Home World Politics Should people with mental disorders be allowed to end their lives? Here’s...

Should people with mental disorders be allowed to end their lives? Here’s how that might work


Could Canadians whose sole health condition is a mental disorder ever be able to access medical assistance in dying?

It’s a question that has divided the medical community, with some believing it would simply never be possible.

It’s largely due to those divisions that the federal government decided to explicitly prohibit such individuals from accessing assisted dying in its revamped MAiD (medical assistance in dying) bill currently being studied in the Senate. Justice Minister David Lametti has said the government wants to see the issue studied further in a parliamentary review.

Amid the ongoing debate, the Quebec Psychiatric Association has come out with a discussion paper outlining what a MAiD regime for those whose sole condition is a mental disorder could look like, with the right safeguards in place.

“This is the beginning of a conversation that is quite focused on how you would actually do this in practice,” said psychiatrist Dr. Mona Gupta, chair of the association’s advisory committee on medical assistance in dying, which released the discussion paper in December that was unanimously approved by the association’s board.

The federal government is working to meet a Feb. 26 deadline to pass Bill C-7, its revised MAiD legislation after part of the previous MAiD law was struck down in 2019 by a Quebec court. The court found the condition that a person’s natural death be “reasonably foreseeable” in order to access MAiD to be unconstitutional.

The government’s revised bill — which passed the House of Commons and is now in the Senate — includes a regime for those whose natural deaths are deemed not reasonably foreseeable, but it explicitly prohibits individuals from seeking an assisted death solely on the basis of a mental illness.

Some experts, as well as parliamentarians, have described the ban as unconstitutional.

If accessing MAiD on the basis of a mental disorder alone was ever permitted in Canada — as it is in a handful of other countries — the Quebec Psychiatric Association provides a bit of a road map, to be studied and discussed further in the years ahead.

One of the paper’s main recommendations is to create an independent oversight body that could oversee the process for cases where mental disorder is the sole underlying condition. It could also be used in other complex cases where the person’s death is not reasonably foreseeable.

The body’s role would include ensuring that two independent psychiatrists act as assessors when determining the person’s eligibility for MAiD, a process that would likely take a number of months if not longer, and ensuring that all of the person’s life circumstances have been properly studied, including whether suicidality (which can be a symptom of a mental disorder) is present.

Gupta makes clear that it would likely be a very small number of individuals who would receive MAiD on the basis of a mental disorder alone.

Her committee points out that developing such a MAiD regime can coexist with suicide prevention strategies, and that such a regime cannot take away from the need to invest in mental health resources.

MAiD is not intended for individuals in an acute crisis, psychotic, profoundly depressed or who may not have had access to even basic mental health supports, Gupta said.

“We need to continue applying suicide prevention efforts to this group of people,” she said. “Assisted dying is really for people who have lived with a condition for years, if not decades, and who have really exhausted everything that there is to offer for treatment.”

Should the government’s new MAiD bill pass the Senate, much of the eligibility criteria will remain the same, aside from the “reasonably foreseeable death” provision. Individuals will still need to have an incurable illness and are suffering intolerably.

When determining whether a mental disorder is incurable and irreversible, chronicity is an important factor to consider, the discussion paper notes.

The committee didn’t specify exactly how long a person should be living with the condition before being able to access MAiD, noting the duration can vary for each individual depending on their care and circumstances.

A majority of psychiatrists surveyed for the paper found the person should have been living with the condition for at least five years before making a MAiD request.

“The incurability of a mental disorder could therefore only be determined at the end of a long process, after attempting several treatments and assessing their effects,” the paper states.

And in determining suffering before a person accesses MAiD, a psychiatrist “should explore other aspects that shape the patient’s life experience and consider strategies to improve the social circumstances that add to the suffering,” says the paper.

Finally, Gupta addressed the concern often expressed in public debate that individuals with a mental disorder might lack the capacity to make the decision to access MAiD.

She said the default position in medicine is that all individuals have the capacity to make decisions about their health care, including the decision to refuse life-saving treatment.

Loading…

Loading…Loading…Loading…Loading…Loading…

Gupta also pointed to the fact that individuals with mental disorders are already allowed to access MAiD if they have a physical condition that meets the eligibility criteria, and their capacity is assessed as part of the application process.

“If the issue of suicide and prognosis and capacity to make decisions are a concern for the person with a mental disorder, why are they suddenly not a concern if the person received a cancer diagnosis?” she said.

“Are there going to be challenging cases? Absolutely. But there are already challenging cases, and I don’t think the cases that are coming are more challenging than some of the cases we’re already dealing with.”





Source by [author_name]

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Must Read

Translate »