Medical Assistance in Dying and Mental Health: A Legal, Ethical, and Clinical Analysis
Open accessAbstract
Medical assistance in dying (MAiD) legislation is now over a year old in Canada, and consideration is turning to whether MAiD should be extended to include serious mental illness as the sole qualifying condition for being eligible for MAiD. This article considers this question from ethical and clinical perspectives. It argues that extending the eligibility for MAiD to include those with a serious mental illness as the sole eligibility criterion is not ethical, necessary, or supported current psychiatric practice or opinion.
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Concerns have been expressed that expanding MAiD eligibility to potentially vulnerable people sends a problematic message, especially to those struggling to find meaning in their lives.
“concerns have been expressed about the message sent by the expansion of MAiD eligibility to potentially vulnerable people [23], who may be struggling to find meaning to their lives [24].”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [24]
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 [24]
MAiD-MD requests place a significant emotional burden on the healthcare professionals who receive and assess them, particularly if they are conscientious objectors or if these requests make them feel powerless to protect people with mental disorders.
“MAiD-MD requests place a significant emotional burden on the healthcare professionals who receive and assess them [24, 55], particularly if they are conscientious objectors [45] or if these requests make them feel powerless to protect people with mental disorders [41, 53].”
From Medical assistance in dying for people living with mental disorders: a qualitative thematic review (2023) · cites this paper as [24]
Outside this, mental illnesses are not terminal.
“Outside this, mental illnesses are not terminal (13).”
From Medical Assistance in Dying: Challenges for Psychiatry (2018) · cites this paper as [13]
Cites
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Four Reasons Why Assisted Dying Should Not Be Offered for Depression
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Should Mental Disorders Be a Basis for Physician-Assisted Death?
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Medical assistance in dying: special issues for patients with mental illness
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A National Survey of Canadian Psychiatrists’ Attitudes toward Medical Assistance in Death
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Nicolini, M. E., Kim, S. Y. H., Churchill, M. E., & Gastmans, C. (2020) · Psychological Medicine · doi:10.1017/s0033291720001543 · Cited by 77 · see citing works
Dembo, J., Schuklenk, U., & Reggler, J. (2018) · The Canadian Journal of Psychiatry · doi:10.1177/0706743718766055 · Cited by 60 · see citing works
van Veen, S. M. P., Ruissen, A. M., & Widdershoven, G. A. M. (2020) · The Canadian Journal of Psychiatry · doi:10.1177/0706743720923072 · Cited by 42 · see citing works
“Opponents of PAD of PPD argue that it is unethical for psychiatrists to admit hopelessness through participating in PAD.(12,28,38) This is expressed in the following quote by Simpson et al.”
BackgroundInfluentialDebating Euthanasia and Physician-Assisted Death in People with Psychiatric Disorders
Grassi, L., Folesani, F., Marella, M., Tiberto, E., Riba, M. B., Bortolotti, L., Toffanin, T., Palagini, L., Belvederi Murri, M., Biancosino, B., et al. (2022) · Current Psychiatry Reports · doi:10.1007/s11920-022-01339-y · Cited by 39 · see citing works
Irremediability in psychiatric euthanasia: examining the objective standard
Nicolini, M. E., Jardas, E., Zarate, C. A., Gastmans, C., & Kim, S. Y. H. (2023) · Psychological Medicine · doi:10.1017/s0033291722002951 · Cited by 31 · see citing works
“First, our findings show that the objective standard for irremediability will be difficult to meet, at least in the paradigm case of depression, because a clinician cannot accurately determine irremediability, as argued by many (Appelbaum, 2017; Blikshavn et al., 2017; Broome & de Cates, 2015; Cowley, 2013, 2015; Jans…”
Backgroundvan Veen, S. M. P., Ruissen, A. M., Beekman, A. T. F., Evans, N., & Widdershoven, G. A. M. (2022) · Canadian Medical Association Journal · doi:10.1503/cmaj.210929 · Cited by 25 · see citing works
Medical Assistance in Dying: Challenges for Psychiatry
Jones, R. M., & Simpson, A. I. F. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00678 · Cited by 18 · see citing works
Self-citationNicolini, M. E., Gastmans, C., & Kim, S. Y. H. (2019) · The American Journal of Bioethics · doi:10.1080/15265161.2019.1659606 · Cited by 10 · see citing works
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., et al. (2023) · Social Science & Medicine · doi:10.1016/j.socscimed.2023.116075 · Cited by 9 · see citing works
Self-citationBastidas-Bilbao, H., Stergiopoulos, V., Cappe, V., van Kesteren, M. R., Stewart, D. E., Gupta, M., Simpson, A. I. F., Dawthorne, M., Rajji, T. K., Castle, D., et al. (2023) · Qualitative Health Research · doi:10.1177/10497323231197365 · Cited by 7 · see citing works
Self-citationMedical assistance in dying for people living with mental disorders: a qualitative thematic review
Favron-Godbout, C., & Racine, E. (2023) · BMC Medical Ethics · doi:10.1186/s12910-023-00971-4 · Cited by 6 · see citing works
“It can also be challenging for family members to accept that their loved one intends to request or has requested MAiD-MD [24].”
BackgroundInfluential
- Authors
- Simpson, A. I. F.
- Affiliations
- Centre for Addiction and Mental Health (CA)
- Corresponding author
- Simpson, Alexander I. F.
- Venue
- The Canadian Journal of Psychiatry
- Publisher
- SAGE Publications
- Published
- 2017-12-07
- Volume
- 63
- Issue
- 2
- Pages
- 80-84
- ISSN
- 0706-7437 (ISSN-L)
- 1497-0015
- PMC
- PMC5788138
- OpenAlex
- W2771102057
- Semantic Scholar
- 692115a189021648d14cfb59e5d589758333db95
- Cited by
- 32
- References
- 10
- Citations by year
- 2026: 2 · 2024: 5 · 2023: 6 · 2022: 5 · 2021: 2 · 2020: 4 · 2019: 5 · 2018: 3
- FWCI
- 3.08
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The Canadian Journal of Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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 › Health Professions › General Health Professions › Health, Medicine and Society
- Keywords
- medical assistance in dying, severe mental illness, eligibility criteria, euthanasia, assisted suicide, psychiatric practice
- MeSH terms
- Mental Disorders, Humans, Suicide, Assisted, Persons with Psychiatric Disorders
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