MONTREAL, Canada – One in 20 Canadians who died in 2023 chose when they would go, as the country’s assisted dying programme continues to expand amid debate over whether to extend the practice to those suffering exclusively from mental illness.
Jacques Poissant (93) asked his daughter if it would be “cowardly to ask to be helped to die” whilst battling prostate cancer.
“He no longer had any zest for life,” Josée Poissant told AFP.
Last year her mother made the same choice at 96 when she realised she would not leave hospital. She died surrounded by her children and their partners listening to the music she loved.
“She was at peace. She sang until she went to sleep,” Poissant said, describing it as “a privilege to have the time to say goodbye”.
Legal expansion
Assisted dying has been legal since 2016 for people at the end of life. The right was extended to those suffering from serious and incurable illness in 2021, even if death was not “reasonably foreseeable”.
Whilst Britain and France are considering similar measures, Canada is preparing to go further. A parliamentary committee is set to start work next month on whether assisted dying should be extended to those suffering exclusively from mental illness.
Claire Brosseau (49) hopes this will be her final battle. She took her right-to-die case to the courts after struggling for decades with bipolar disorder.
“I’ve been treated by psychiatrists, psychologists, counsellors and 12-steps rehab in Montreal, New York City, Toronto and Los Angeles,” she said.
The former stand-up comedian said she has tried antidepressants, antipsychotics, mood stabilisers, benzodiazepines, sleeping pills and stimulants, cognitive behavioural therapy, dialectical behavioural therapy, tai chi, reiki, meditation, veganism, art therapy and music therapy.
“There’s nothing really that I haven’t tried. It’s just been too much for too long,” she told AFP.
Brosseau lives alone with her dog Olive in a Toronto flat. “I have about 10 to 30 minutes a day where I’m OK. But the rest of it is just terrible,” she said.
She only goes out to walk Olive when the streets are deserted, has limited contact with her family, no longer sees her friends, and has groceries delivered. Her psychiatrist appointments are conducted by video.
A change in the law would allow her to “go in peace and safety, surrounded by love. It won’t be violent. I won’t be alone,” she said.
Concerns raised
Canada was to allow assisted dying regardless of illness by 2024, but this was pushed back by three years, with the government saying it wanted to make sure the mental health system was ready.
Eight out of 10 Canadians support assisted dying, but some worry about widening it further.
The issue has been trivialised to the point of being “presented as a form of therapy”, said Trudo Lemmens, a health law professor at the University of Toronto.
“We have already seen a sharper rise in cases than in other countries” like Belgium and the Netherlands, which pioneered the practice, he said.
“The desire to commit suicide is often an integral part of a psychiatric disorder,” and it is extremely difficult to predict how a mental illness will develop, he said.
However, Mona Gupta, a psychiatrist who chaired an expert panel that advised the government, said there is no clinical reason to separate people with mental disorders from those with chronic physical illnesses.
“We are talking about a very small number of people” who have chronic, severe, treatment-resistant mental disorders, Dr Gupta said.
“We have to acknowledge that there are people who have been ill for decades and have undergone all kinds of treatments, and that the suffering caused by certain mental illnesses is sometimes just as unrelievable as physical pain,” she said.
Maintaining control
Rachel Fournier (71), who has brain cancer, has learnt that her request to die has been approved.
“When you’re suffering, you feel like it’s never going to end,” the Quebecker told AFP.
“Knowing that there will be an end, and that I can choose the moment, is an immense relief. I’m keeping control over my life even though I can’t control what’s happening to my body,” said the mother of two and grandmother of four from her room in a palliative care centre.
Two doctors examined her request, making sure all the criteria required by law were met.
The applicant must be an adult, “have decision-making capacity”, suffer from a serious or incurable illness, and “experience constant, unbearable physical or psychological suffering that cannot be relieved under conditions deemed tolerable”.
Only then is a doctor authorised to administer the lethal drugs on the date and time the patient has chosen.
Fournier said she is proud to live in a country that allows patients to decide for themselves. She watched her mother sink into dementia without being able to ask to leave “with dignity”, as she had wished, because the law was not yet in force.
“I don’t want my daughters to have to answer the question: ‘Do we pull the plug?’” she said.
Final celebrations
For weeks, the former gallerist has been spending part of her days “revisiting my life” through old photo albums.
In Canada, more families are choosing to turn their loved one’s last day into a moment of celebration with music, singing, speeches and a buffet.
“Come celebrate my life,” read the invitations one man sent out for his last day on Earth.
Doctors who have accompanied these patients talk of ceremonies in gardens, family vacation cabins by lakes and on boats.
Undertakers are offering dedicated spaces to families.
“We noticed that people were going to hotels or renting Airbnbs,” said Mathieu Baker, whose Quebec funeral complex rents out a room with plants and paintings.
Baker recalled one woman who asked to watch a horror film one last time before she passed and another who opted for a few final beers and cigarettes. “These are very beautiful moments, very powerful ones,” he said.
“It is often a celebration,” confirmed Georges L’Espérance, a doctor who has been providing assisted dying since the early days.
“Thanks to medicine, we have added years to people’s lives, but not always life to those years,” he said.
“The decision to end life must rest with the patient,” he said, adding that medical paternalism took a back seat in Canada long ago.
Brosseau rejects the idea that people with mental illness are incapable of making informed decisions. “We’re allowed to get married, write a will, make decisions that affect our entire lives. But not this one?”
She wants to be recognised as a whole person, capable of deciding, worthy of compassion and respect. “To deny me this right is to deny my humanity,” she said.
- Assisted dying remains illegal in South Africa, with those who help others to die facing potential murder charges. However, advocacy group DignitySA has been preparing a High Court application to have the criminal law declared unconstitutional and to compel Parliament to enact a regulated framework for doctor-assisted suicide and euthanasia for competent terminally-ill adults. The organisation is arguing that the right to a dignified death should be protected under South Africa’s Constitution. The legal battle dates back to 2015 when the High Court granted terminally-ill barrister Robin Stransham-Ford the right to die, but the decision was overturned by the Supreme Court of Appeal in 2016. DignitySA’s founder, Professor Sean Davison, was convicted in 2019 for helping three people die and served a three-year house arrest sentence.
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