Justice Minister David Lametti under fire for ‘unbelievable’ comparisons between euthanasia and suicide

Did Justice Minister David Lametti say the quiet part out loud?

In a recent interview for the Star’s “It’s Political” podcast, Lametti conflated medical assistance in dying (MAID) and suicide. After I expressed reservations about the expansion of MAID in March to people with mental illness without adequate social and medical supports, Lametti told me to “remember that suicide generally is available to people. This is a group within the population who, for physical reasons and possibly mental reasons, can’t make that choice themselves to do it themselves. And ultimately, this provides a more humane way for them to make a decision they otherwise could have made if they were able in some other way.”

While the minister was alluding to Supreme Court decisions to suggest rights that are given to some can’t be denied to others because they are physically incapable, his comments shocked observers and practitioners — in part, because they fly in the face of suicide prevention efforts, but also because they shatter a common argument from MAID advocates, that there is a clear distinction between euthanasia and suicide.

Psychiatrist Derryck Smith called Lametti’s comments “terrible,” “very distressing,” “so misinformed” and “unbelievable.”

“It sounds like he’s encouraging suicide,” the University of British Columbia emeritus professor said.

“MAID has nothing to do with helping people who are not capable of suicide,” he stressed. “The two are quite different, so I think he’s confused in his own mind about what this whole issue is about.”

Brian Mishara, the director of the Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices at the Université du Québec in Montreal, said Lametti is treating MAID as if it were any other medical treatment that needs to be widely available rather than as a measure of last recourse.

“It scares the hell out of me,” he said.

Trudo Lemmens, the Scholl chair in health law and policy at the University of Toronto and a critic of MAID’s expansion, found Lametti’s words “very disturbing” and said they reflect a “normalization” of end-of-life practices by medical professionals “as a form of inherently beneficial therapy. That deeply worries me. And it’s reflected (by Lametti) in the podcast in a way that was not reflected before.”

One key question in the debate over MAID’s expansion is how to tell whether someone’s suffering from mental illness is truly irremediable. The federal government’s expert panel noted there is “limited knowledge about the long-term prognosis for many conditions,” and said it “is difficult, if not impossible” for doctors to accurately predict the future of an individual patient.

Despite this, and the fact that patients who seek MAID may be experiencing “a symptom of the very condition which is the basis for a request for MAID,” Ottawa still plans to press ahead with the legislated expansion in March.

But it does prompt the question: are we willing to end people’s lives through MAID knowing that some of them could otherwise have gone on to lead happy lives?

Several witnesses testified before a parliamentary committee that if MAID had been available to them, they would have ended their lives without knowing help was around the corner.

“My personal experience tells me that you can be in a state of mind and suffering from severe depression that you believe is going to last the rest of your life,” said Sean Krausert, executive director of the Canadian Association for Suicide Prevention.

But others, like Smith, argue psychiatrists will be able to navigate the choppy waters ahead. “I personally have no problems separating a patient who is having suicidal ideation from a person who is seeking MAID,” he said. “For one thing, the person seeking MAID has probably been suffering with psychiatric illness for eight to 10 years,” he added. “We’re not talking here about an 18-year-old woman who suddenly got depressed and is having suicidal thoughts.”

To be clear, no one is talking about that.

“Mental illness is not like cancer. It doesn’t just get worse,” Mishara told me recently.

Canada, he argued, should follow the Netherland’s example and require those wanting to end their lives to first undergo reasonable treatment options. Suicidal patients, he noted, can be hospitalized against their will, and the vast majority of them — 90 per cent — never attempt suicide again. That’s proof, he said, that people’s ability to make good decisions can be compromised by symptoms of mental illness. And since the decision to die by MAID is an irreversible one, he suggested, people should be protected from making it.

But that, of course, means treatments must be available and fully funded. It requires government action and investments.

Perhaps it’s easier for the state and society to say, here, choose to die.

That message should concern us all.

Early research, according to Lemmens, suggests MAID may actually increase suicide rates outside of the MAID regime. Suicides in Canada went up after MAID’s introduction in 2016, but in 2020, after the government sent $2,000 CERB cheques to so many, rates fell by 15 per cent. That raises even more uncomfortable questions.

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