A National Survey of Canadian Psychiatrists’ Attitudes toward Medical Assistance in Death

57% of the sample reported having patients who recovered from a mental illness who may have received physician-assisted death if it were available at the time.

“In addition, 46% of the sample endorsed the belief that no psychiatric illness is irremediable to the extent that physician-assisted death would be considered, and 57% of the sample reported having patients who recovered from a mental illness who may have received physician-assisted death if it were available at the time (results not shown in tables).”

Personal faith is associated with lower support for MAID for MI.

“Personal faith No, % ( n ) 40.5 (81) Yes, % ( n ) 24.8 (61) Odds ratio (95% CI) 0.49 (0.3-0.7)**”

• Also stated in: § Discussion · boosted

  “As expected and consistently reported in the literature, there was a correlation between personal faith and decreased support for MAID on the basis of mental illness.”

Psychiatrists who believed that legalisation of MAID on the basis of mental illness would change psychiatrists' response to suicidal ideation were more likely to support MAID for mental illness (OR 1.5; 95% CI 1.0 to 2.3).

“Psychiatrists who had the belief that legalisation of MAID on the basis of mental illness would change psychiatrists’ response to suicidal ideation were more likely to support MAID for mental illness (OR, 1.5; 95% CI, 1.0 to 2.3).”

Psychiatrists who believed that legalisation of MAID on the basis of mental illness would change psychiatrists' commitment to their patients through enduring suffering were less likely to support MAID for mental illness (OR 0.22; 95% CI 0.1 to 0.3).

“Psychiatrists who had the belief that legalisation of MAID on the basis of mental illness would change psychiatrists’ commitment to their patients through their enduring suffering were less likely to support MAID for mental illness, compared to those who did not have this belief (odds ratio [OR], 0.22; 95% confidence interval [CI], 0.1 to 0.3).”

Psychiatrists who had patients in the past who recovered from mental illness but think may have received MAID if it were available at the time were less likely to support MAID for mental illness (OR 0.23; 95% CI 0.1 to 0.4).

“Psychiatrists who have had patients in the past who recovered from mental illness but think may have received MAID if it were available at the time were less likely to support MAID for mental illness, compared to psychiatrists who did not have such patients (OR, 0.23; 95% CI, 0.1 to 0.4).”

Belief that suicide can be a rational choice is associated with support for MAID for mental illness.

“who had the belief that suicide could be a rational choice reported supporting for MAID for mental illness.”

• Also stated in: § Discussion · boosted

  “Not surprisingly, belief that suicide can be a rational act by a competent person was strongly correlated with support of MAID on the basis of mental illness.”

29.4% of respondents were supportive of MAID on the basis of mental illness.

“In our study, only 29.4% were supportive of MAID for mental illness.”

Support for MAID on the basis of mental illness is considerably less than support for MAID in general.

“Seventy-two percent of respondents were supportive of the legalisation of MAID under certain circumstances, but only 29.4% were supportive of MAID on the basis of mental illness.”

Only 29.4% of respondents supported MAID on the basis of mental illness.

“Table 3 shows that most respondents support legalisation of MAID under certain conditions as suggested in the Carter decision (71.8%) but only 29.4% support MAID on the basis of mental illness.”

Psychiatrists who reported having personal faith were less likely to support MAID for mental illness (OR 0.49; 95% CI 0.3 to 0.7).

“Psychiatrists who report having personal faith were less likely to support MAID for mental illness (OR, 0.49; 95% CI, 0.3 to 0.7).”

Belief that legalisation of MAID on the basis of MI would change psychiatrist response to persistent SI is associated with higher support for MAID for MI.

“Belief that legalisation of MAID on the basis of MI would change psychiatrist response to persistent SI No, % ( n ) 29.1 (85) Yes, % ( n ) 38.3 (59) Odds ratio (95% CI) 1.5 (1.0-2.3)*”

• Also stated in: § Discussion · plain

  “A related and unexpected finding was that respondents who reported believing that legalisation of MAID for mental illness would change their approach to persistent suicidal ideation were more likely to support it.”

Nearly all psychiatrists who had the belief that suicide could be a rational choice reported supporting MAID for mental illness.

“Nearly all psychiatrists who had the belief that suicide could be a rational choice reported supporting for MAID for mental illness.”

9.5% of respondents were undecided about MAID for mental illness.

“9.5% were undecided”

46% of the sample endorsed the belief that no psychiatric illness is irremediable to the extent that physician-assisted death would be considered.

“In addition, 46% of the sample endorsed the belief that no psychiatric illness is irremediable to the extent that physician-assisted death would be considered, and 57% of the sample reported having patients who recovered from a mental illness who may have received physician-assisted death if it were available at the time (results not shown in tables).”

61.2% of respondents were not supportive of MAID for mental illness.

“the 61.2% who were not supportive of MAID in our sample”

Having had patients in the past who recovered from MI but think may have received MAID if it were available at the time is associated with lower support for MAID for MI.

“Have had patients in the past who recovered from MI but think may have received MAID if it were available at the time No, % ( n ) 54.4 (74) Yes, % ( n ) 21.6 (60) Odds ratio (95% CI) 0.23 (0.1-0.4)**”

• Also stated in: § Discussion · hedged

  “reporting having had a patient in the past who would have received MAID were it available but went on to recover from their mental illness”

Belief that legalisation of MAID on the basis of MI would challenge psychiatrists' commitment to endure with their patients through their suffering is associated with lower support for MAID for MI.

“Belief that legalisation of MAID on the basis of MI would challenge psychiatrists’ commitment to endure with their patients through their suffering No, % ( n ) 53.4 (78) Yes, % ( n ) 19.8 (58) Odds ratio (95% CI) 0.22 (0.1-0.3)**”

• Also stated in: § Discussion · plain

  “Respondents who believed that legalising MAID for mental illness would challenge psychiatrists’ commitment to endure through their patients’ suffering were unlikely to show support for MAID for mental illness.”

Experience working with people with life-threatening conditions is not significantly related to support for MAID for mental illness.

“Experience working with people with life-threatening conditions and length of time in practice did not have a significant relationship with support for MAID for mental illness.”

72% of respondents were supportive of the legalisation of MAID under certain circumstances.

“Respondents to our survey showed substantial support (71.8%) for MAID under certain circumstances”

Half of respondents did not think any psychiatric illness could be considered 'irremediable' in the sense that MAID would be justifiable.

“Half of respondents did not think any psychiatric illness could be considered “irremediable” in the sense that MAID would be justifiable”

Length of time in practice is not significantly related to support for MAID for mental illness.

“Experience working with people with life-threatening conditions and length of time in practice did not have a significant relationship with support for MAID for mental illness.”

57% of respondents reported having treated patients who they believe would have received MAID were it legal for mental illness but instead went on to recover.

“57% reported having treated patients who they believe would have received MAID were it legal for mental illness but instead went on to recover.”

There was substantial variation among respondents in what might be considered 'irremediable'.

“Amongst our respondents, there was substantial variation in what was might be considered “irremediable.””

Most respondents supported legalisation of MAID under certain conditions as suggested in the Carter decision (71.8%).

“Table 3 shows that most respondents support legalisation of MAID under certain conditions as suggested in the Carter decision (71.8%) but only 29.4% support MAID on the basis of mental illness.”

An Alberta court of appeal decision predating Bill C-14 ruled that criteria laid out in the Carter decision do not exclude psychiatric illness.

“Notably, an Alberta court of appeal decision, which predates Bill C-14, ruled that criteria laid out in the Carter decision do not exclude psychiatric illness.”

• cites [5] 5. Canada (Attorney General) v E.F., 2016 ABCA 155 (CanLII) [Internet; cited 2017 Feb 7]. Available from: http://canlii.ca/t/grqkgNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The few studies considering physician-assisted death on the basis of mental illness have found significantly less support among physicians than in general.

“The few studies considering physician-assisted death on the basis of mental illness have found significantly less support among physicians than in general.8,10”

• cites [8] 8. Bolt EE, Snijdewind MC, Willems DL, et al. Can physicians conceive of performing euthanasia in case of psychiatric disease, dementia or being tired of living? J Med Ethics. 2015;41(8):592–598. [DOI] [PubMed] [Google Scholar] sourceNot checked yet

  Not checked in the free run.

• cites [10] 10. Ganzini L, Leong GB, Fenn DS, et al. Evaluation of competence to consent to assisted suicide: views of forensic psychiatrists. Am J Psychiatry. 2000;157(4):595–600. [DOI] [PubMed] [Google Scholar] sourceNot checked yet

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When chronically ill patients are followed over longer time periods and given a good standard of care, there is evidence of substantial rates of improvement in treatment-resistant depression.

“This is true of both treatment-resistant depression25 and borderline personality disorder,26”

• cites [25] 25. Fekadu A, Rane LJ, Wooderson SC, et al. Prediction of longer-term outcome of treatment-resistant depression in tertiary care. Br J Psychiatry. 2012;201(5):369–375. [DOI] [PubMed] [Google Scholar]Not checked yet

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Psychiatrists in general are more supportive of MAID than the general physician population in Canada.

“Respondents to our survey showed substantial support (71.8%) for MAID under certain circumstances, suggesting that psychiatrists in general are more supportive of MAID than the general physician population in Canada.”

• Also stated in: § Discussion · plain

  “who in the most recent survey done by the Canadian Medical Association were 44.8% in favour of legalising MAID.7”

• cites [7] 7. Rich P. Physician perspective on end-of-life issues fully aired [Internet]. Canadian Medical Association: 2014. [cited 2017 Feb 7]. Available from: https://www.cma.ca/En/Pages/Physician-perspective-on-end-of-life-issues-fully-aired.aspx [Google Scholar]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

The survey sample was representative of all CPA members.

“This demonstrates that our sample was representative of all CPA members.”

Due to small sample size, estimates for the relationship between the belief that suicide can be a rational choice and support for MAID for mental illness were unstable and could not be confidently reported.

“Due to small sample size, the estimates for the relationship between the belief that suicide can be a rational choice and support for MAID for mental illness were unstable and could not be confidently reported.”

Psychiatrists have significant reservations about MAID for the mentally ill.

“Our study suggests that psychiatrists have significant reservations about MAID for the mentally ill.”

The study failed to capture many psychiatrists, particularly in Quebec but also in Ontario, who are not members of the CPA.

“Another limitation is the failure to capture the many psychiatrists, particularly in Quebec but also in Ontario, who are not members of the CPA.”

When chronically ill patients are followed over longer time periods and given a good standard of care, there is evidence of substantial rates of improvement in borderline personality disorder.

“This is true of both treatment-resistant depression25 and borderline personality disorder,26”

• cites [26] 26. Biskin RS. The lifetime course of borderline personality disorder. Can J Psychiatry. 2015;60(7):303–308. [DOI] [PMC free article] [PubMed] [Google Scholar] Articles from Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie are provided here courtesy of SAGE PublicationsNot checked yet

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There are very similar demographics between the study sample and the general pool of CPA members.

“However, there are very similar demographics between the study sample and the general pool of CPA members”