Canadian psychiatrists’ attitude toward medical assistance in dying for people with mental illnesses appears to have undergone a sea change over the past five years.
When Canada first legalized assisted dying in 2016, a survey of its members by the Canadian Psychiatric Association found 54 per cent supported excluding people suffering solely from mental illnesses.
Just 27 per cent were opposed, while another 19 per cent were unsure.
But in another survey of its members conducted last October, a plurality of respondents — 41 per cent — agreed that individuals suffering only from mental disorders should be considered eligible for medically assisted deaths.
Thirty-nine per cent disagreed, while 20 per cent were unsure.
The association released the latest survey results on Thursday, one day after royal assent was given to a revised bill expanding access to assisted dying to intolerably suffering people who are not near the natural end of their lives.
The Trudeau government had originally proposed a blanket ban on assisted dying for people suffering only from mental illnesses. But, under pressure from the Senate, the revised bill imposes a two-year time limit on that exclusion.
In the meantime, the government is now legally required to appoint an expert panel to study the issue and, within one year, to recommend the protocols and safeguards that should apply in such cases.
The association did not take a firm position on assisted dying for people with mental illnesses during debate on Bill C-7, even though it blasted the idea of a blanket ban as unconstitutional, discriminatory and stigmatizing.
In its latest survey, 89 per cent of respondents said psychiatric assessments should be required in cases where the sole underlying condition is a mental disorder.
Sixty-eight per cent agreed the reflection period between requesting and being assessed for an assisted death should be longer in such cases.
Eighty-seven per cent agreed that “collateral history” of patients in such cases should be obtained from others who know them, and 78 per cent said a formal oversight or review process should be established.
The association says just over 2,000 members received the survey and 474 of them (23 per cent) responded.
It also held virtual townhalls on the issue and asked for written comments.
In summarizing the verbal and written comments, the association says those who supported assisted dying for people suffering solely from mental illnesses felt “there should be fair and equal access to MAID as with any other service in health care and that having a mental disorder should neither be equated with a lack of competence nor disqualify someone from consideration.”
Those opposed argued that suicidality is “usually considered a symptom” of mental illness, that it’s difficult to ascertain whether an illness is “irremediable” and that allowing assisted dying would devalue the lives of people with mental illnesses.
The association says both sides expressed concerns about how to translate “legal terms such as ‘mental disorder,’ ‘grievous,’ ‘suffering’ and ‘irremediable’ into objective psychiatric or medical language.”
Similarly, both sides were concerned that the law specifies patients may refuse treatments unacceptable to them and questioned how a mental disorder “could objectively be deemed ‘irremediable’ when lack of access to treatment is an issue, particularly for people of low socio-economic status, those in rural or remote areas, or members of racialized communities.”
Some of those opposed went so far as to suggest that a patient must have tried all available treatments, including electroconvulsive therapy and psychosurgery before an assisted death could be contemplated.