MAiD and Mental Health – the “Reckless” Road Ahead

The Canadian Special Joint Committee on Medical Assistance in Dying (MAiD) has published a scathing report into the government’s proposed expansion of assisted suicide and euthanasia for those with mental health conditions. This policy is known as MAiD where mental disorder is the sole underlying medical condition (MAiD MD-SMUC). However, for the second time, the government has delayed introduction of the policy due to concerns over patient safety.

The Committee’s report described the possible introduction of MAiD MD-SMUC as “reckless”. Witnesses informed the Committee that “many psychiatrists do not support the practice of MAID MDSUMC”. Fundamentally, it was reported that “it is difficult, if not impossible, to accurately predict the long-term prognosis of a person with a mental disorder”.

Some witnesses argued that the current approach, “is cavalier, inadequate, and will result in the premature deaths of persons who could get better. It faultily assumes that because a person has not yet found relief from a mental disorder, that he or she cannot find relief. Relying on an agreement of an assessor and a requestor on a “case-by-case basis” is especially reckless in the face of a paucity of evidence that the person suffering will not get better.”

Other witnesses expressed their fears that socio-economic or psychosocial vulnerabilities may contribute to requests for MAID MD-SUMC. However, Dr. Stefanie Green, a MAiD practitioner, believed that, “people would not be eligible for MAID MD-SUMC on the basis of socio-economic vulnerabilities”. However, she conceded that, “people are quite complicated and it’s hard sometimes to discern which factors are involved.”

In addition, some witnesses opined that adequate criteria have not been established for determining irremediability. According to Dr Sonu Gaind, of the Department of Psychiatry at Sunnybrook Health Sciences Centre, reported “there is evidence that clinicians’ predictions are wrong over half the time.” On top of this, the committee was told that “there is no way to distinguish requests for MAID MD-SUMC from suicidality”.

The report concluded that, “there is no reason to believe that these fundamental problems will be resolved in the foreseeable future. As such, another arbitrary deadline extending the sunset clause, while better than proceeding as planned, is not the path forward.”