Despite filibustering by the Conservatives, Bill C-7, which expands the conditions for obtaining medical assistance in dying, will become law sooner or later. This will be good news for people suffering from severe physical or mental illness or disability who want to end their lives.

But the expert panel charged with working out the exact parameters for permitting those deaths has an impossible task. Whatever restrictions they impose, some people are bound to be given a medically assisted death, not just because they are grievously ill, but because they are poor or persecuted or unwanted. That’s a terrible price for some to pay so that others may end an intolerable life.

Under the current law, someone may obtain medical assistance in dying if they have a “grievous and irremediable medical condition” and a “natural death has become reasonably foreseeable.” In 2019, the Quebec Superior Court declared the law too restrictive. Rather than appeal the decision to the Supreme Court of Canada, the Liberal government decided to answer the Quebec court’s concerns with Bill C-7.

The amended bill expands the conditions for MAID to include an intolerable physical condition in which death is not reasonably foreseeable, or an incurable mental illness if the person is capable of making a reasoned decision to end their life. But the Conservatives are fighting the bill at every turn. On Thursday, government lawyers secured a fourth and final one-month extension on the deadline to comply with the court’s ruling.

Reasonable people can support MAID in principle while having serious concerns with Bill C-7, and with the Quebec court’s decision. The Council of Canadians with Disabilities condemns “the expansion of Medical Assistance in Dying as a legally- and socially-sanctioned substitute for assistance in living.”

Catherine Frazee, professor emerita in the School of Disability Studies at Ryerson University, stated in a video that society is fundamentally reinventing MAID “so that it is no longer an alternative to a painful death, but for some, instead, an alternative to a painful life.”

Conservative Senator Denise Batters, an advocate for mental-health issues, told me she considers C-7 “a four-alarm fire for mental-health issues in this country” that “will set back the mental-health movement by years.”

Someone might think their mental or physical illness or disability has rendered existence intolerable when the real issue is the poverty they face, or an abusive environment, or their inability to receive the appropriate treatment or therapy.

“And I would add to that, what if they are Black, or Indigenous or a person of colour and/or queer and or gender non-conforming and all of the other marginalizations?” asks Susan Cadell, a social work professor at University of Waterloo whose research includes studying the impact of MAID on grieving families. “It gets even more complex because all of those things work against the individual getting the help they need. And so intractable mental illness that may qualify someone for MAID may in fact be a systemic problem rather than an individual problem.”

This was already an issue with C-14, the 2016 legislation that permitted medically assisted deaths. As the pandemic revealed to those who did not already know, many people in long-term and palliative care suffer from neglect that leaves them feeling life is not worth living. Should the state assist their death, or improve the quality of care?

If that is an issue for those nearing death, imagine how much larger an issue it is for those suffering from a severe but not life-threatening mental or physical illness or disability.

In Canada, 1 per cent of deaths are medically assisted, according to a federal government report. In the Netherlands, which permits MAID for a number of nonterminal conditions, the figure is 4 per cent. The passage of C-7 will move Canada closer to the Netherlands figure. Is that what we want?

The expert panel should use the two-year study period before MAID is permitted for those with severe mental-health issues to put the strictest safeguards in place. Are we sure that someone seeking a medically assisted death has received the best possible care? That they aren’t facing pressure from family members or caregivers who find them a burden?

Our utilitarian society appears to accept that the good of ending unbearable suffering for some surpasses the harm of needless deaths for others. It’s a hard bargain we’re making.

The Globe and Mail, February 26, 2021