CoChat
Sign Up
Cited by 12Ethics and bioethics in healthcarePalliative Care and End-of-Life IssuesPalliative and Oncologic Care

Making a case for the inclusion of refractory and severe mental illness as a sole criterion for Canadians requesting medical assistance in dying (MAiD): a review

Bahji, Anees, Delva, Nicholas·2022·Journal of Medical Ethics
DOI 10.1136/medethics-2020-107133
Open this paper in CoChat — free account

Abstract

Background: Following several landmark rulings and increasing public support for physician-assisted death, in 2016, Canada became one of a handful of countries legalising medical assistance in dying (MAiD) with Bill C-14. However, the revised Bill C-7 proposes the specific exclusion of MAiD where a mental disorder is the sole underlying medical condition (MAiD MD-SUMC). Aim: This review explores how some persons with serious and persistent mental illness (SPMI) could meet sensible and just criteria for MAiD under the Canadian legislative framework. Methods: We review the proposed Bill C-7 criteria (capacity, voluntariness, irremediability and suffering) as well as the nuances involved in separating a well-reasoned request for assisted suicide from what might be solely a manifestation of a SPMI. Findings: In this paper, we argue against the absolute exclusion of patients with SPMIs from accessing MAiD. Instead, we propose that in some circumstances, MAiD MD-SUMC may be justifiable while remaining the last resort. Conducting MAiD eligibility assessments removes the need to introduce diagnosis-specific language into MAiD legislation. Competent psychiatric patients who request MAiD should not be treated any differently from other eligible candidates. Many individuals with psychiatric disorders will be incapable of consenting to MAiD. The only ethical option is to assess eligibility for MAiD on an individual basis and include as legitimate candidates those who suffer solely from psychiatric illness who have the decisional capacity to consent to MAiD.

Integrity signals

Registry

Crossref · 10.1136/medethics-2020-107133

Cites

55 of 55 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The introduction of MAiD-MD into the continuum of care can affect the therapeutic relationship, which is closely correlated with patients' hope for improvement, a key facilitator of recovery.

    “The introduction of MAiD-MD into the continuum of care can affect the therapeutic relationship [17, 48, 59], which is closely correlated with patients’ hope for improvement [37], a key facilitator of recovery [23, 52].”

    From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [48]

  • People living with mental disorders are often not taken seriously unless they have physical symptoms or somatic manifestations.

    “People living with mental disorders are often not taken seriously [20, 48] unless they have physical symptoms or somatic manifestations.”

    From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [48]

  • Mental suffering can be difficult to understand and tends to be less recognized than suffering arising from physical illnesses.

    “Mental suffering can be difficult to understand [24, 48] and tends to be less recognized than the suffering arising from physical illnesses [15, 21, 39].”

    From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [48]

  • Healthcare professionals' involvement or support of MAiD-MD could affect patients' resilience and the therapeutic relationship and potentially influence the patient to lose hope that their situation will improve.

    “Healthcare professionals’ involvement or support of MAiD-MD could also affect the resilience of patients [60], the therapeutic relationship [26, 48, 60] and potentially influence the patient to lose hope that their situation will improve if they have the impression that the healthcare professional is abandoning the therapeutic project [23, 37].”

    From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [48]

  • In Canada, the planned extension of MAiD to mental disorders as the sole underlying condition has been repeatedly postponed, reflecting ongoing difficulties in defining clinically reliable and ethically acceptable criteria.

    “In Canada, the planned extension of Medical Assistance in Dying (MAiD) to mental disorders as the sole underlying condition has been repeatedly postponed, reflecting ongoing difficulties in defining clinically reliable and ethically acceptable criteria”

    From Forensic-psychiatric and medico-legal challenges in euthanasia and assisted suicide for patients with mental disorders: balancing autonomy, vulnerability, and professional responsibility (2026) · cites this paper as [10]

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Bahji, A., & Delva, N.
Affiliations
  • University of Calgary (CA)
  • Queen's University (CA)
Corresponding author
Bahji, Anees
ORCID
Bahji, Anees
Venue
Journal of Medical Ethics
Publisher
BMJ
Published
2021-04-13
Volume
48
Issue
11
Pages
929-934
ISSN
  • 0306-6800 (ISSN-L)
  • 1473-4257
DOI
10.1136/medethics-2020-107133
OpenAlex
W3152556357
Cited by
12
References
55
Citations by year
2026: 3 · 2025: 2 · 2024: 3 · 2023: 4
FWCI
0.36
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Medical Ethics (publishedVersion)
  • PubMed (publishedVersion)
Funders
2020 Friends of Matt Newell Endowment in Substance Use Research (N/A)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
  • 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
Keywords
medical assistance in dying, serious and persistent mental illness, physician-assisted death, Bill C-14, decision-making capacity, psychiatric patients, voluntariness
MeSH terms
Mental Disorders, Canada, Chronic Disease, Euthanasia, Humans, Medical Assistance, Suicide, Assisted

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review