A number of countries set aside March 17 as a celebration of St. Patrick’s Day.

The first St. Patrick’s Day parade in Ireland was held in Waterford in 1903. Strangely enough, this came hundreds of years after the first parade in North America. 

One of the longest-running and largest Saint Patrick’s Day parades in North America occurs each year in Montreal whose city flag includes a shamrock in its lower-right quadrant. This yearly celebration has been organized by the United Irish Societies of Montreal since 1929.

The parade has been held yearly without interruption since 1824. St. Patrick’s Day itself, however, has been celebrated in Montreal since as far back as 1759 by Irish soldiers in the Montreal Garrison following the British conquest of New France.

But this year’s St. Patrick Day promised a much darker, very somber day of international concern. This was the day Canada was prepared to implement medically assisted suicide for people whose primary health issue was a mental health disorder.

In 2015, Canada introduced medically assisted dying after its Supreme Court ruled that requiring people to cope with intolerable suffering infringed on fundamental rights to liberty and security. In 2021, the Canadian law was expanded after the Superior Court of Quebec struck down the government’s original assisted death law on constitutional grounds because it only applied to people whose deaths were “reasonably foreseeable.”

The 2021 law then expanded eligibility to people experiencing “grievous and irremediable” conditions. It included a separate provision for people suffering from mental illnesses. This provision was added to the law by Canada’s unelected Senate.

Perhaps understanding that the mental health aspect of the law was not just controversial but beyond the pale of the act of a compassionate, informed society, the implementation of this aspect of the law was postponed until 2023. It was then again postponed until March 17, 2024.

In the last two weeks, Canada announced it was postponing implementation of the mental health aspect of the law until 2027.

The reasons given were varied. The official, governmental explanation was, “… a special parliamentary committee studying the law concluded that there are not enough doctors, particularly psychiatrists, in the country to assess patients with mental illnesses who want to end their lives and to help them do so.” A committee spokesperson stated, “The system needs to be ready, and we need to get it right … It’s clear from the conversations we’ve had that the system is not ready, and we need more time.”  

 Many other reasons for this delay have been speculated. These reasons include:

It is a consequence of the inability of Canada’s public health care system to offer adequate psychiatric care, which is chronically underfunded and facing demand that outstrips its availability.

Many psychiatrists say the plan would undermine efforts to prevent suicide, and they have expressed fear that patients with complex problems will abandon treatments that can take years to achieve results in favor of a medically assisted death.

Not wanting to be left out, political viewpoints have entered the fray. The opposition Conservative Party charged that the liberal government of Prime Minister Justin Trudeau is promoting a “culture of death.” Some on the left oppose the expansion for mental illnesses and have said they want to focus on further expanding psychiatric care. At least one conservative member in Parliament favors an indefinite extension stating, “I don’t see any indication that the fundamental issues that are at the heart — or should be at the heart — of putting a pause on this expansion will be resolved.”

There are still other speculations. Canada has a socialized health care system. One analysis conducted in 2020 estimated a potential annual health care cost savings of $66 million. Certainly, the risk of medical practitioners recommending assisted suicide as a cost-cutting measure to alleviate strain on the health care system is alarming.

Then, there are religious aspects being taken into consideration. In Canada, in every province but one, the government exempts taxpayer-funded religious institutions from providing services deemed contrary to their beliefs. In 2016, these exemptions were extended to specifically cover assisted suicide. Last week, a Catholic archbishop filed a challenge to Canada’s law on physician-assisted death, which includes both medically assisted suicide and euthanasia.

Lack of access to quality care has been a baseline, foundational issue for as long as there has been a health care system. If you are wealthy or have health insurance coverage, you have the keys to unlock the door of the healthcare system. If you do not have that key, you are confronted with a “No Trespassing” sign. Shouldn’t a compassionate enlightened society be known not for how it treats the elite in its society, but the downtrodden?

In addition, readily being presented with assisted dying services—instead of treatments or alternatives—can create a sense of being undervalued or marginalized. It implies that end-of-life choices should be prioritized over efforts to provide care, support, or treatments that could improve one’s quality of life or extend their lifespan.

I have the good fortune of being included in a small group of professionals studying eating disorders and end of life options. The issues are many and daunting. Any real progress is problematic, albeit not impossible, at best.

And then, I read a question which so eloquently encapsulated a fundamental concern about physician assisted suicide. That is …

“Why is their suffering acknowledged enough for euthanasia but not enough to fund clinical research?”

Why indeed.