Forty years since John Scully was diagnosed with major depressive disorder, his condition has not improved despite trying nearly every known medical treatment, from shock therapy to transmagnetic stimulation.
The 82-year-old said he wanted the pain to end. He wanted to do it legally and painlessly in a way that respected the people he loved. He required medical assistance on his deathbed.
But like many Canadians with mental illnesses that doctors have been unable to treat successfully, Scully had to wait.
The Liberal government passed legislation in 2021 to expand eligibility to patients with mental disorders only, including a two-year delay to allow practice guidelines to be developed. Last month, it rushed legislation and delayed it for another year.
In an interview, Scully said the waiting process was painful.
“I have utter contempt for the panel, and the government for delaying applications,” Sculley said. “They can’t make up their minds. That’s why they kick the cans down the road.”
The Liberal government’s decision to expand medical assistance for death to people with mental illness as the only underlying condition has sparked widespread reaction in Canada, which is set to join a handful of countries in Europe that grant access for that reason.
Opponents, including some disability advocates, worry about whether it will further open the door to abuse and coercion, and people will choose to take their own lives when what they really need is better access to supports, including housing and mental health care.
There is also a lack of consensus among medical experts on how to judge whether a mental illness is “serious and incurable” to qualify for end-of-life medical assistance.
Conservative leader Pierre Poilievre has promised to scrap expansion plans if he becomes prime minister.
Proponents argue that the move would provide autonomy and dignity to those who have exhausted all other treatment options, and that not doing so would violate the Canadian Charter of Rights and Freedoms by discriminating against people with disabilities.
Scully, a former reporter who covered 35 war zones during his long and award-winning career, also suffers from severe spinal stenosis and chronic kidney disease. But these physical ailments did not qualify him for euthanasia.
By law, March 17, 2024, Scully will finally be eligible to apply, although he expressed doubts that the government would follow through on its promise.
He already has paperwork. But he said he was too frustrated to start filling out the form. “I haven’t touched them, I might tear them off.”
Scully described his condition as “non-stop, persistent and incurable” and his life was “no fun” due to severe mental illness. He said he felt as if the government had cornered him.
“It was a terrible choice they forced on me, and I think everyone else: (assisted dying) or suicide.”
Dr Chantal Perrot, a family doctor who assesses and provides medically assisted deaths, said, “It’s terrible that patients think they have a choice between continuing to suffer significantly and taking their own lives.”
The latter also “exacerbates the distress of family and friends who love them,” Perot said. “Suicide is a very isolating and lonely act for most people and it’s not a dignified way to end a life.”
She said there was no need to delay expanding the program further.
“Each patient will be assessed on a case-by-case basis, taking into account the uniqueness of their life, circumstances and wishes,” she said.
“We will conduct these assessments as we do with all other patients who request (euthanasia), and we will do so with the integrity and thoroughness that applies to all of our medical work.”
Scully said he did not ignore the need to consult with doctors and family before accessing euthanasia, but said the situation had made him lose faith in the system and questioned whether it had his best interests at heart .
Finally, he said: “I am the one who should decide whether I should die or not.”
Since medically assisted dying has become available, the diversity of people accessing medically assisted dying is “as remarkable as the breadth of the population,” Perrot said. But she can’t always make assessments, in part because many people don’t meet current regulations.
“It’s hard to tell people they have to wait another year,” she said, for people whose incurable conditions are mental illnesses.
In a statement, Attorney General David Lametti said he knew the delay was frustrating and disappointing.
But he doubled down on the delay, saying it was a “prudent path forward” so the government could consider expert advice and practitioners could speed up their understanding of how to assess complex cases.
“Medical assistance at the end of life is a complex and deeply personal issue for many people and their families,” Lametti said. “It’s critical that we get this right.”
Many other patients are frustrated by eligibility issues that fall outside the current framework.
For Ron Posno, who suffers from mid-stage Alzheimer’s and dementia, euthanasia remains out of reach — though he can foresee wanting it when his condition becomes mentally and physically debilitating.
Because at that point, he may not be able to make it clear to practitioners that euthanasia is what he wants, as currently required by law.
A special joint committee of parliament published a report in February recommending that the government allow people with serious and incurable medical conditions, diseases or disorders that prevent them from making early requests for euthanasia.
“My wife and I are doing well at this point in our lives, and we’re doing what we can,” Posnow said. “But part of that relief is my belief that I’ll get (assisted dying) when it’s actually available.”
Posno said he has gone through all the processes involved in accessing the program, including having his request reviewed by an independent physician. He said his healthcare provider has assured him that euthanasia will be provided if the federal government decides to add advance requests to the system.
There’s no sign that Ottawa is headed in that direction anytime soon, but Bosnow remains optimistic that he’ll be able to die with the dignity he wants.
“This is a beacon of hope for those of us facing things we don’t want to deal with,” he said. “It gave us a way out, a beacon of hope.”
David Fraser, Canadian Press
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