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FACTCHECK

FactCheck: Are psychiatric patients in Canada given leaflets for assisted dying when they go to A&E?

The claim was made by the chairman of the Assisted Dying Committee.

CLAIMS THAT PSYCHIATRIC patients attending Canadian Emergency Rooms are given leaflets offering assisted dying as a healthcare option have been spread in the wake of the Oireachtas Commission on Assisted dying.

The claim, which was made by the chairman of the Oireachtas committee, Michael Healy-Rae, has been contradicted by Canadian authorities.

So who is right?

The Claim 

The claim was made by Healy-Rae on 20 March while at a press conference, where he presented a minority report which opposed legislation for assisted dying in Ireland.

It came after the Oireachtas Committee recommended that the Government should legislate to allow for assisted dying to take place here.

“In Canada, if you go into an A&E, and if you are seeking assistance – you could have psychiatric problems, medical problems, whatever – one of the things that you will be handed, you will be handed a leaflet on assisted dying,” he said.

“And it will be offered to you for all intents and purposes as a healthcare option. I don’t agree with that.”

The Evidence 

The Journal contacted Healy-Rae for the source of his claim. Healy-Rae could not say where he first heard it, whether it was during the committee or outside of it, or if the person who told it to him was Irish or Canadian.

Five other members of the Oireachtas Committee who spoke to The Journal, Alan Farrell, Gino Kenny, Emer Higgins, Mary Seery Kearney, and Robert Troy said that they either had not heard or could not remember the claim about leaflets in committee.

The committee had heard from experts on assisted dying in Canada; however, at no point did any of them make the claim recounted by Healy-Rae.

The Journal was able to find two utterances in the committees that were similar, though not the same, as the claim made by Healy-Rae.

One came during a discussion featuring Professor David Albert Jones, a bioethicist based in England who helped to draft the UK General Medical Council’s guidance on Treatment and Care towards the End of Life.

“Suicide prevention is still a priority for all kinds of reasons,” Jones told the committee in July 2023. “However if this is in place, it can cause problems for the implementation of suicide prevention among certain categories of people.

“Consider a scenario from Canada, for example, where someone with a terminal illness attempts suicide and ends up in the accident and emergency department. There have been cases where it has been suggested to people, who had not previously requested it, that they have medical assistance in dying.”

Jones responded to The Journal’s queries to say that the source for his statement was a story about a man with terminal cancer who was assessed for medically assisted death following a suicide attempt.

That story, in turn, cites the University of Toronto’s Joint Centre for Bioethics seminar series in 2021, videos of which are still available online, and which contain a number of additional important details.

The case apparently referred to by Jones involved a 75-year-old man who was diagnosed with metastatic pancreatic cancer – a disease with a five-year survival rate of 1%, and which patients die from on average one year after diagnosis.

The patient in the case decided not to receive chemotherapy, but instead to take a palliative approach. He reportedly inquired to his family doctor about medically assisted death.

However, before he was evaluated for this, the patient is reported to have attempted suicide.

Doctors at the emergency room where he was treated then inquired about his condition to see whether he had the capacity to request medical assistance to die.

The patient, who had no previous psychiatric history, told doctors that he was in pain and that he feared future disability.

While the doctors determined that the man was capable of asking for medical assistance in dying, they did not proceed with his request; they instead arranged a series of meetings with the patient to fully assess his condition and his options.

This case matches part of Jones’s statement to the committee, specifically the section where he referred to “someone with a terminal illness [who] attempts suicide and ends up in the accident and emergency department.”

However, there are other factors at play here that were initially omitted from the narrative, not least that the patient had attempted suicide in part because they were suffering from a painful, incurable and terminal illness.

In other words, the psychiatric element was not the sole factor in the case.

This is vitally important: to qualify for assisted dying in Canada, patients must have a “grievous and irremediable medical condition”, and mental illnesses on their own do not make people eligible for medical assistance in dying either currently or at the time of the case study (though there are plans for such conditions to be covered in the future).

The outcome of the case was also given at the University of Toronto Joint Centre for Bioethics seminar: while in hospital, the patient’s pain eased and subsequent meetings with doctors about his options gave him a sense of control. The man was later discharged back to his home without requesting medical assistance to die.

About a week later the patient threatened to kill himself again and was taken to hospital. His condition rapidly deteriorated and he asked for palliative sedation, which is usually intended to keep a patient unconscious until death. However he died within an hour of his request, before it could be enacted.

This case involving a visit to a patient in an emergency room is controversial – that’s why it was included in the seminar on bioethics. However it is also very unusual; in no way does it suggest, as Healy-Rae’s statement does, that medically assisted suicide is routinely suggested to most patients who enter emergency departments in Canada.

Jones also provided The Journal with sources to back his claim that “there have been cases where it has been suggested to people, who had not previously requested it, that they have medical assistance in dying”.

These included reports that a Veterans Affairs caseworker had suggested medically assisted death, as well as a woman who claimed that a suicide crisis line worker had also brought up the subject to her.

Although these examples show that such conversations can be initiated in different settings, they do not back up Healy-Rae’s claim that emergency departments were regularly distributing leaflets on how to receive medical assistance in dying.

The second example of a similar claim made at the Oireachtas committee came from Dr Feargal Twomey a consultant in palliative medicine who works with the Royal College of Physicians of Ireland.

“If you go into an overfilled emergency department in Canada now and you cannot get a psychiatric assessment because it is too busy, you will be offered medical assistance in dying [...] before you have been assessed. You can be. It does not happen routinely but you can be,” Twomey said.

Again, there appears to be significant information missing from this description, as psychiatric conditions are not eligible for medical-assisted dying in Canada.

The Journal made multiple attempts to contact Twomey about the source of this claim, but received no response.

Canadian authorities who responded to inquiries from The Journal about whether psychiatric cases could receive medical assistance in dying – and whether such patients were handed leaflets in emergency departments – were unanimous in rejecting the claim.

“Absolutely not,” a spokesperson for the Quebec Health Service said in response to an inquiry on whether Healy-Rae’s comments were accurate.

“There is no policy to provide leaflets on assisted dying to patients presenting for emergency care, or elsewhere and no evidence to support the claims made by this individual,” a spokesperson for Shared Health, the Manitoba provincial health service, said in response to an inquiry on Healy-Rae’s comments.

“To ensure this service is provided in a safe manner, a system of safeguards has been designed to protect vulnerable patients and support all patients to make an informed decision.”

“I can confirm we don’t hand out Medical Assistance in Dying leaflets to patients in our emergency departments”, a spokesperson for Nova Scotia Health told The Journal.

(The Journal was able to find examples of leaflets outlining the Canadian medically assisted dying programme, but there was no indication that these were given out routinely, or in emergency rooms).

“While providing Medical Assistance in Dying (MAID) and sharing information on the service is allowed for under Canada’s Criminal Code, promoting, encouraging, or advocating for medical assistance in dying is an offence,” The Department of  Health and Social Services for the Northwest Territories (NWT) told The Journal after the publication of this article. 

“For this reason, MAID is not actively promoted in the NWT through the distribution of leaflets or other materials to the public or patient population,” they confirmed.

“Medical Assistance in Dying is not meant to provide end of life treatment for accident victims and emergency visits,” Health Canada, the national authority for health policy, said by email.

“MAID is intended for persons who freely choose to pursue a medically assisted death in situations where they have a grievous and irremediable (i.e. incurable) medical condition that puts them in an advanced state of irreversible decline in capability that causes them enduring physical or psychological suffering that can not be relieved under conditions they consider acceptable.”

Health Canada also listed out the criteria to be eligible for medical assistance for dying, which includes “being capable of making health care decisions for yourself”, as well as making a voluntary request for medical assistance in dying that cannot be the “result of outside pressure or influence”.

They also noted that patients must have informed consent before they could opt for a medically assisted death, which includes being informed for their diagnosis, available forms of treatment, and options to relieve suffering, including palliative care.

They also noted that consent could be withdrawn “at any time and in any way.”

A proposal to allow Canadians suffering from mental illnesses to seek medical assistance in dying was delayed until March, 2027, as the medical system was said to be unready.

Similar eligibility criteria will apply to these cases, including freely given consent from the patient, as well as the sign-off of two doctors. 

The final report by the Irish Committee on Assisted Dying recommended for legislation to allow people the right to avail of assisted dying, but with a tight set of restrictions on who would be able to use this service, which it envisions being operated by the HSE.

Some of the safeguards the report seeks to see established include making acting contrary to assisted dying laws a criminal offence, allowing for doctors and healthcare workers to conscientiously object to being directly involved with assisted dying, and that palliative care and the operation of assisted dying should be independent of each other, and separately funded.

There is also strict restrictions outlined on who would be eligible to avail of assisted dying. These include an age limit of 18, and rules around in what circumstances living with an illness of medical condition would make someone eligible.

There is currently no proposal for Irish law to legislate for medical assistance in dying to be allowed for those who are suffering from psychiatric conditions.

The Verdict

Kerry TD Michael Healy-Rae claimed that psychiatric patients attending Canadian Emergency Rooms are given leaflets offering assisted dying as a healthcare option.

When contacted by The Journal Healy-Rae was unable to provide a source for this claim.

The Oireachtas Committee on Assisted Dying, which Healy-Rae chaired, did hear claims about the Canadian system involving psychiatric cases.

One involved the case of a man with a terminal illness who had attempted suicide after already requesting medical assistance in dying.

The other was a claim made by palliative care expert Feargal Twomey, who claimed that psychiatric patients in Canada may be offered medical assistance in dying if emergency departments are too busy.

However, this was rejected by Canadian health authorities and there is no current allowance for medical assistance in dying to be given to psychiatric patients under Canadian law.

There is also no evidence to support a claim that leaflets suggesting medical assistance in dying are regularly given to such patients in Canadian emergency rooms.

Official statements by Canadian authorities indicate that medically assisted dying is not being suggested routinely in such departments, or to patients with psychiatric illnesses only.

We therefore rate the claim: FALSE. As per our verdict guide, this means: The claim is inaccurate.

Update: A response from The Department of  Health and Social Services for the Northwest Territories was added on 11 April 2024. This was additional information that corroborated the other Canadian sources that spoke to The Journal. It did not affect the verdict of the article. 
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