Earlier this month, the federal Liberal government announced its intent to indefinitely halt the planned expansion of medical assistance in dying (MAID) to include those whose only condition is a mental illness.
This comes as a relief to the many disability and mental health organizations who have urged the government to consider the implications of expanding MAID while mental healthcare, housing, income support and food security remain inaccessible for so many.
But this latest move doesn’t mean that legalization of MAID for mental illness (MAID-MI) is entirely off the table. The Liberals will table legislation that will maintain the exclusion of mental illness as a sole criteria for accessing MAID. But that legislation still has to pass, and there are ongoing legal challenges to the current laws, which prohibit people whose only condition is a mental illness from accessing MAID.
MAID-MI remains a nuanced and relevant issue in healthcare and law. It’s also a deeply relevant issue in LGBTQ2S+ communities. But you wouldn’t know that based on recent consultations: this month’s decision followed nearly six years of parliamentary committee meetings, expert panels and witness testimonies. None of this consultation process included dedicated representation or consideration of queer and trans communities. In the hundreds of pages of government reports published on this matter, the LGBTQ2S+ community has been mentioned only once.
As a mentally ill queer and trans person—and someone who has researched MAID professionally—this angers me. We’ve all heard the statistics. Queer and trans communities experience disproportionately high rates of mental illness, suicidality and death by suicide. Any potential legislation impacting people with mental illness, such as MAID-MI, would therefore disproportionately impact queer and trans people. Despite this, our government appears to have forgotten (or perhaps excluded) us in conversations about MAID-MI, and mainstream LGBTQ2S+ organizations in Canada have remained largely silent on the matter.
I’ve spent the past four years researching MAID-MI, thinking about it and talking to queer people about it, both formally through my research, and informally in my daily life. It’s a profoundly nuanced and emotionally charged topic; but it’s important to face it head-on. Queer and trans people need to care about MAID, and we need to care enough to look beyond, and challenge, the dominant narratives in the debate.
When I tell people that I research queer perspectives on MAID-MI, they often assume that I support it. There exists a commanding narrative that all critiques of Canada’s MAID program are the product of right-wing fear-mongering or religious propaganda. I see queer people reflexively support and defend MAID, in all of its iterations, because conservatives and right-wing Christians have made themselves the face of MAID opposition. Proponents of MAID have been all too happy to perpetuate the idea that resistance to MAID expansion is fuelled exclusively by religious zealotry, opposition to bodily autonomy or some cruel desire to prolong suffering. But this is patently false, and the invisibility of queer and trans voices on this matter has only contributed to this skewed narrative.
I write this as a suicidal, mentally ill, disabled queer and trans person who strongly opposes carceral responses to suicidality and forced treatment for people labelled as mentally ill, who wholeheartedly supports access to abortion and who accesses gender-affirming care. My concerns about MAID-MI are grounded not in religious or ethical opposition to the concept of assisted dying but in a foundational opposition to eugenics, and in a profound love for the people in my communities.
When I think about our government facilitating access to assisted death as a response to irremediable mental illness and intolerable suffering in my communities, I think about the concept of mental illness and what it means for a mental illness to be “irremediable.” There is a long history of queer and trans identities being pathologized in medical systems, but we know that the high rates of mental illness and suicide in our communities are not inherent characteristics of our identities; we know that conversations about mental illness are never just about mental illness. They are necessarily conversations about homophobia and transphobia, racism and ableism, abuse, housing and food (in)security, gender-based violence, access to gender-affirming care. I think about the increasing legislative, social, physical and emotional violence against trans people, and I wonder what it means to deem us “irremediable” for our emotional responses to living in a world that wants us dead.
We can plainly see what the government is doing to make death more accessible, but plans to make life more accessible are much more opaque.
I think about the fact that every day, I see fundraisers and mutual aid campaigns for people in my community trying to make rent, afford medications or therapy, buy groceries, get surgery, care for their loved ones, bury their loved ones. Our government once claimed that MAID expansion would be accompanied by “ensur[ing] the proper supports are in place […] so that no one chooses to end their life because they can’t get the help they need.” Yet, since initial MAID expansion in 2021, we have only seen increases in cost of living, in rates of poverty and in levels of food insecurity. Wait times for community mental health counselling have increased, and there are fewer Canadians with a regular healthcare provider. All the while, MAID deaths have increased steadily, year after year. We can plainly see what the government is doing to make death more accessible, but plans to make life more accessible are much more opaque—if they exist at all.
I think about the complexity of accessing gender-affirming care in many provinces, such as New Brunswick, and about the fact that the province has a dedicated phone line to facilitate access to MAID, but does not provide that same service for gender-affirming care. Before I wish for access to assisted death, I wish for trans people to be able to exist in bodies that feel like home.
I think about my friends who want to die. I wish that they could access support without fear of involuntary treatment or potentially deadly “wellness checks” from cops. I wish that they did not have to choose between accessing therapy and keeping a roof over their heads. What does it mean to be irremediably mentally ill when mental healthcare is often prohibitively costly? I wonder why, legislatively, we have been so much closer to government-funded assisted death for mental illness than we have been to universal mental healthcare.
I think about how easily the system reduces entire lives and histories to a dollar amount in a cost-benefit analysis. In the midst of the AIDS crisis, Marilynne Seguin, founder of MAID advocacy organization Dying With Dignity, said that with MAID, “the bottom line is economic.”
“The AIDS question,” she said, would highlight that the healthcare system “can no longer afford to keep thousands of people alive as human vegetables.” In 2020, the Parliamentary Budget Officer released a report detailing how MAID expansion would reduce healthcare costs. I wonder if autonomy is truly at the centre of efforts to expand MAID.
I think about these things, and many others: people in crisis, especially racialized people, and especially Indigenous and Black people, being killed by cops or ignored to death in waiting rooms; disabled people living in poverty and still having to fight for every penny of support from the government; the difficulty of finding culturally competent and affirming healthcare providers, especially in rural areas. I think of Trans Day of Remembrance, and how many people we lose every year; our government’s National Suicide Prevention Action Plan, which includes no specific consideration of queer and trans communities; of suicidal people being turned away from emergency departments; of trans kids growing up in families and communities that don’t accept them; of the increasing privatization of healthcare. I think about my 18-year-old self—closeted, suicidal, isolated—and I know that if MAID-MI had been legal for her, she would have fought tooth and nail to access it, and I would not be here today.
I think about these things, and I can’t help but feel that the government, when it comes to MAID, is not in the business of acting in the best interest of my communities.
Over and over, I hear the argument that legalizing MAID-MI will grant people the autonomy to end their suffering. Equating MAID-MI with autonomy facilitates the narrative that to be opposed is to be opposed to autonomy; equating MAID-MI with relief of suffering facilitates the narrative that those who are opposed want people to suffer. These ways of talking about autonomy and relief of suffering are euphemistic and strategic—simultaneously broad and yet hyper-specific—and they obfuscate the reality of the matter at hand. Legalizing MAID-MI does not magically grant people the autonomy to end their suffering. It grants medical professionals the authority to determine if someone is mentally ill enough or suffering enough to die.
Canada no longer plans to legalize MAID-MI next year, but the debate rages on. We, as queer and trans people, need to care about this. We need to listen to the disabled people who have been raising the alarm on MAID for years. We need to wrench back the narrative from the clutches of right-wing, anti-trans, anti-abortion zealots. We need to follow in the footsteps of our queer elders, those who lived and died before us, by showing up for one another when our lives are on the line. And we need to continue to fight for and demand gender-affirming care, non-carceral mental healthcare, universal basic income—for the autonomy to relieve our suffering in ways beyond a government-assisted death.
In the ongoing fight for our autonomy, I want us to expect and demand more from our governments than access to an assisted death. I do not want to live in a world where queer and trans death is such a foregone conclusion that the best we can do is ask the government to make it quick and clean and easy.
