A group of Canadian psychiatrists involved with medical assistance in dying respond to calls to exclude patients with mental health disorders.

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A recent editorial published in the Globe and Mail suggested “it’s time to take a step back on assisted death” (4 November 2023) and various other publications have started to jump on and suggest Canada needs to permanently exclude persons with mental health disorders from their right to request medical assistance in dying (MAiD).

The positions taken by these publications are both erroneous and misleading with respect to MAiD for people with mental disorders. We are Canadian psychiatrists involved with MAiD and are responding to these misguided pieces.

Photo Credit: Onasill ~ Bill/flickr. Image description: Parliament Hill and West Block of the Canadian Parliament buildings.

The Globe editorial board (the authors of the editorial) both bemoaned the rates of assisted death in Canada and used this rate to argue against allowing access to MAiD by people who have a mental disorder as their sole underlying condition. The authors neglected to report that the increasing numbers of MAiD deaths are almost entirely accounted for by persons whose natural deaths are reasonably foreseeable. These are people who would have been eligible even prior to the legislative change of March 2021. Any rise in the number of MAiD deaths year over year is wholly independent from MAiD requests by people with mental disorders (currently not allowed). Indeed, the number of people who accessed MAiD with non-foreseeable deaths (track 2) was 463 deaths in 2022, that is 3.5% of all MAID deaths and 0.14% of all deaths in Canada that year.

Currently, Canada’s MAiD laws allow people with a mental disorder to access MAiD only if they also have a physical condition. Those whose request is based solely on a mental disorder are excluded from applying. In practical terms, this means that someone with a mental disorder cannot apply for MAiD but should that same person receive a diagnosis of a physical condition, they instantly become eligible to apply. This is ethically and medically nonsensical. No one believes that medicine can cure all ills. In the face of this uncomfortable truth, medical assistance in dying can be a compassionate response for those eligible persons who make a voluntary request and where the safeguards have been respected. Why should our response be any different for people with mental disorders? Quite simply, it shouldn’t.    

Several pieces contend that Canada’s legislation does not contain the safeguards adopted by other countries. However, the authors seem to be unaware that countries that allow MAiD for people with mental disorders do not have different eligibility criteria or legislated safeguards for persons with mental as opposed to physical disorders. And apart from Canada and Québec, no jurisdiction that allows assisted dying has specifically excluded people with mental disorders. What then are the things that Canada’s law is not doing that other countries are? Quite simply, there aren’t any. 

In fact, Canada has adopted an approach similar to other countries that allow assisted dying for people whose deaths are not foreseeable. This approach treats all people equally in law and ensures that bodies responsible for the implementation and oversight of clinical practice – regulators, educators, and professional associations – develop appropriate rules, training, and processes to provide high quality and prudent eligibility assessments.

Discrimination against people with mental disorders is based on the paternalistic assumption that they cannot make autonomous health care decisions and the erroneous belief that MAID eligibility can never be established for persons with mental disorders. Severe, unremitting, treatment-refractory mental disorders are fortunately rare, but those who suffer from them deserve the same options, and the same compassion, as all other Canadians who suffer from chronic medical conditions.

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Alexandra McPherson (Alberta), Mona Gupta (Québec), Suzanne Leclair (Québec), Francois Lesperance (Québec), Selene Etches (Nova Scotia), Shiloh Gossen (Nova Scotia), Donna E. Stewart (Ontario), Justine Dembo (Ontario), Raed Hawa (Ontario), Mark Lachmann (Ontario), Lilian Thorpe (Saskatchewan), Craig Buchholz (Alberta), Michael Trew (Alberta), Derryck Smith (BC), Janet Kusler (BC), and Laura Calhoun (BC) are Canadian psychiatrists.