The federal government committee looking at physician assisted dying released its long-awaited recommendations recently to much debate.\u00a0 The permissive approach it recommends reflects the spirit of the Supreme Court of Canada declaration that the prohibition of physician assisted dying violates the fundamental human right to make one\u2019s own decisions about one\u2019s bodily integrity and medical care.<\/p>\n
The Supreme Court also ruled, and the committee accepted, that Canadians should not face a cruel choice between intolerable suffering and a violent or dangerous self-inflicted death.<\/p>\n
But what concerns many is the committee recommendation that those enduring psychological suffering due to mental illness should also be eligible for medical aid in dying.<\/p>\n
Why the concern?\u00a0 Physician assisted dying is not a real \u2018choice\u2019 for those with mental illness if we don\u2019t first offer them adequate care and support.\u00a0 And the unfortunate reality is that, in Canada, mental health is vastly under-serviced.<\/p>\n
One of the consistent worries voiced throughout Canada\u2019s long national discussion of physician assisted dying is the desire to protect vulnerable people.\u00a0 One fear is that people with disabilities may be directly pressured or coerced into consenting to medical aid in dying.<\/p>\n
More insidiously though, vulnerable people may come to desire death due to a lack of any reasonable alternative to their suffering.\u00a0 For this reason, many have called for us to redouble our attention to providing access to high quality palliative care so that people are not driven toward medically assisted death by uncontrolled pain.<\/p>\n
With the committee inclusion of psychological suffering due to mental illness as a condition eligible for physician assisted dying, we must ask the same question about access to high quality mental health care and social support. \u00a0How can we offer one as a \u2018choice\u2019 without the other?<\/p>\n
Here, it is worth returning to the Supreme Court of Canada\u2019s declaration in another case that \u201cthe mentally ill have historically been the subjects of abuse, neglect and discrimination in our society.\u201d\u00a0 This neglect has resulted in \u201cyears of under funding of mental health,\u201d in the words of the Mental Health Commission of Canada.<\/p>\n
An article published earlier this month in JAMA<\/em> Psychiatry<\/em> reviewed 66 cases of medical aid in dying provided to people with psychiatric illnesses in the Netherlands between 2011 and 2014. \u00a0The review found that most of these cases were women (70 percent) with chronic severe conditions, and 56 percent were described as socially isolated or lonely.\u00a0 As Dr. Paul Appelbaum commented in an editorial accompanying the article, these results raise \u201cthe concern that physician-assisted death served as a substitute for effective psychosocial intervention and support.\u201d<\/p>\n The government committee report released last week recognizes this concern, recommending generally that the government support the Mental Health Commission of Canada\u2019s pan-Canadian mental health strategy.\u00a0 However, the primary attention appears to be how to ensure appropriate mental health services are available for people who are requesting medical assistance in dying.<\/p>\n Attention to mental health care and social supports must begin well before a person reaches this point.<\/p>\n Interestingly, the impact of people with mental illness being eligible for physician assisted dying may be to strengthen the argument that we should provide equal concern and resources in Canada for mental as for physical health.<\/p>\n There is currently a systematic stigma in how we organize services and funding for people with mental health problems. For example in 2007, the Wait Time Alliance and the Canadian Psychiatric Association proposed benchmark wait times for access to psychiatric services for people with serious mental illnesses.\u00a0 Yet according to their 2015 report, provinces have yet to even publish wait time data for psychiatric care.\u00a0 In the meantime we have worked hard and succeeded in reducing wait times for hip and knee replacement, cataract and bypass surgery, radiation therapy and diagnostic imaging.<\/p>\n Hopefully the availability of physician assisted dying for people with mental illness will stimulate efforts to make sure that accessible and effective treatments are available for them.\u00a0 Let\u2019s hope the committee recommendations will galvanize further innovation to improve medical and social support for some of the most vulnerable among us.<\/p>\n","protected":false},"excerpt":{"rendered":" The federal government committee looking at physician assisted dying released its long-awaited recommendations recently to much debate.\u00a0 The permissive approach it recommends reflects the spirit of the Supreme Court of Canada declaration that the prohibition of physician assisted dying violates the fundamental human right to make one\u2019s own decisions about one\u2019s bodily integrity and medical […]<\/p>\n","protected":false},"author":913,"featured_media":293294,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","ep_exclude_from_search":false,"footnotes":""},"categories":[],"tags":[],"article-status":[],"irpp-category":[],"section":[],"irpp-tag":[],"class_list":["post-293296","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"\n