Canada Will Legalize Medically Assisted Dying For Eligible People Addicted to Drugs

Canada will legalize medically assisted dying for people who are addicted to drugs next spring, in a move some drug users and activists are calling “eugenics.”

The country’s medical assistance in dying (MAID) law, which first came into effect in 2016, will be expanded next March to give access to people whose sole medical condition is mental illness, which can include substance use disorders. Before the changes take place, however, a special parliamentary committee on MAID will regroup to scrutinize the rollout of the new regulations, according to the Toronto Star.

Currently, people are eligible for MAID if they have a “grievous and irremediable medical condition”, such as a serious illness or disability, that has put them in an advanced state of irreversible decline and caused enduring physical or psychological suffering—excluding mental illness. Anyone who receives MAID must also go through two assessments from independent health care providers, among meeting other criteria. According to a statement from Health Canada, the assessments must explore a person’s treatment history and “a person cannot refuse all or most treatments and automatically render themselves incurable for the purposes of accessing MAID.” People who haven’t attempted multiple treatments won’t qualify.

The contentious idea of including people who are addicted to drugs is being discussed this week at a conference for the Canadian Society of Addiction Medicine in Victoria, British Columbia.

“I don't think it's fair, and the government doesn't think it's fair, to exclude people from eligibility because their medical disorder or their suffering is related to a mental illness,” said Dr. David Martell, physician lead for Addictions Medicine at Nova Scotia Health, who is presenting a framework for assessing people with substance use disorders for MAID at the conference.  “As a subset of that, it's not fair to exclude people from eligibility purely because their mental disorder might either partly or in full be a substance use disorder. It has to do with treating people equally.”

However, some drug users and harm reduction advocates told VICE News they’re upset the idea of drug users being given access to MAID is even being discussed, as they feel other public health measures, including better access to overdose prevention sites, opioid agonist medications like methadone, a regulated drug supply, housing, and employment are lacking.

“I just think that MAID when it has entered the area around mental health and substance use is really rooted in eugenics. And there are people who are really struggling around substance use and people do not actually get the kind of support and help they need,” said Zoë Dodd, a Toronto-based harm reduction advocate.

Martell, who has been a MAID provider since 2016, said he agrees that health care options for people with substance use disorders are underfunded and that he hopes this conversation will draw more attention to those concerns.

He said he hasn’t heard a desire for assisted death from his patients who have substance use disorders—and it’s not something he’s sure he would raise as an option unless he was involved in end-of-life planning.

“The idea that we might promote or push this on people, that doesn't resonate with me at all,” he said, adding that even if someone with a substance use disorder was approved to receive MAID, he’s not sure he could be the one to help them end their life.

Martell was part of a Nova Scotia working group that included doctors, psychiatrists, ethicists, and policy analysts. He said some of the criteria they discussed included: requiring an assessor who had expertise in treating substance use disorders if that was the motivation for the MAID request and assessing what type of treatment the person had received and for how long.

“In addition to having a mental disorder that has been there for a very long time and that is significantly impairing their function, treatments have to have been tried and those treatments have to be treatments that are expected, usual, and evidence-based,” Martell said. But there’s no one size fits all answer to what that could mean, he added.

“One of the problems that we had, I think looking at it with that lens, had to do with the fact that we don't really have a whole lot of guidelines when it comes to addiction treatment,” Martell said. “There's still a lot of debate about it, but of the ones that do exist, we need to know that those have been tried.”

Opioid agonist therapy, which involves giving people medications like methadone or buprenorphine to help control their cravings, is considered the gold standard for treating opioid addiction.

But Dodd said that those medications aren’t easily accessible to everyone who needs them in Canada.

“I know people have to travel several hours to get access to what they need in the more rural places,” she said.

Martell said assessors will also need to be able to distinguish whether someone is suicidal or has a “reasoned wish to die.” The former might be linked to a more acute crisis or be a feature of a longstanding psychiatric condition, while the latter applies to someone who is “thinking in a calm and measured way about wanting (their) suffering to end, being able to reason through it,” Martell said. But he noted a person can exhibit signs of both, making it an even trickier ethical ground to navigate, and that it would be “fairly impossible” to make the distinction if the person being assessed was intoxicated.

Health Canada said assessments are carried out over a period of time and “not during a time of acute emotional distress or crisis.” The agency said assessors must make sure individuals seeking MAID have seriously considered all supports available to them, including couselling, mental health and disability supports, housing and income supports, and palliative care.

“No one can receive MAID solely on the basis of lack of social supports such as housing and mental health and addiction services.”

As Canada prepares to legalize MAID for people with mental disorders, each province will have to develop its own protocol for how to assess people.

Dr. Simon Colgan, lead physician for the Community Allied Mobile Palliative Partnership which provides palliative care to homeless people, said MAID requests “must be understood within the context of a person's lived experience and this takes time and relationship.”

He said any MAID protocols for people with substance use disorders should be made with the input of people with lived experiences.

Karen Ward, a drug user activist in Vancouver, said she considers the expansion of MAID to include people with substance use disorders a “statement in federal law that some people aren't really human.”

“The government has made death accessible while a better life remains impossible,” she said.  “Homes for all, guaranteed dignified incomes, access to healthcare, education and employment: these aren't radical demands.”

While there have been fears around a massive influx of people wanting MAID assessments once the new regulations kick in, Martell said if triaged properly he expects the number of people to qualify to be relatively low.

Update, October 23: The story has been updated with additional comment from Health Canada.