Change to assisted dying law overlooks Nunavut's mental health crisis, say advocates

Nunavut wellness advocates say Canada needs to consider Nunavut voices on changes to the medically assisted dying program.

In two years, federal legislation will expand assisted dying to people with a severe mental illness. Medically assisted deaths have been legal in Canada since 2016, but only for people whose death is imminent. Bill C-7 expands the service to people who are very sick and suffering, but not likely to die.

Bill C-7, which the Senate passed on Wednesday with revisions, will impact Inuit, but the Embrace Life Council, a non-profit group for suicide prevention based in Iqaluit, says the scope of mental illness within Nunavut needs to be addressed before the amendment to the law comes into effect.

"More research is required to determine the relationship between mental health and the current public health emergency of suicide in Nunavut," the Embrace Life Council said in a letter to Nunavut Senator Dennis Patterson. The letter also notes that mental illness has a "significant impact on productivity, morbidity and mortality in Nunavut."

While Nunavut is in a territory-wide suicide crisis and sees high rates of untreated mental illness, the council says there isn't enough measurable data to show what mental illnesses are prevalent in Nunavut, who suffers with them and how those illnesses may be connected to suicide.

The council also argues that Canada has a responsibility under the Nunavut land claim to consult Inuit within the two year window the federal government has legislated for implementing the change to assisted dying law.

Kylie Aglukark, the council's president, says Nunavut residents don't have enough in-territory access to health services, including for mental health.

"We're required already to leave the territory to access basic services," Aglukark said.

This is especially true for people who have a severe and long-term mental illness that could lead to the level of suffering that would make a person eligible for assisted dying. 

"We need more [mental health] services. We need to not have our residents being shipped to southern Canada for basic services that should be offered in Nunavut," Aglukark said.  

The Embrace Life Council held a special board meeting to talk about the changes to Canada's medically assisted dying program.   

Senator says mental health treatment centre is too slow

The amendment follows a Quebec court ruling that criteria previously set out for medically assisted dying was unconstitutional. 

This move to include people who suffer solely from a severe and irremediable mental illness came after some senators argued that excluding mental illness is also unconstitutional. 

But in a March 17 vote that saw the bill passed, Senator Patterson voted not to include mental illness in the medically assisted dying program.  

He says the federal government has failed to bring mental health treatment to Nunavut, and there aren't enough mental health services in the territory for people to get better.

"There are organizations working against suicide and for wellness who are concerned that making it easier to choose to die with a mental illness in Nunavut without mental health supports, than to go on living and become well, is not a fair choice," he told CBC News. 

Patterson said little movement has been made on a 2019 promise by then Indigenous Services Minister Seamus O'Regan to see a mental health and addictions treatment centre built in Iqaluit.

Citing territorial health officials, he says Inuktut terminology also needs to be developed for assisted dying.

Embrace Life Executive Director Cecile Guerin says, it's crucial that language used to educate people on assisted dying is clear, non-judgemental and doesn't add to existing trauma.  

She says many politicians are referring to assisted death as assisted suicide. The council says that language needs to change. 

"These words can bring back a lot of pain," Guerin said, adding with suicide, people usually die alone and their families are left with tremendous grief, she added. 

"Assisted death is planned. When people die there are loved ones with them. It's a deliberate process." 

Medically assisted dying can be made available in the territory for any patient who is eligible, Nunavut's Health department said in an email. 

Depending on a patient's situation, the new legislation requires expert physicians. For people who are not near the end of life, there will be a wait time as part of the application. 

The process is "patient driven, and the patient is the decision maker about all aspects," the Health department said. "There are safeguards in place and patients will be provided with all options, including palliative care."