Canada is working to determine who, if anyone, should be offered doctor-assisted death as a result of mental illness. In other words, it's doctor assisted suicide.
Doctor assisted death is mostly prominent in people who have terminal illnesses like cancer, The National Post reported last week. Moving into doctor assisted death for mental illness raises a whole new host of questions.
Dutch psychiatrist Dr. Sisco van Veen notes that with cancer, something inside the body can be seen, but “in psychiatry, really all you have is the patient’s story, and what you see with your eyes and what you hear and what the family tells you.”
Mental disorders lack “prognostic predictability", which can make determining suffering near impossible.
As Canada moves closer to legalizing doctor-assisted deaths for people with mental illness whose psychological pain has become unbearable to them, "difficult conversations" are ahead, Veen told the National Post.
In March 2023, Canada will become one of just a few nations that allow medical aid in dying, or MAID, for mental illness like depression, bipolar disorder, personality disorders, schizophrenia, PTSD.
Dr. Grainne Neilson, past president of the Canadian Psychiatric Association and a Halifax forensic psychiatrist said: “I think there’s going to be lots of uncertainty about how to apply this in March 2023. My hope is that psychiatrists will move cautiously and carefully to make sure MAID is not being used as something instead of equitable access to good care.”
The argument developing over MAID for mental illness is robust. Many in the mental health field think that mental illness is never irremediable and there's always hope for a cure. Others say "there still exists a profound lack of understanding about, and fear of, mental illness, and that the resistance reflects a long history of paternalism and unwillingness to accept that the suffering that can come from mental illness can be as equally tormenting as the suffering from physical pain."
The Canadian Parliament has moved past whether MAID should be offered to those who are eligible, and is now studying how it should be assessed.
The National Post described how the idea has made its way through Parliament:
That decision formed the impetus for Canada’s MAID law, Bill C-14, which allowed for assisted dying in cases where natural death was “reasonably foreseeable.”
In 2019, a Quebec Superior Court justice ruled the reasonably foreseeable death restriction unconstitutional, and that people who were intolerably suffering but not imminently dying still had a constitutional right to be eligible for euthanasia.
In March 2021, Bill C-7 was passed that made changes to the eligibility criteria. Gone is the “reasonably foreseeable” criterion and, as of March 17, 2023, when a two-year sunset clause expires, MAID will be expanded to competent adults whose sole underlying condition is a mental illness.