The federal government has decided to delay the expansion of medical assistance in dying (MAID) to those suffering from mental illness until 2027.
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Here are three issues which make MAID a complex decision when it comes to the mentally ill:
1. An individual’s freedom to die and to choose the way in which they die.
2. Medical ethics and the doctrine of “doing and allowing,” known as DDA.
3. Pragmatic medical issues — unlike many physical conditions, diagnosing mental illness in term of its long-term impact on the patient is difficult to get right.
On the first issue regarding the freedom to die, dying is not hard. Human life is fairly fragile. If an individual wants to die, there are numerous methods that can be used to do it.
The impetus for MAID comes from the belief that people should be able to lawfully “die with dignity,” as opposed to other, more accessible methods of ending one’s life which are not dignified.
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Inevitably, there are going to be individuals who want to die with dignity and Canadian society broadly agrees with the principle that they should be afforded that right.
Indeed, for a free society to deprive someone of the “right to die” seems paradoxical.
The question then becomes what are the proper limits on this freedom.
Stigmatizing individuals for suicide is an example of how society historically discouraged individuals from taking their own lives.
Some religions continue to view the taking of one’s own life as unethical, another method of discouraging suicide.
Even how we describe taking one’s own life influences the debate.
Terms such as “‘committing suicide” or “dying by suicide” create a very different impression than having a “medically assisted death.”
The larger societal debate is about whether suicide is ethical, or fundamentally or circumstantially wrong.
This bring us to the medical issue of the doctrine of “doing and allowing.”
Western medical ethics tend to have trouble viewing death as a treatment. For that reason, euthanasia has always been ethically complicated.
For example, allowing someone to die by posting a “do not resuscitate” (DNR) order for a critically ill patient at the patient’s request is viewed differently from taking medical action which actively assists in ending that person’s life, even with their consent.
When a medical professional has been trained to try to save everyone they are treating — whether a child, adult, rich, poor, law-abiding or criminal — it may be very difficult to convince them that helping their patient to die is an ethical option.
Often, every fibre of their being will resist this idea.
When mental health is the sole criterion used to determine whether someone should qualify for MAID, there are also pragmatic issues.
One can reasonably determine when it comes to an individual’s physical health, when they effectively have no realistic chance of recovery.
In those cases, it is relatively easy to make an informed decision about whether MAID is appropriate.
By contrast, determinations about a patient’s mental health are much more complex when it comes to the question of whether MAID is appropriate.
Take the example of a patient who suffers from chronic depression asking for MAID.
Is their request to die a result of their depression, or is it based on the fact that the patient has no realistic hope of recovery?
When a patient in the late stages of terminal cancer requests MAID, there is very little chance they will recover.
But when a patient who is chronically depressed asks for MAID in the belief they have no realistic hope of recovering, the issue becomes more complex.
For that reason, it is easy to understand why many doctors, who are predisposed to treating their patients rather than actively helping to end their lives, may be hesitant to expand MAID to cases where the sole criterion in making the determination is the mental health of the patient.
If we believe the primary purpose of MAID is to allow the individual the freedom to decide when to end their life, then allowing it solely on the basis of mental illness is logical.
But if the primary determinant is whether the condition the patient is suffering from will inevitably lead to their death, the decision becomes more complicated.
— Alex Vezina is the CEO of Prepared Canada Corp, teaches Disaster and Emergency Management at York University and is the author of Continuity 101. He can be reached at info@prepared.ca.
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