Canadian lawmakers now charged with revisiting the end-of-life requirement in Canada's Medical Assistance in Dying (MAID) law would do well to review some of the important evidence that the Québec Superior Court appears to have sidestepped.

An expert witness who provided critical testimony in the Truchon & Gladu case was Dr. Mark Sinyor, a Canadian psychiatrist widely recognized for his clinical expertise and research on suicide prevention. In a comprehensive 50-page affidavit, Dr. Sinyor detailed for the court the "likely impact" of expanding MAiD for persons who are not at the end of life.

His affidavit begins by pointing out a clear distinction. Under the current law, physicians provide assistance with a dying process that is already occurring. Under an expanded law, physicians would bring about a death that is  not otherwise foreseeable. According to Dr. Sinyor:

 

"The two circumstances are not the same, and in my professional opinion, should not be conflated as the considerations and societal impact are likely to differ substantially."

The societal impact to which he refers, in part arises from a well-established phenomenon referred to as "suicide contagion". Dr. Sinyor explains that suicide contagion occurs "through a process called  social learning in which vulnerable people identify with others who have had suicidal thoughts and/or behaviour." After reviewing a range of relevant international research, he cautions:

"Expansion of MAID to include suffering not at the end of life is likely to lead to suicide contagion and higher suicide rates, and to have a negative impact on suicide prevention...."

Dr. Sinyor's affidavit, which is available upon request from the Québec Superior Court, also reflects upon the influence of "suicide messaging", noting media guidelines, informed by public health policy, that advise against "portraying suicide as achieving results and solving problems". He notes the extent to which many elderly people with chronic conditions, and younger people with severe disabilities, "feel like a burden to their loved ones and that their families would be better off if they were dead". When others in similar circumstances are seen to 'solve the problem' of 'being a burden', the effect of such messaging is profound:

"If MAID becomes an option for a subset of Canadians with intractable medical and/or psychiatric conditions, the question is whether it might create a "duty to die" amongst people who feel like a burden but you would not otherwise have contemplated suicide."

In the conclusion to Dr. Sinyor's affidavit, Canadian lawmakers will find a clear signal of the weight and consequence that lies ahead for them in the wake of the Truchon & Gladu decision:

"...Normalizing suicide death via MAID as a remedy for suffering not at the end of life is likely to increase suicide rates in Canada at a time where there is a universal consensus among public and mental health experts of the imperative to decrease suicide rates."