is ongoing, and time will be needed to disseminate it across the country to doctors and nurse practitioners who want to provide assisted dying to those who only have a mental disorder.

Federal officials said that the delay will allow more time for the government to develop practice standards for assessing the more complex assisted dying requests. The explanation was given during a technical briefing to media provided on the agreement the officials would not be named.

Those standards will have to be adapted by provincial and territorial regulators and clinicians, a process that is currently expected to take place in March.

Officials said an accredited medical assistance in dying curriculum is also being developed for clinicians. It is expected to be rolled out in the fall and completed by the end of the year.

Bennett said the curriculum for practitioners is "pretty well ready," but the delay will give them more time to "actually learn what is in the modules."

Officials said the delay is also allowing the government to better collect and report data on assisted dying cases. They are expecting a relatively small number of new applicants to apply as a result of the expansion.

New regulations that allow for "enhanced data collection" came into force at the beginning of the year. The data will go beyond simple demographic details to look at how alternative treatments were offered and considered before the assisted dying process.

Lametti said he has agreement from the NDP and the Bloc Québécois to pass the bill in the short time available.

NDP MP Alistair MacGregor said in a statement that he had been concerned about the expansion and wholeheartedly supports the delay.

"The Liberals can’t just delay the expansion. They need to get better supports and treatment options for people suffering with mental illness," he said.

The Senate will also need to approve the move to push the expansion into next year.

Helen Long, CEO of advocacy organization Dying With Dignity Canada, said she was "deeply disappointed" on behalf of the individuals who have been waiting to apply under the expanded program. 

"I feel like it's a long delay. We would have hoped it would have been something shorter," she said.

"And I think for those people who have treatment-resistant mental disorders who've been excluded from the right to apply, this just continues to deny them compassion and extend their suffering."

Long argued that keeping people with mental disorders from accessing assisted dying is discriminatory and perpetuates stigma that they do not have the capacity to make their own health-care decisions. 

But the government heard from many voices saying to "slow this down," Lametti said Thursday.

"And at that point it became a question of how long. And those negotiations have led to where we are today."

Conservative MP Michael Cooper said on Twitter that the delay is not enough and the "dangerous expansion" needs to be scrapped altogether. 

Tories have argued that it is difficult for doctors to tell when a person's suffering due to a mental disorder is past the point of treatment, so the policy could lead to avoidable deaths.

"One year won't resolve the problems. Experts are clear that irremediability cannot be determined for mental illness," Cooper said.

This report by The Canadian Press was first published Feb. 2, 2023.

David Fraser, The Canadian Press