Making a case for the inclusion of refractory and severe mental illness as a sole criterion for Canadians requesting medical assistance in dying (MAiD): a review

2021 ◽  
pp. medethics-2020-107133
Author(s):  
Anees Bahji ◽  
Nicholas Delva
Keyword(s):  
Mental Illness ◽  
Assisted Suicide ◽  
Medical Condition ◽  
Psychiatric Patients ◽  
Public Support ◽  
Medical Assistance ◽  
Assisted Death ◽  
Medical Assistance In Dying ◽  
Legislative Framework ◽  
Sole Criterion

BackgroundFollowing several landmark rulings and increasing public support for physician-assisted death, in 2016, Canada became one of a handful of countries legalising medical assistance in dying (MAiD) with Bill C-14. However, the revised Bill C-7 proposes the specific exclusion of MAiD where a mental disorder is the sole underlying medical condition (MAiD MD-SUMC).AimThis review explores how some persons with serious and persistent mental illness (SPMI) could meet sensible and just criteria for MAiD under the Canadian legislative framework.MethodsWe review the proposed Bill C-7 criteria (capacity, voluntariness, irremediability and suffering) as well as the nuances involved in separating a well-reasoned request for assisted suicide from what might be solely a manifestation of a SPMI.FindingsIn this paper, we argue against the absolute exclusion of patients with SPMIs from accessing MAiD. Instead, we propose that in some circumstances, MAiD MD-SUMC may be justifiable while remaining the last resort. Conducting MAiD eligibility assessments removes the need to introduce diagnosis-specific language into MAiD legislation. Competent psychiatric patients who request MAiD should not be treated any differently from other eligible candidates. Many individuals with psychiatric disorders will be incapable of consenting to MAiD. The only ethical option is to assess eligibility for MAiD on an individual basis and include as legitimate candidates those who suffer solely from psychiatric illness who have the decisional capacity to consent to MAiD.

scholarly journals The provision of medical assistance in dying: protocol for a scoping review

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017888 ◽  
Author(s):  
Simon J W Oczkowski ◽  
Ian Ball ◽  
Carol Saleh ◽  
Gaelen Kalles ◽  
Anatoli Chkaroubo ◽  
...  
Keyword(s):  
Capital Punishment ◽  
Scoping Review ◽  
Assisted Suicide ◽  
Future Research ◽  
Medical Assistance ◽  
Knowledge Gaps ◽  
Eligibility Criteria ◽  
Assisted Death ◽  
Medical Assistance In Dying ◽  
Clinical Trial Registries

IntroductionMedical assistance in dying (MAID), a term encompassing both euthanasia and assisted suicide, was decriminalised in Canada in 2015. Although Bill C-14 legislated eligibility criteria under which patients could receive MAID, it did not provide guidance regarding the technical aspects of providing an assisted death. Therefore, we propose a scoping review to map the characteristics of the existing medical literature describing the medications, settings, participants and outcomes of MAID, in order to identify knowledge gaps and areas for future research.Methods and analysisWe will search electronic databases (MEDLINE, EMBASE, CINAHL, CENTRAL, PsycINFO), clinical trial registries, conference abstracts, and professional guidelines and recommendations from jurisdictions where MAID is legal, up to June 2017. Eligible report types will include technical summaries, institutional policies, practice surveys, practice guidelines and clinical studies. We will include all descriptions of MAID provision (either euthanasia or assisted suicide) in adults who have provided informed consent for MAID, for any reason, including reports where patients have provided consent to MAID in advance of the development of incapacity (eg, dementia). We will exclude reports in which patients receive involuntary euthanasia (eg, capital punishment). Two independent investigators will screen and select retrieved reports using pilot-tested screening and eligibility forms, and collect data using standardised data collection forms. We will summarise extracted data in tabular format with accompanying descriptive statistics and use narrative format to describe their clinical relevance, identify knowledge gaps and suggest topics for future research.Ethics and disseminationThis scoping review will map the range and scope of the existing literature on the provision of MAID in jurisdictions where the practice has been decriminalised. The review will be disseminated through conference presentations and publication in a peer-reviewed journal. These results will be useful to clinicians, policy makers and researchers involved with MAID.

Canadian Undergraduates’ Perspectives on Medical Assistance in Dying (MAiD): A Quantitative Study

2021 ◽  
pp. 082585972110507
Author(s):  
Erin Hawrelak ◽  
Lori Harper ◽  
John R. Reddon ◽  
Russell A. Powell
Keyword(s):  
Mental Illness ◽  
Undergraduate Students ◽  
Mentally Ill ◽  
Life Experiences ◽  
Medical Condition ◽  
Mental Illnesses ◽  
Medical Assistance ◽  
Factors Associated ◽  
Medical Assistance In Dying ◽  
Religion And Ethnicity

Background and Objectives: In 2016, Medical Assistance in Dying (MAiD) became legal in Canada for those suffering a grievous and untreatable medical condition. Currently, it is not available to minors or to those with an untreatable mental illness, although it is likely the scope of MAiD will be widened to include persons with severe and untreatable mental illnesses. However, little is known about the factors predicting acceptance or rejection of MAiD for persons with either a grievous medical condition or an untreatable mental illness. Methods: A survey was administered to 438 undergraduate students to examine factors associated with their acceptance or rejection of MAiD. The survey included four different scenarios: a young or old person with an untreatable medical condition, and a young or old person with an untreatable mental illness. Demographic questions (age, sex, religion, etc), personality measures, and an attitude towards euthanasia scale were also administered, as well as questions assessing participants’ general understanding of MAiD and their life experiences with death and suicide. Results/Conclusion: Overall, most of the Canadian undergraduate participants accepted MAiD for both terminally ill and mentally ill patients; however, different variables, such as age, religion, and ethnicity, predicted the acceptance or rejection of MAiD for each scenario.

scholarly journals “For Their Own Good”: A Response to Popular Arguments Against Permitting Medical Assistance in Dying (MAID) where Mental Illness Is the Sole Underlying Condition

2018 ◽  
Vol 63 (7) ◽  
pp. 451-456 ◽  
Author(s):  
Justine Dembo ◽  
Udo Schuklenk ◽  
Jonathan Reggler
Keyword(s):  
Mental Illness ◽  
Patient Autonomy ◽  
Medical Condition ◽  
Value Of Life ◽  
Natural Death ◽  
Medical Assistance ◽  
Liberal Democracies ◽  
Medical Assistance In Dying ◽  
Underlying Medical Condition

Canada is approaching its federal government’s review of whether patients should be eligible for medical assistance in dying (MAID) where mental illness is the sole underlying medical condition, and when “natural death” is not “reasonably foreseeable”. For those opposed, arguments involve the following themes: capacity, value of life, vulnerability, stigma, irremediability, and the role of physicians. It has also been suggested that those who are able-bodied should have to kill themselves, even though suicide may be painful, lonely, and violent. Opponents of MAID for severe, refractory suffering due to mental illness imply that it is acceptable to remove agency from such patients on paternalistic grounds. After years of efforts to destigmatise mental illness, these kinds of arguments effectively declare all patients with mental illness, regardless of capacity, unable to make considered choices for themselves. The current paper argues that decisions about capacity must be made on an individual-patient basis. Given the rightful importance granted to respect for patient autonomy in liberal democracies, the wholesale removal of agency advocated by opponents of a permissive MAID regime is difficult to reconcile with Canadian constitutional values.

19. Medical Assistance in Dying

2019 ◽  
pp. 615-665
Author(s):  
G. T. Laurie ◽  
S. H. E. Harmon ◽  
E. S. Dove
Keyword(s):  
Medical Treatment ◽  
Assisted Suicide ◽  
Double Effect ◽  
Legal Aspects ◽  
Assisted Dying ◽  
Physician Assisted Suicide ◽  
Medical Assistance ◽  
Philosophical Concept ◽  
Medical Assistance In Dying ◽  
The Relationship

This chapter discusses ethical and legal aspects of euthanasia and assisted dying. It first examines the non-voluntary termination of life, covering the relationship between medical treatment and assistance in dying as a matter of failure to treat, and the philosophical concept of ‘double effect’. The chapter then discusses activity and passivity in assisted dying; dying as an expression of patient autonomy; suicide and assisted suicide; physician-assisted suicide; and assisted dying in practice.

scholarly journals Analysis of the Medical Assistance in Dying Cases in Ontario: Understanding the Patient Demographics of Case Uptake in Ontario since the Royal Assent and Amendments of Bill C-14 in Canada

2017 ◽  
Vol 7 (2) ◽  
pp. 263-287 ◽  
Author(s):  
Alexandra E. Rosso ◽  
Dirk Huyer ◽  
Alfredo Walker
Keyword(s):  
Nurse Practitioners ◽  
Medical Condition ◽  
Medical Personnel ◽  
Drug Regimen ◽  
Criminal Code ◽  
Medical Assistance ◽  
Eligibility Criteria ◽  
Medical Assistance In Dying ◽  
Patient Demographics ◽  
The Individual

On June 17, 2016, the Canadian government legalized medical assistance in dying (MAID) across the country by giving Royal Assent to Bill C-14. This Act made amendments to the Criminal Code and other Acts relating to MAID, allowing physicians and nurse practitioners to offer clinician-administered and self-administered MAID in conjunction with pharmacists being able to dispense the necessary medications. The eligibility criteria for MAID indicates that the individual 1) must be a recipient of publicly funded health services in Canada, 2) be at least 18 years of age, 3) be capable of health-related decision-making, and 4) has a grievous and irremediable medical condition. Because this is a new practice in Canadian health care, there are no published Canadian statistics on MAID cases to date, and this paper constitutes the first analysis of MAID cases in both the province of Ontario and Canada. Internationally, there are only a few jurisdictions with similar legislation already in place (US, the Netherlands, Belgium, Luxembourg, Switzerland, Columbia, Japan, and the United Kingdom). The published statistics on MAID cases from these jurisdictions were reviewed and used to establish the current global practices and demographics of MAID and will provide useful comparisons for Canada. This analysis will 1) outline the Canadian legislative approach to MAID, 2) provide an understanding of which patient populations in Ontario are using MAID and under what circumstances, and 3) determine if patterns exist between the internationally published MAID patient demographics and the Canadian MAID data. Selected patient demographics of the first 100 MAID cases in Ontario were reviewed and analyzed using anonymized data obtained from the Office of the Chief Coroner for Ontario so that an insight into the provision of MAID in Ontario could be obtained. Demographic factors such as age, sex, the primary medical diagnosis that prompted the request for MAID, the patient rationale for making a MAID request, the place where MAID was administered, the nature of MAID drug regimen used, and the status/specialty of medical personnel who administered the MAID drug regimen were analyzed. The analysis revealed that the majority of the first 100 MAID recipients were older adults (only 5.2% of patients were aged 35-54 years, with no younger adults between ages 18-34 years) who were afflicted with cancer (64%) and had opted for clinician-administered MAID (99%) that had been delivered in either a hospital (38.8%) or private residence (44.9%). Although the cohort was small, these Ontario MAID demographics reflect similar observations as those published internationally, but further analysis of both larger and annual case uptake in both Ontario and Canada will be conducted as the number of cases increases.

scholarly journals Medical Assistance in Dying and Mental Health: A Legal, Ethical, and Clinical Analysis

2017 ◽  
Vol 63 (2) ◽  
pp. 80-84 ◽  
Author(s):  
Alexander I. F. Simpson
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Serious Mental Illness ◽  
Clinical Analysis ◽  
Psychiatric Practice ◽  
Eligibility Criterion ◽  
Medical Assistance ◽  
Medical Assistance In Dying

Medical assistance in dying (MAiD) legislation is now over a year old in Canada, and consideration is turning to whether MAiD should be extended to include serious mental illness as the sole qualifying condition for being eligible for MAiD. This article considers this question from ethical and clinical perspectives. It argues that extending the eligibility for MAiD to include those with a serious mental illness as the sole eligibility criterion is not ethical, necessary, or supported current psychiatric practice or opinion.

scholarly journals Author(iz)ing Death: Medical Aid-in-Dying and the Morality of Suicide

2019 ◽  
Vol 34 (1) ◽  
pp. 53-77 ◽  
Author(s):  
Anita Hannig
Keyword(s):  
Public Discourse ◽  
Medical Assistance ◽  
Death With Dignity ◽  
Assisted Death ◽  
Medical Aid ◽  
Medical Assistance In Dying ◽  
Aid In Dying ◽  
Death With Dignity Act ◽  
Twentieth Anniversary ◽  
Dignity Act

In 2017, Oregon marked the twentieth anniversary of enacting the Death with Dignity Act, allowing terminally ill, mentally competent adult patients to end their life by ingesting a lethal medication prescribed by their physician. In U.S. public discourse, medical aid-in-dying is frequently equated with the terminology and morality of suicide, much to the frustration of those who use and administer the law. This article reflects on the stakes of maintaining a distinction between a medically assisted death and the most common cultural category for self-inflicted death—suicide. It uncovers the complicated dialectic between authorship and authorization that characterizes medical assistance in dying and attendant moralities of purposive death, speaking to broader disciplinary concerns in the cultural study of death and medicine. By stressing the primacy of debilitating, life-limiting illness in an aided death and by submitting such a death to the rationale and management of institutionalized medicine, advocates carve out a form of intentional death that occupies a category of its own. The diffusion of agency onto a patient’s fatal illness, medicine, and the state—both discursively and in practice—enhances the moral and social acceptability of an assisted death, which becomes an authorized form of dying that looks very different from the socially deviant act of suicide.

The Somatechnologies of Canada's Medical Assistance in Dying Law: LGBTQ Discourses on Suicide and the Injunction to Live

Somatechnics ◽  
2017 ◽  
Vol 7 (2) ◽  
pp. 201-217 ◽  
Author(s):  
Alexandre Baril
Keyword(s):  
End Of Life ◽  
Assisted Suicide ◽  
Mental Disability ◽  
Medical Assistance ◽  
Disabled People ◽  
Canadian Government ◽  
Physically Disabled ◽  
Medical Assistance In Dying ◽  
Oppressed Group ◽  
Physically Disabled People

In June 2016, the Canadian government passed Bill C-14 on medical assistance in dying, allowing for medically assisted suicide when ‘death has become reasonably foreseeable.’ While available for ill or physically disabled people at the end-of-life, medically assisted suicide is denied in cases where people are perceived to have a mental disability and whose suffering is strictly emotional/psychological, such as suicidal people. I argue that this distinction results in constructing two classes of suicidal subjects by considering physically disabled or ill people as legitimate subjects who should receive assistance in dying and suicidal people as illegitimate subjects who must be kept alive through what I call the ‘injunction to live’ and ‘somatechnologies of life’. Analysing discourses on suicide targeting lesbian, gay, bisexual, trans* and queer (LGBTQ) people in LGBTQ scholarship, I argue that, based on the silencing of suicidal subjects through the injunction to live, suicidal people constitute an oppressed group whose claims remain unintelligible within society, law, medical/psychiatric systems and LGBTQ scholarship. This article calls for listening to suicidal people's voices and developing an accountable response to their suffering and claims.

A Communitarian Approach to Physician-Assisted Death

1997 ◽  
Vol 6 (1) ◽  
pp. 78-87 ◽  
Author(s):  
Franklin G. Miller
Keyword(s):  
Assisted Suicide ◽  
Well Being ◽  
Self Determination ◽  
Social Goal ◽  
Medical Assistance ◽  
Assisted Death ◽  
Relief Of Suffering ◽  
The Face ◽  
The Right ◽  
Timing Of Death

The standard argument in favor of the practice of voluntary physician-assisted death, by means of assisted suicide or active euthanasia, rests on liberal, individualistic grounds. It appeals to two moral considerations: (1) personal self-determination—the right to choose the circumstances and timing of death with medical assistance; and (2) individual well-being—relief of intolerable suffering in the face of terminal or incurable, severely debilitating illness. One of the strongest challenges to this argument has been advanced by Daniel Callahan. Callahan has vigorously attacked the practice of physician-assisted death and the goal of legalization as deep affronts to values of community: “By assuming that the relief of suffering is a goal important enough to legitimate killing as a way of achieving it, we corrupt the idea of such relief as a social goal and duty. We cease helping to bear one another's suffering, but eliminate altogether the person who suffers. We thereby jeopardize both the future of self-determination and the kind of community that furthers its members' capacity to bear one another's suffering. Why bear what can be eliminated altogether?” In another passage Callahan remarks, “For there is a deep sense in which suicide and euthanasia are likely to represent, at least in part, a failure of the community, whether that of the intimate community of family and friends, or the larger civic community, to respond to the needs of another.”

Mental illness and medical aid in dying

2020 ◽  
Author(s):  
Gali Katznelson ◽  
Jacek Orzylowski
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Disorder ◽  
Mental Health Care ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Medical Condition ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Aid In Dying

A 2017 survey of 529 psychiatrists in Canada found that while 72% of psychiatrists supported medical assistance in dying (MAID) in some cases, only 29.4% supported MAID solely on the basis of mental disorders.  Understanding and addressing the concerns of mental health professionals will be crucial in deciding whether and how to expand MAID solely for a mental disorder in Canada. The report, “The State of Knowledge on Medical Assistance in Dying Where a Mental Disorder Is the Sole Underlying Medical Condition,” authored by The Council of Canadian Academies, highlights some concerns that mental health professionals might harbour. These include potentially feeling that there is a conflict between providing MAID and their duties as mental health care workers, the subjectivity of the current law, and Canada’s inequitable mental health care system.

Sign in / Sign up

Export Citation Format

Share Document