Psychiatrists rebut misconceptions about MAiD for mental illness

11 December 2023

As the date approaches when MAiD for mental illness alone will become available, it seems that there is more public debate on the practice. These are much-needed conversations. All Canadians need to realize what is happening in our country and what is at stake, and to collectively decide what kind of country we want to live in.

A recent Globe & Mail editorial called for a halt to MAiD for mental illness. Many of the arguments in the Globe editorial are ones the EFC made in our latest submission to a parliamentary committee in November.

A group of psychiatrists involved with MAiD disagrees with this position. They were published in a journal article describing the arguments against MAiD for mental illness as “erroneous and misleading.”

In response, a group of Canadian psychiatrists has written about MAiD for mental illness, addressing the troubling inaccuracies in the journal article. This second group of psychiatrists tackles the misconceptions and misleading statements in the first journal article, and links to evidence and supporting studies.

In broad strokes, they point out that it’s not possible to predict which patients with mental illness will not improve, meaning MAiD for mental illness can’t fit within the parameters of the current MAiD law.

MAiD is for irremediable medical conditions, ones that can be predicted to not improve. Worldwide scientific evidence shows assessors cannot predict irremediability in cases of mental illness, meaning that this eligibility criterion cannot be met. Even precision modeling predictions show such predictions are wrong over half the time. 

They confirm that it’s not possible to distinguish between a desire for suicide and a desire for MAiD.

Evidence shows we cannot distinguish suicidal ideation caused by mental illness from motivations for MAiD for mental illness (indeed, overlapping characteristics suggest there may be no distinction to make).

Further, they point out the impact that MAiD for mental illness will have on a population that tends to be marginalized.

Those with mental illness have higher rates of psycho-social suffering. Combined, this could mean that MAiD assessors will be wrong over half the time when predicting irremediability, will wrongly believe they are filtering out suicidality, and will instead provide death to marginalized suicidal individuals who could have improved. That is the ultimate discrimination.

These psychiatrists also set the record straight on how Canada’s laws compare to other jurisdictions. Many jurisdictions that allow MAiD restrict it to an end-of-life context. For those that do allow MAiD for mental illness, they have safeguards that Canada does not have. They point out,

The few jurisdictions allowing MAiD for mental illness have safeguards Canada lacks, notably (unlike Canada) requirement of due care and no reasonable alternative, or treatment futility, prior to MAiD eligibility.

Rather than learning from other countries’ experiences, all of which have more safeguards than Canada, the authors manipulate these details and erase known dangers.

The psychiatrists noted that some of the authors of the problematic journal article were part of the 2022 federal Panel which, in their words,

refused to recommend any additional legislative safeguards, and refused to recommend any minimum number, types or lengths of treatment before providing assisted suicide for mental illness, despite Canada’s laws not requiring past access or attempts at treatment before MAiD. Their Panel claimed society had made an “ethical choice” to provide MAiD even if MAiD and suicide were not distinct entities.

They conclude:

Canadians have received faulty reassurances, but effective safeguards do not actually exist, and evidence does not support the planned 2024 expansion of MAiD to mental illness. The Globe and Mail editorial board is right – Canada should halt the planned expansion.

This journal article presents clear, evidence-based arguments from subject matter experts on why Canada should not proceed with MAiD for mental illness. We encourage you to read and share it with your friends and family, and send it to your local MP.