Opinion: MAiD for mental illness? We can do better

The impending expansion of Canada’s assistance-in-dying law is fraught.

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In 2016, Parliament passed legislation that allows adults facing irremediable physical illness to request medical assistance in dying. This was later expanded to include unbearable suffering. Now it is set to expand again, on March 17, to allow people diagnosed with mental illness to seek MAiD.

The issues surrounding MAiD are complex, and even more so in regards to mental illness. Assessing the wish of an individual with mental illness to terminate their life must be taken within a broad context, and it is this context that must be addressed carefully if, and before, MAiD becomes available for mental illness in Canada.

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Take, for example, a context in which a well-informed, 82-year-old who is at the end of a long life and who has been suffering irremediable mental illness for 40 years begs to end their suffering in a dignified way. Applying MAiD may be a reasonable response.

However, when a 35-year-old who should have many years ahead of them is suffering from persistent mental illness and expresses their wish for MAiD, do they really want to die? Would it be reasonable to ask whether it is that they don’t want to live the way they do? What might be lacking in their life that, if changed, could prevent them from seeking MAiD? Are we willing and/or able to address these challenges?

Historically, mental illness has not been a priority for care and for research funding. Relying mainly on pharmacare for the past several decades, even when other evidence-based treatments are available, suggests that the current, mainstream approach is limited. Medications can offer a partial (often ineffective) response, but they serve mainly to manage symptoms, not to treat root causes.

There is a growing awareness that mental illness is not “a thing,” but rather a process affected by myriad factors and circumstances. In his book The Myth of Normal, Dr. Gabor Maté says that with its predominantly biological approach, psychiatry commits the same errors as other medical specialties: “It takes complex processes intricately bound with life experience and emotional development, slaps the ‘disease’ label on them, and calls it a day.”

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Moreover, he says, “the gospel of genetic causation shields us from having to confront our hurts, leaving us all the more at their mercy.”

Delving into the possible underpinnings of mental illness and the adversarial circumstances that trigger it, and developing programs that properly address it, is a difficult and expensive undertaking with which society does not seem to be ready to engage. The result is that people diagnosed with mental illnesses are often subjected to outdated practices that are increasingly proving insufficient, and sometimes plain harmful.

In addition to the failings of psychiatric care, there are other factors that affect one’s life, which in certain circumstances could lead a person to seek MAiD. It is generally agreed that connections, relationships and a sense of belonging are critical for well-being. The challenges faced by people with serious mental illnesses are often compounded by poverty, isolation, loneliness and stigma (both societal and internalized). No wonder it is hard to sustain a sense of meaning under such circumstances.

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Mental health care best practices should address the inadequacy of psychiatric care and the social determinants that critically impact well-being. Instead of supporting “good death” we should support good life! Arguing that not allowing people with mental illness to seek MAiD would be discriminatory can in fact be viewed as society’s abandonment of its responsibility to create proper living conditions for people with mental illness, which is in itself discriminatory.

The onus is on us to make sure people don’t wish to end their lives because of their living conditions. This is a moral and ethical obligation we have not exercised responsibly. Legislating MAiD for mental illness may put us on a slippery slope that could reinforce our failings.

Ella Amir is executive director of AMI-Quebec, a Montreal-based community organization that helps families manage the effects of mental illness.

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