Warning: This article contains discussions about suicide. Links to advice and helplines can be found at the bottom of the article.
In the next year, Canada will be one of the few countries in the world where patients with severe and terminal mental illness can seek medical assistance while they are dying.
Assisted suicide – sometimes referred to as euthanasia or medical assisted dying (MAID) – to end the suffering of terminally ill adults first became legal in Canada in June 2016. In March 2021, the law was further amended to allow euthanasia for patients affected by a “severe and incurable medical condition” but not due to a mental illness, long-term disability, or curable condition.
The new change of lawSlated to take effect in March 2023, MAID will be approved for people whose only underlying medical condition is major depression, bipolar disorder, personality disorder, schizophrenia, PTSD, or another mental illness deemed “untreatable” by treatment.
To be eligible, people with psychiatric disorders must be at least 18 years of age, be “mentally competent,” provide informed consent, and demonstrate that their decision is not the result of external pressure or influence.
However, opinion among experts on this sensitive issue is mixed and it is not yet clear how certain aspects of the legislative change will be addressed.
A Recent study published by the Canadian Medical Association Journal examined MAID for people with irreversible psychiatric illnesses in the Netherlands, where the law has been legislated since 2002. This report describes how difficult it is to define whether a mental illness is truly irreversible and untreatable. Unlike a progressive or degenerative health condition, most mental disorders lack “prognostic predictability,” meaning it is extremely difficult — some argue impossible — to predict how the condition will progress or respond to treatment.
It also notes that around 90 percent of MAID requests for people with mental illness are denied by psychiatrists in the Netherlands.
Speaking about Canada’s recent decision, Dr. Sisco van Veen, one of the Dutch psychiatrists involved in the study National Post: “In psychiatry you really only have the story of the patient and what you see with your eyes and what you hear and what the family tells you.”
“I think there’s going to be a lot of uncertainty about how this will be applied in March 2023,” added Dr. Grainne Neilson, former president of the Canadian Psychiatric Association and Halifax-based forensic psychiatrist, also spoke to the National Post. “My hope is that psychiatrists will be careful and cautious.”
If you or someone you know is struggling, in the US you can get help and support from the National Suicide Prevention Lifeline on1-800-273-8255. For Canada, the Canada Suicide Prevention Service can be called 24 hours a day at 1.833.456.4566 or by texting 45645 (available from 4 p.m. to midnight ET). In the UK and Ireland it is Samaritan can be reached at 116 123. International helplines can be found at SuicideStop.com.