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.

scholarly journals Regulating Death: A Brief History of Medical Assistance in Dying

2021 ◽  
Vol 0 ◽  
pp. 1-4
Author(s):  
Connor T. A. Brenna
Keyword(s):  
Medical Condition ◽  
Death And Dying ◽  
Historical Review ◽  
Medical Assistance ◽  
Care Community ◽  
Medical Assistance In Dying ◽  
Do No Harm ◽  
History Of ◽  
Underlying Medical Condition

Unique reports of suicide and euthanasia date back more than 2 millennia, reflecting evolving philosophies of death and dying as expressions of the mores dominating a given era. One longstanding theme in the history of decisions to die has been staunch opposition founded in religious claims that one’s body is a trust from the divine (and therefore not wholly in their ownership). The role of the physician has also been traditionally estranged from participation in such decisions, dating back to rudimentary conceptions of medical ethics in the Hippocratic notion primum non nocere (‘first, do no harm’). However, fundamental principles in the modern philosophy of medicine lend support to the idea that physicians can be justified in actions which cause some harm, in so far as they are acting to fulfil a greater ethical imperative. This brief historical review explores the inception of modern North American medical assistance in dying (MAiD) policy through a series of critical case studies in the unfolding of its practice. Medically assisted dying has presently been legalised in Canada and some United States jurisdictions, but with critical caveats surrounding circumstances of mature minors, advance directives and mental illness as participants’ sole underlying medical condition. While the modern regulations surrounding MAiD continue to take shape, the palliative care community is well-positioned to both guide and scrutinise the ethics of this practice.

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.

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.

A Values-Based Analysis of Recovery-Oriented Practice in Mental Health Care and Medical Assistance in Dying

2020 ◽  
Vol 39 (2) ◽  
pp. 1-10
Author(s):  
Rosanna Macri ◽  
Frank Wagner ◽  
Melanie I. Stuckey
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Medical Condition ◽  
Criminal Code ◽  
Comprehensive Analysis ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
People With Mental Illness ◽  
Considerable Debate ◽  
Underlying Medical Condition

The Criminal Code of Canada has been amended to allow medical assistance in dying (MAiD) under prescribed criteria. There has been considerable debate regarding whether people with mental illness as the sole underlying medical condition should be eligible. It is argued that access to MAiD is not compatible with recovery-oriented care. Based on a comprehensive analysis exploring the ethical principles guiding decision making around MAiD, this paper offers a discussion of the compatibility between MAiD and recovery-oriented care and demonstrates significant overlap of these principles. The discussion around MAiD as an option in recovery-oriented care is legitimate and needs to continue.

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.

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.

Psychogenic Coma: Case Report

2003 ◽  
Vol 33 (3) ◽  
pp. 317-322 ◽  
Author(s):  
Cynthia L. Baxter ◽  
William D. White
Keyword(s):  
Case Report ◽  
Antipsychotic Medication ◽  
Clinical Case ◽  
Medical Condition ◽  
Dissociative Disorder ◽  
Short Term ◽  
Not Otherwise Specified ◽  
Dsm Iv ◽  
Underlying Medical Condition

Coma is present when the patient appears asleep, is unrousable, and unresponsive. Where no underlying medical condition is found, the role of the psychiatrist may become prominent. We present a clinical case and review the literature on psychogenic coma. According to DSM-IV-TR, psychogenic coma is a dissociative disorder not otherwise specified. Management is largely supportive. Principles include speaking in a reassuring manner and avoiding repeated painful stimuli. Education of family and other professionals that symptoms are real and not consciously feigned may be important. There may be a short-term role for anxiolytic and/or antipsychotic medication to assist return to consciousness.

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