Misunderstanding of mental illness clouds MAID expansion, patient and psychiatrist say
Psychiatrists divided on extending MAID to those suffering solely from mental illnesses
WARNING: This story includes discussion of suicidal thoughts
Canadians suffering from debilitating mental illness cannot yet legally qualify for medical assistance in dying, unlike almost all others with severe illnesses — a restriction some advocates feel is rooted in misunderstanding.
Eligibility for MAID was set to expand in March to include people with mental illness.
But on Thursday, Health Minister Mark Holland introduced legislation that will delay the expansion of assisted dying to include those suffering solely from mental illness to 2027.
Holland accepted the majority recommendations of a parliamentary committee that warned Canada's health system is not ready to allow MAID for people with only a mental illness because there's too much work to do before the legislation was set to expand.
Graeme Bayliss wants the right, at some point, of a doctor-assisted death.
Bayliss, 34, has lived with depression and obsessive compulsive disorder since his teens and says he is currently managing.
But he says he finds the possibility of MAID as a way out comforting, and makes him more willing to try new treatments and medications should he face tough times again.
"It can be very disappointing when a new treatment or a new method fails," Bayliss said in an interview. "You're taking the risk of another failure, which itself could be discouraging, which itself could lead you toward suicidal thoughts."
As a MAID advocate, Bayliss says he also considers it safer for someone to receive medical assistance in dying than to be traumatized following an attempted suicide or to have family members come across a body unexpectedly.
"People get sort of lumped in together as having mental illnesses in a way that you wouldn't lump people in together who had physical illnesses," Bayliss said.
The misunderstanding, he says, is also reflected in a lack of familiarity with the manifestations and impact of mental illnesses, which can range from mild depression to psychosis.
"It's that apparent lack of nuance in the way that we think about mental illness as a society broadly," Bayliss said.
"I think that lack of nuance … makes mentally ill people an undifferentiated mass that is not viewed as having thoughts and experiences of its own."
Similarly, Dr. Derryck Smith, a clinical professor emeritus of psychiatry at the University of British Columbia, asks why people with mental illness are treated separately from those with physical illness when it comes to MAID.
Currently, someone can request MAID if their death is "reasonably foreseeable" under what's known as Track 1, or if they suffer from a "grievous and irremediable condition," Track 2.
Neither track includes mental illness.
If the legislation were to expand, doctors expect sufficiently mentally ill patients would be covered under Track 2.
"We don't have a special category for stroke victims or kidney disease or cancer or anything like that," Smith said. "We have a special group for mental illness. And that, to me, is the evidence of the ongoing stigma that psychiatric patients face."
Smith says psychiatrists in Canada are currently divided on MAID, much the way other physicians were before it was introduced in this country.
On Wednesday, the Ontario Psychiatric Association released its survey of psychiatrists and psychiatry residents across the country.
It suggested 33 per cent of respondents agreed with expanding MAID for mental disorders as a sole underlying medical condition, and that 80 per cent agreed Canada's medical system is not prepared to safely support the expansion. The electronic survey of 497 respondents was conducted between Dec. 7, 2023 and Jan. 23.
Smith expects the dissent will fade with time and that within 10 years, what's now controversial will no longer be debated.
Transparent discussions
He cites the most recent statistics from Health Canada, on why people sought MAID in 2022, to support his position.
"The reason why most people wanted an assisted death wasn't because they were in intolerable pain," Smith said. "It was because they lost the functional ability to do the things that brought them joy in their lives, and many psychiatric patients who have been ill for 20 or 30 years do not have any joy left in their life."
Dr. Madeline Li, a psychiatrist at Princess Margaret Cancer Centre in Toronto, has assessed hundreds of patients for MAID due to cancer. She's not ideologically opposed to MAID for mental disorders, but wants the legislation to be more specific than it currently is for physical illnesses under Track 2.
Initially, when MAID was introduced, Li says she took patients' requests at face value and didn't question why they made the request. She now digs deeper.
"I will discuss transparently with the patient whether I think MAID is the right choice for them and help them understand my rationale and let them convince me that it is the right decision for them," she said.
Li says she'd also like the federal legislation on Track 2 patients to be clearer on whether indirect factors — like inability to access mental health care, poverty and lack of adequate housing — can compromise an individual's voluntariness in MAID cases.
Without that clarity, Li fears individuals who are marginalized will experience preventable deaths that shouldn't happen in medicine.
For his part, Bayliss acknowledges his privilege as a straight, white, middle-class man with an insurance plan that means he doesn't have to pay directly for medications.
"I still think that there are other treatments and medications that I'd like to try long before I consider that step," he said.
If you or someone you know is struggling, here's where to get help:
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Suicide Crisis Helpline: Call or text 988
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Kids Help Phone: 1-800-668-6868 (phone), live chat counselling on the website.
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Canadian Association for Suicide Prevention: Find a 24-hour crisis centre.
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This guide from the Centre for Addiction and Mental Health outlines how to talk about suicide with someone you're worried about.
Clarifications
- A previous version of the headline referred to the "stigma" of mental illness. It's been changed to "misunderstanding" to better reflect the subjects' points.Feb 01, 2024 12:19 PM ET
ABOUT THE AUTHOR
With files from CBC's Christine Birak