Medical Assistance in Dying and Mental Health: A Legal, Ethical, and Clinical Analysis (original) (raw)
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An ethical-legal analysis of medical assistance in dying for patients with mental illness
Alberta Law Review
This essay considers sources of opposition to allowing access to medical assistance in dying for individuals with mental illness. It originated with an observation by members of the University of Toronto Joint Centre for Bioethics that in mainstream Canadian culture—as well as in political, academic, and professional circles—such opposition remains widespread (and often reflexive) even in light of broad support for access to assisted dying for individuals with illness manifesting in physical suffering. Most Canadians treat the prospect of assisted dying for those with mental illness with suspicion, and it is worth exploring why this opposition persists, what arguments can be leveled to support it, and whether those arguments can be sustained. To that end, I identify five sources of opposition to assisted dying for the mentally ill that seem to characterize the public debate, and argue that none succeed. They either rely on false premises or otherwise fail to secure the conclusion th...
Healthcare Policy | Politiques de Santé, 2019
Canadian medical assistance in dying (MAiD) legislation was introduced in 2016. Although Bill C-14 attempted to balance patient autonomy and the protection of the vulnerable, recent court challenges suggest that an ideal balance has not been achieved. Numerous advocacy initiatives as well as a parliamentary review currently focus on three specific populations: mature minors, patients requesting MAiD via an advance directive and patients with a mental illness as the sole underlying condition. This article approaches these issues from an ethical and legal lens. We first outline a policy review on existing MAiD legislation in 11 jurisdictions. We then use the Oakes test (a critical assessment tool in the Carter v Canada case) to determine whether the restrictions on the three above-mentioned groups are consistent with the Canadian Charter of Rights and Freedoms. Finally, we consult our literature review to propose reasonable solutions that would be more consistent with the Charter.
A National Survey of Canadian Psychiatrists' Attitudes toward Medical Assistance in Death
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2017
Bill C-14 allows for medical assistance in dying (MAID) for patients who have intolerable physical or psychological suffering that occurs in the context of a reasonably foreseeable death. In Canada, psychiatrist support for MAID on the basis of mental illness and beliefs influencing level of support are unknown. The objectives of this research were to 1) determine if psychiatrists are supportive of MAID under certain conditions and on the basis of mental illness and 2) determine what factors are related to psychiatrist support for MAID on the basis of mental illness. This cross-sectional study was conducted among 528 psychiatrists in Canada using an online survey platform (February 19 to March 11, 2016). The response rate was 20.9% ( n = 528). Most psychiatrists supported the legalisation of MAID in some circumstances (72%); however, only 29.4% supported MAID on the basis of mental illness. Factors correlating with decreased support for MAID for mental illness were the belief that M...
Shaffer, C. S., Cook, A. N., & Connolly, D. A. (2016). Should medical assistance in dying extend to persons with a mental disorder? Introducing a framework for discussion. [Special Issue]. Psynopsis, 38, 18-19. Psynopsis is Canada’s Psychology Magazine. Each of its quarterly issues focuses on a particular area of psychological research and/or practice with relevance, not only to the discipline and profession, but also to the range of stakeholders who may rely on or benefit from the work of Canada’s psychologists. In our article, we discuss issues and dilemmas that arise from the extension of medical assistance in dying to persons with a mental disorder, and introduce a recent publication that provides a guide for discussion.
Standing Committee on Justice and Human Rights House of Commons; Standing Committee on Legal and Constitutional Affairs of the Senate – Parliament of Canada, 2020
Purpose: (1) To provide an in-depth analysis of Parliament’s constitutional responsibilities under the Canadian Charter and the Supreme Court decision in Carter; (2) To present a critical analysis of the proposed policy under which “persons whose sole underlying medical condition is a mental illness” would not be eligible to medical assistance in dying, but persons whose death is not reasonably foreseeable, and who are suffering from a mental illness and an additional underlying “grievous and irremediable medical condition” under section 241.2 of the Criminal Code would be eligible; (3) To analyze whether the proposed bill could be unconstitutional and challenged on the basis that it affects the rights to life, liberty, security, and substantive equality of the more vulnerable, in particular women victims of sexual abuse and domestic violence.
Frontiers in Psychiatry
Persons with severe and persistent mental illness (SPMI) make up a vulnerable group within mental healthcare and society. Not only do they suffer from long-term, serious psychiatric disorders; they often also experience considerable problems in their psychosocial functioning. Research has disclosed that the care needs of this target group are complex, and that the life expectancy of these persons is significantly lower than in the general population. Given (1) the lower life expectancy of persons with SPMI, (2) the higher suicide risk related to mental disorders, and (3) the legalization and practice of medical assistance in dying in an increasing number of countries, it is of utmost importance to map the ethical aspects and challenges of end-of-life care needs in persons with SPMI. Therefore, we charted the way end-of-life care is provided for them by means of a scoping review of the scientific literature, with an emphasis on the ethical aspects surrounding it. We explore existing ...
BMC Medical Ethics, 2020
It has historically been a crime in Canada to provide assistance to someone in ending their own life, however, this paradigm was inverted in 2015 when the Supreme Court of Canada (SCC) ruled that restrictions on this practice, within certain defined parameters, violated the right to life, liberty, and security of the person. Subsequently, recent legal and policy decisions have highlighted the issue of how to balance the rights of individuals to access MAiD with the rights of care providers to exercise conscience-based objections to participation in this process. We argue that there is significant harm and ethical hazard in disregarding individual and institutional rights to conscientious objection and since measures less coercive than the threat of regulatory or economic sanctions do exist, there should be no justification for such threats in Canada's health care systems.