Euthanasia requests in a Canadian psychiatric emergency room: A case series

MAiD-MD can generate issues of transference and countertransference, particularly given the enduring relationship that some patients have with their healthcare professional.

“MAiD-MD can generate issues of transference and countertransference, in particular given the enduring relationship that some patients have with their healthcare professional [2, 28, 53, 59, 60, 71, 76].”

In Canada, a series of psychiatric patients who applied for MAiD-NT were denied it although, based on their characteristics, they would have been eligible for MAiD-NT in other countries such as Belgium or the Netherlands.

“A series of cases of patients with psychiatric disorders who applied for MAiD-NT were denied it, although, based on their characteristics, would have been eligible for MAiD-NT in other countries (e.g. Belgium, Netherlands) [67, 68].”

For some disorders, such as borderline personality disorders, a physician intervening by MAiD-NT could encounter moral distress because the criteria might not consider the common fluctuating suicidal ideation and behavior, contemporary psychosocial rehabilitation treatment, and the individual's potential for a life worth living.

“For some disorders, such as borderline personality disorders, a physician intervening by MAiD-NT could encounter moral distress, since the criteria for the procedure might not take into consideration the common fluctuating suicidal ideation and behavior in these disorders, the contemporary forms of psychosocial rehabilitation treatment, and the individual’s potential for having a life worth living”

Adding a more rigorous assessment process for MAiD-MD requests, including various safeguards, could impose an additional burden on an already struggling healthcare system.

“In this context, adding a more rigorous assessment process for MAiD-MD requests, including various safeguards, could impose an additional burden on an already struggling system [28, 45].”

MAiD-MD may seem irreconcilable with the valuing of recovery-oriented approaches in mental health care, and some fear that its introduction into the continuum of care will cause a paradigm shift from improving quality of life towards assessing eligibility for MAiD-MD.

“MAiD-MD may seem irreconcilable with the valuing of recovery-oriented approaches in mental health care [65], and some fear that its introduction into the continuum of care will cause a paradigm shift from a goal of improving quality of life towards a goal of assessing eligibility for MAiD-MD [28].”

Transference and countertransference can lead healthcare professionals to facilitate access to MAiD-MD, or to respond to a MAiD-MD request with hostility, which could make a patient reluctant to share suicidal thoughts, push them to act on those thoughts, or lead them to change healthcare professionals, thus harming continuity of care.

“Transference and countertransference often come together and are usually unconscious, but they can lead healthcare professionals to facilitate access to MAiD-MD, or to respond to a MAiD-MD request with hostility, which could subsequently make a patient reluctant to share their suicidal thoughts, push them to act on those suicidal thoughts, or lead them to change healthcare professionals, thus harm”