Searching for relief from suffering: A patient-oriented qualitative study on medical assistance in dying for mental illness as the sole underlying medical condition
Open accessAbstract
Medical assistance in dying (MAiD) was introduced into Canadian legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is excluded from eligibility; this is expected to change in 2024. Incurability, intolerable suffering, capacity to make healthcare decisions, and suicidality have been publicly debated in connection with mental illness. Few studies have explored the views of persons with mental illness on the introduction and acceptability of MAiD MI-SUMC; this study aimed to fill this gap. Thirty adults, residing in Ontario, Canada, who self-identified as living with mental illness participated. A semi-structured interview including a persona-scenario exercise was designed to discuss participants' views on MAiD MI-SUMC and when it could be acceptable or not. Reflexive thematic analysis was used to inductively analyze data. Codes and themes were developed after extensive familiarization with the dataset. A lived-experience advisory group was engaged throughout the study. We identified six themes: The certainty of suffering; Is there a suffering threshold to be met? The uncertainty of mental illness; My own limits, values, and decisions; MAiD MI-SUMCas acceptable when therapeutic means, and othersupports, have been tried to alleviate long-term suffering; and Between relief and rejection. These themes underline how the participants' lived experience comprised negative impacts caused by long-term mental illness, stigma, and in some cases, socioeconomic factors. The need for therapeutic and non-therapeutic supports was highlighted, along with unresolved tensions about the links between mental illness, capacity, and suicidality. Although not all participants viewed MAiD MI-SUMC as acceptable for mental illness, they autonomously embraced limits, values, and decisions of their own along their search for relief. Identifying individual and contextual elements in each person's experience of illness and suffering is necessary to understand diverse perspectives on MAiD MI-SUMC.
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Patient-oriented qualitative work from Ontario, Canada documents frustration among individuals with severe mental disorders regarding inadequate access to effective treatment options, with some participants perceiving this inadequate access as contributing to their consideration for MAiD.
“Patient-oriented qualitative work from Ontario, Canada similarly documents frustration among individuals with severe mental disorders regarding inadequate access to effective treatment options, with some participants perceiving this inadequate access as contributing to their consideration for MAiD.30”
From Medical Assistance in Dying for the Sole Underlying Condition of Mental Disorder (MAiD MD-SUMC): an analysis and qualitative evidence synthesis (2026) · cites this paper as [30]
Patient and family interviews reveal that some individuals requesting MAiD for mental disorders describe long-standing, reflective decision-making rather than impulsive intent.
“Patient and family interviews reveal that some individuals requesting MAiD for mental disorders describe long-standing, reflective decision-making rather than impulsive intent”
From Medical Assistance in Dying for the Sole Underlying Condition of Mental Disorder (MAiD MD-SUMC): an analysis and qualitative evidence synthesis (2026) · cites this paper as [30]
Decisional capacity can coexist with mental disorders.
“suggesting that decisional capacity can coexist with mental disorders.30”
From Medical Assistance in Dying for the Sole Underlying Condition of Mental Disorder (MAiD MD-SUMC): an analysis and qualitative evidence synthesis (2026) · cites this paper as [30]
The semi-structured interview guide, based on a persona-scenario exercise, was developed using participatory approaches, including input from lived-experience advisors.
“The semi-structured interview guide [35], based on a persona-scenario exercise (PSE) [36] to facilitate participant engagement, was developed using participatory approaches, including input from our lived-experience advisors.”
Persons with mental illness and family participants were aligned in their views on MAiD MI-SUMC service delivery, with a variety of perspectives expressed within both groups in our study.
“Persons with mental illness and family participants were aligned in their views on MAiD MI-SUMC service delivery, with a variety of perspectives expressed within both groups in our study [35, 41, 42].”
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- Authors
- Bastidas-Bilbao, H., Stergiopoulos, V., van Kesteren, M. R., Stewart, D. E., Cappe, V., Gupta, M., Buchman, D. Z., Simpson, A. I. F., Castle, D., Campbell, B. H., & Hawke, L. D.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- University Health Network (CA)
- Centre Hospitalier de l’Université de Montréal (CA)
- Corresponding author
- Hawke, Lisa D.
- ORCID
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2023-08
- Volume
- 331
- Pages
- 116075
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W4383164129
- Cited by
- 9
- References
- 43
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 3
- FWCI
- 2.30
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Social Science & Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- medical assistance in dying, mental illness, eligibility criteria, patient perspectives, suffering, acceptability, stigma, suicidality, lived experience
- MeSH terms
- Adult, Mental Disorders, Canada, Humans, Medical Assistance, Ontario, Suicide, Assisted, Qualitative Research
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