Should Assisted Dying for Psychiatric Disorders Be Legalized in Canada?

Abstract

In the wake of the Supreme Court decision in Carter v Canada (AG), Canadian Parliament has legalized Medical Assistance in Dying (MAID) for people who are suffering from a grievous and irremediable medical condition. Access is restricted by the definition of grievous and irremediable, which includes being in an “advanced state of decline that cannot be reversed” and being at a point where the “natural death of the person has become reasonably foreseeable taking into account all medical circumstances.” Prior to the government's introduction of the new law, a Special Joint Parliamentary Committee had recommended that MAID should be available much more widely, including for those who request MAID for the suffering associated with mental illness. In this paper, the authors argue against providing access to MAID for mental illness. Discussing evidence from Belgium and the Netherlands, they point out that there is a gap between the idealized basis upon which MAID is advocated for patients with psychiatric conditions and the reality of its practice. The assumption that only patients with true irremediable depressive disorders would have access to assisted dying, after careful assessment of their decision-making capacity based on rigorous thresholds, is not supported by the evidence. Because of the necessarily broad criteria used to regulate assisted dying, legalizing the practice for psychiatric conditions will place already vulnerable patients at risk of premature death.

Keywords: Euthanasia, Assisted Suicide, Medical Assistance in Dying, Mental Health, Psychiatry, Criminal Law, End of Life, Competency, Capacity, Consent