Warning: This article includes discussions of suicide. Links to advice and helplines can be found at the bottom of the article.
Next year, Canada will become one of the few countries in the world that will allow patients with severe and incurable mental illness to seek medical aid in dying.
Assisted suicide – sometimes known as euthanasia or medical aid in dying (MAID) – to end the suffering of terminally ill adults first became legal in Canada in June 2016. In March 2021, the law was further amended to allow assisted dying for patients who had a “grievous and irremediable medical condition,” but not on the grounds of mental illness, a long-term disability, or a curable condition.
The new change in the law, set to come into action in March 2023, will allow MAID for people whose only underlying condition is severe depression, bipolar disorder, personality disorders, schizophrenia, PTSD, or any other mental health condition that’s deemed “irremediable” by any treatment.
In order to be eligible, people with psychiatric conditions must be 18 or older, “mentally competent,” provide informed consent, and show their decision isn’t the result of outside pressure or influence.
However, opinion among experts on this sensitive issue is mixed and it's still not clear how certain aspects of the amended law will be regulated.
A recent study published by the Canadian Medical Association Journal looked at MAID for people with irremediable psychiatric conditions in the Netherlands, where the act has been regulated by law since 2002. This report details just how difficult it is to define whether a mental health condition is truly irremediable and untreatable. Unlike a progressive or degenerative physical health condition, most mental disorders lack “prognostic predictability,” meaning it’s extremely difficult — some argue impossible — to forecast how the condition will progress or respond to treatment.
It also notes that around 90 percent of MAID requests for people with mental illness are denied by psychiatrists in the Netherlands.
Speaking about Canada’s recent decision, Dr Sisco van Veen, one of the Dutch psychiatrists from the study, told the National Post: “In psychiatry, really all you have is the patient’s story, and what you see with your eyes and what you hear and what the family tells you.”
“I think there’s going to be lots of uncertainty about how to apply this in March 2023,” added Dr Grainne Neilson, former president of the Canadian Psychiatric Association and a Halifax forensic psychiatrist, also speaking to the National Post. “My hope is that psychiatrists will move cautiously and carefully.”
If you or someone you know is struggling, help and support are available in the US at the National Suicide Prevention Lifeline on 1-800-273-8255. For Canada, the Canada Suicide Prevention Service can be called 24/7 on 1.833.456.4566 or text on 45645 (available from 4pm to Midnight ET). In the UK and Ireland, the Samaritans can be contacted on 116 123. International helplines can be found at SuicideStop.com.