Canada needs time for ‘deeper conversation’ on assisted dying, mental health: Holland

OTTAWA — Thirteen years ago, in the throes of a major political loss and personal crisis, Mark Holland experienced the darkest period of his life.

Since his return to federal politics, he’s been candid about his suicide attempt, and the mental-health struggle that took him “to the doorstep of my own oblivion.”

Now, as the federal health minister, he is asking Parliament to slow down on his government’s plan to expand access to medically assisted death for people whose sole underlying condition is mental illness. 

Holland asserts that the ordeal he survived is different from the suffering of people who he said would qualify under the program.

More time is needed to get medical systems and the public ready to tell the difference, he told The Canadian Press.

“I want to make sure, with every inch of me, that everybody is afforded the same path out of darkness that I was able to find,” Holland said in an interview about his own mental-health experience.

“Where we’re having really difficult conversations is: What do we do when there are circumstances that we can’t figure out? Where people are in nightmarish pain?”

Under existing legislation, people in mental anguish will qualify for medical assistance in dying starting in mid-March. 

Last week, Holland tabled legislation to delay expanding the eligibility for three years.

Provinces told him they either weren’t ready or weren’t willing to move forward, he said, and putting it off is meant to allow for more time to prepare. 

The pause would also give Canadians more bandwidth to confront their discomfort with the policy, he said. 

“Because it’s uncomfortable, it’s easy to pretend there are simple solutions and to not dig into it,” Holland said. “I think part of the idea of this pause is to allow an opportunity for a deeper conversation.”

Holland was a career politician until he lost his seat in the 2011 federal election. After that loss, he said he fell into despair. 

“There’s a feeling of complete hopelessness and isolation and abandonment and feeling that … there isn’t any way out of the pain that you’re in,” he said.

What separates his experience from that of those with mental illness who could eventually have access to assisted death is that he sought help and it worked, he said.

“When you’re in that circumstance and you go and you seek help, the vast, vast majority of people will, with clinical support, support and love of friends and family, are going to be able to get lifted out of that circumstance and see that it was a moment in time,” he said.

Many people who suffer from poor mental health struggle to get help, the minister acknowledged. 

But medical assistance in death is intended for people who have “tried everything” and are “unable to escape their mental hell,” he said.

“That’s a big difference.”

Public sentiment on the policy is difficult to gauge.

A September Angus Reid poll commissioned by Cardus found that while there was broad support across Canada for existing assisted death policies, half of respondents surveyed were opposed to expanding eligibility to people who only suffer from mental illness. 

Meanwhile, an Ipsos poll conducted on behalf of Dying With Dignity Canada last summer suggested 80 per cent of those surveyed thought an adult should be able to get assessed and, if eligible, receive assisted dying for severe, treatment-resistant mental disorders if they are experiencing intolerable suffering. 

While some people conflate suicidal thoughts and long-term, indomitable suffering out of good-faith concern, Holland said he believes fears are sometimes expressed to “play games and politics.”

If Parliament grants the extension, it will mainly be up to provinces to get staff ready to separate people in crisis from the very few who should qualify, he said. 

“My job, when I’m talking to my provincial and territorial counterparts every day, is to make sure that they’re working toward that, and asking them how we can support them in it,” he said. 

The pause would put the expansion off until well after the next election. The Liberals’ Conservative opponents have said they would scrap the expansion if elected.

The scale of the mental-health problems in Canada is enormous, Holland said, and the government is moving to improve access as part of a series of bilateral deals with provinces and territories.

“I didn’t understand that what I was going through was so common to other people’s experience, that so many of us hit that moment where we don’t think we can handle (it) anymore, and we feel like we’re alone,” he said. 

But that isn’t an argument against assisted death, he said. 

“The challenges that we have in mental health and how we’re going to address that as a society are separate and apart and totally different from the conversations about the extremely limited circumstances where you have an intractable mental illness.”

If you or someone you know is thinking about suicide, support is available 24/7 by calling or texting 988, the national suicide prevention helpline.

This report by The Canadian Press was first published Feb. 6, 2024.

Laura Osman, The Canadian Press