MAID Bill Is an Affront to Equality

Archibald Kaiser, Isabel Grant, Trudo Lemmens & Elizabeth Sheehy

Toronto Star editorial March 11, 2021

Canada’s legal system has an ugly track record on mental illness: exclusionary immigration laws; involuntary sterilization; restrictive marriage and voting statutes; debacles of institutionalization, deinstitutionalization and criminalization; and casualties of the war on drugs. Our nation has abandoned Canadians with mental illness to poverty, isolation and substandard living conditions. Now, based on a misguided interpretation of equality, Parliament intends to pass Bill C-7 and provide medical assistance in dying (MAID) to those suffering from mental illness.

In extending MAID to persons with disabilities whose deaths are not reasonably foreseeable, Bill C-7 exposes the shallowness of Canada’s commitment to the human rights of persons with disabilities. And while people with mental illness were initially protected, Parliament will further destabilize the equality and security of people with mental illness by including them in the legislation through a sunset provision in two years.

We urge MPs to reflect where Bill C-7 would lead us with state-supported medical termination of life for those not already dying. So far, they have ignored the voices of people with disabilities, including those with mental illness, when they decried the removal of the current safeguard of “reasonably foreseeable natural death.”

The United Nations committee set up under the Convention of the Rights of Persons with Disabilities (CRPD) — ratified exactly 11 years ago by Canada — and three special rapporteurs have expressed concern about how Bill C-7 violates the human rights of persons with disabilities. Now, Parliament may further undermine the remaining protection of persons with mental illness, adding insult to an injurious, discriminatory bill.

As Parliament continues to ignore Canada’s obligations under theCRPD, we should be mindful of some basic truths about mental illness.

People do not die from mental illness. They are at risk of premature mortality due to poverty, poor health, human rights violations, and even homicide, including by police. They are marginalized by inequality and ableism, as they struggle with mental health conditions and society’s neglect.

Almost half of all Canadians will suffer from mental illness in their lifetime. Social, economic, and environmental factors, as well as inequalities play a huge role. Discrimination increases the risk of mental health problems. Those with mental illness die disproportionately by suicide. Of Canada’s 4,000 suicide deaths per year, 90 per cent involved people living with a mental health problem. Bill C-7 would give people with mental illness a legal impetus to see MAID as a solution to socially inflicted suffering.

But offering death should never be our response. The Centre for Addiction and Mental Health emphasizes there is no reliable standard for determining when mental illness is “irremediable.” Social and political exclusion contribute to mental illness; diagnoses are contested and change over time, as our Supreme Court emphasized. Homosexuality, for example, was only removed from the leading diagnostic manual as a pathology in 1973.

Other jurisdictions show that with MAID for mental illness, women will disproportionately be its recipients, including women who have experienced sexual trauma and abuse, and others whose experience of trauma, racism and colonialism has led to intolerable suffering. Bill C-7 now opens up MAID as a more accessible alternative than providing the ongoing supports people need to live with mental illness. MAID is uniformly covered by the health care system; supports, on the other hand, are often expensive, require lengthy waits — sometimes years — and are thus largely inaccessible to many.

Arguing that denying assisted suicide to people with mental illness who are not dying is discriminatory ignores the overlay of stigma, discrimination and exclusion. In Canada, we condemn people with disabilities to live in poverty, to unemployment, homelessness, segregation and loneliness. If assisted dying is extended to people with mental illness, the message is clear: after relegating you to the margins, after our broken promises, Canada offers you death instead of a good life.

Substantive equality in Canada does not require that we treat everyone the same. The Supreme Court emphasizes it demands acknowledging “historical or current conditions of disadvantage, products of the persistent systemic discrimination that continues to oppress groups.” (A. G. (Ontario), 47). We must recognize the disadvantages faced by marginalized groups and alleviate them. Instead, Bill C-7 ignores the unique risks they face.

In under five years, Canada has reneged on the compromise reached to limit MAID to those at the end of life. It will now extend MAID to those with mental illness with almost no legislative study or debate. All this has happened during a global pandemic, when people with disabilities are fighting to stay alive. If Bill C-7 is adopted, Canada can no longer claim to be a progressive country committed to protecting the rights of all its members when it devalues disabled Canadians so profoundly.

We hope that we will look back on this bill as a serious blight on Canada’s human rights record — along with other shameful practices we have inflicted on disabled lives. The question is: how many disabled lives will this realization cost?


Archibald Kaiser is Professor, Schulich School of Law and Department of Psychiatry, Dalhousie University

Isabel Grant is Professor, Peter A. Allard School of Law, University of British Columbia

Trudo Lemmens is Scholl Chair in Health Law and Policy, Faculty of Law and Dalla Lana School of Public Health, University of Toronto

Elizabeth Sheehy is Professor Emerita of the Faculty of Law, University of Ottawa