Medical Assistance in Dying is defined as ‘the administration or prescription of a substance to a person that causes their death, at their request and after having met specific criteria’.
In February this year, the Canadian federal government announced plans to delay the expansion of MAID eligibility for those whose only medical condition is a mental illness to March 2024, which is one year later than expected. The serious consideration of this legislative change has sparked national debate, half (51%) of Canadians opposing the idea of expanding MAID for those whose only illness is mental.
In 2016, Canada legalised euthanasia for those with terminal illness and in 2021 this widened to include those with incurable, but not terminal illness. Subsequently, Canada has seen a significant increase in medically assisted deaths. From 2020 to 2021, this figure rose by 35%. Critics argue that the swift implementation of such legislation is leading to a concerningly rapid increase in rates of euthanasia.
Canada’s healthcare priorities are switching from healing to allowing autonomy and freedom. Although the provision of MAiD aims to reduce suicide rates, evidence from other countries suggest this will not be the case. A 2022 investigation found no “negative association between assisted suicide and non-assisted suicide’. An overwhelming amount of evidence suggests that giving this autonomy to those whose only underlying condition is psychiatric would be a mistake.
Firstly, mental health is difficult to measure as many illnesses have vague symptoms, and mental health suffering can be subjective . Currently, those suffering from a mental health condition are only eligible for MAiD if they also suffer a ‘grievous and irremediable’ physical condition. Importantly, however, medical professionals and psychiatrists have so far been unsuccessful in agreeing on criteria for assessing whether a patient’s mental illness is ‘grievous and irremediable’ and therefore eligible for MAiD.
We cannot predict the future of someone’s mental illness. A 43-year-old mother who previously suffered with severe depression and experienced numerous suicide attempts reflected on this period of her life; “I would have wanted MAiD but I recovered and lead a rich life”. This exemplifies the inability to accurately determine whether mental illness is irremediable, as if the patient truly believes it is, and has attempted suicide, it is likely that a psychiatrist would approve her request for MAiD, especially given the lack of criteria to determine eligibility.
It will be very difficult to distinguish between those whose mental illness induces suicidal thoughts and those whose mental illness is ‘irremediable’, and therefore should have access to MAiD. Furthermore, this case shows how severe mental illness damages a patient’s decision-making capacity. Having legal capacity means being able to understand the relevant information in deciding about treatment and being able to appreciate the reasonably foreseeable consequences of such a decision.
Further, expansions to eligibility criteria send an unhealthy message to Canadian citizens and undermine the existing structures of mental health support. 55% of Canadians say they worry about MAiD replacing social service improvements. If the Canadian government passes this legislation next year, the underlying message is that suicide is a valid option for the mentally ill.
All too much evidence highlights that Canada has very poor mental health services. Only 20% of people with depression receive treatment, and a third of Canadians report that their mental health care needs were not met. To offer euthanasia in a country with such deficient mental health support is morally questionable, as the lack of proper care aggravates suffering and so influences one’s decision. Instead of assisted suicide, providing Canadians with adequate care, even if their mental illness is “irremediable”, is indicative of a government which respects its citizens. It seems that Trudeau’s government is willing to offer its citizens death rather than provide sufficient services to alleviate their suffering.
Theoretically, if healthcare practitioners follow correct guidelines, the number of Canadians who access MAiD due to mental illness should be limited. However, studies have shown that doctors too frequently disobey guidelines when it comes to physical illnesses. Given the complicated nature of mental illness, it is not unlikely that the number of this type of case will rise.
Taking all the evidence into account, it certainly appears counterintuitive to introduce MAiD when 70% of those who survive suicide attempts make no further attempts.