Warning: This story includes discussion of suicide.
As the federal government looks to delay the expansion of medical assistance in dying (MAID) to people suffering solely from mental illness, the Northwest Territories' senator is voicing her reservations about whether the N.W.T. is in a position to offer MAID at all.
"There's some great challenges that we face in terms of health, in terms of accessing mental health care," said Margaret Dawn Anderson.
"Until we are in a place where health care is at 100 per cent, and there is some continuity and consistency in that health care service … I struggle to see how MAID can be applied in the Northwest Territories."
MAID eligibility was set to extend on March 17 to people whose sole underlying condition is a mental disorder. Last month however, the federal government announced plans to introduce legislation that would delay that expansion.
Justice Minister David Lametti said some provinces, territories and health-care professionals need more time to adopt practice standards for dealing with more complex MAID requests, and that the federal government will need more time to go over the final report of Parliament's Special Joint Committee on MAID, which is expected on February 17.
"We do have to respect decisions of the courts. They have said that medical assistance in dying is a right that Canadians have, and so … the process will continue to move forward, but we're going to do it in a measured and prudent way," Lametti told reporters on Dec. 15.
Cancelling the expansion would require different legislation, he said, and "I think that would run us afoul of the courts."
The federal Justice Department wouldn't say how long the expansion might be delayed.
At least 12 people have received MAID in N.W.T.
It's unclear whether the N.W.T. is among the jurisdictions that need more time to update MAID practice standards.
CBC News requested an interview with an N.W.T. physician and with the territorial minister of Health and Social Services, Julie Green, but neither were granted by the end of the day on Wednesday.
In an emailed statement, N.W.T. health department spokesperson Umesh Sutendra said the government has safeguards to protect residents seeking medically-assisted death and the medical practitioners who provide it.
"The [N.W.T. government] has no role in the federal government's advancement of MAID," said Sutendra.
The health department said at least 12 people have received MAID in the Northwest Territories since 2016. It wouldn't say where in the territory they're from, citing the risk of identifying them.
According to the federal government's most recent annual report on MAID, there were 10,064 MAID deaths in Canada in 2021.
The average age of a person provided MAID was 76, and the most commonly cited underlying medical condition was cancer.
To be eligible for medically-assisted death in Canada, a person must satisfy a set of criteria.
Among them: they must be adults capable of making their own decisions, they must have a serious and incurable disease, and they must be enduring "unbearable physical or mental suffering" from their disease or disability that "cannot be relieved under conditions [they] consider acceptable."
There are also a number of safeguards. For example, a person seeking MAID must be informed of "available and appropriate means to relieve their suffering," including counselling and disability support services, and they must be offered consultations with these service providers.
Also, a practitioner with expertise in the person's condition must be consulted in the MAID assessment process.
In Senator Anderson's view however, MAID in the N.W.T. is problematic because of the barriers residents face in accessing adequate, consistent and culturally-appropriate health care and mental health services.
She pointed to high physician vacancy rates and high suicide rates in the territory.
The department of Health and Social Services reports that since 2006, physician vacancy rates in the territory have fluctuated between 30 and 43 per cent.
Last October, the N.W.T.'s chief coroner reported an "alarming" increase in suicide deaths, particularly among young men.
"The amount of suicides that are taking place in the N.W.T. is also a sign that there is a an existing issue," said Anderson. "Within the Northwest Territories there are services that are lacking or absent to assist individuals who are dealing with mental health issues."
She said housing and food insecurity compound people's mental health issues.
Expert panel says safeguards exist to expand MAID
Anderson's concerns were echoed by the Expert Panel on MAID and Mental Illness, established under the federal legislation that broadened MAID eligibility.
The panel said Indigenous leaders and communities worried that it's easier for their people to access a way to die than to access the resources to live healthy lives.
In its final report, the panel wrote that "in the course of assessing a request for MAID — regardless of the requester's diagnoses — a clinician must carefully consider whether the person's circumstances are a function of systemic inequality."
It also recommended that regional health regulatory bodies in each province and territory consult with First Nations, Inuit and Métis people to create practice standards for MAID for people suffering from mental illness.
The expert panel was not mandated to debate whether MAID eligibility should be expanded. Rather, it was tasked with providing advice for the provision of MAID to people seeking it on the basis of mental illness.
The panel made 19 recommendations, and determined that the necessary eligibility criteria and safeguards exist to extend MAID to people whose sole underlying condition is a mental disorder.