Medical professionals in Canada are divided over a new law that will allow patients suffering severe mental illness to seek medical aid in dying.
From March 2023, Canada will become one of the only countries in the world to allow those who are not in the end stages of a terminal illness to medical aid to end their lives.
Opinion is split over whether it’s possible to diagnose if patients suffering illnesses such as depression, schizophrenia and bipolar disorder face realistic prospects of recovery.
“In psychiatry, really all you have is the patient’s story, and what you see with your eyes and what you hear and what the family tells you,” Dutch psychiatrist Dr Sisco van Veen told The National Post.
Dr Van Veen is the lead author of a new study published by the Canadian Medical Association which lays bear the difficulty in determining whether a mentally ill patient offers any prospect of improvement.
The paper surveyed 11 psychiatrists in the Netherlands, where it’s been legal for citizens suffering “irredeemable” mental suffering to seek medical aid in dying since 2002.
It found that “making meaningful prognostic claims about psychiatric suffering is challenging or, some feared, impossible”.
Dr Grainne Neilson, a forensic psychiatrist and former president of the Canadian Psychiatric Association, told the National Post she thought there would be “lots of uncertainty” about how to apply the legislation from next March.
“My hope is that psychiatrists will move cautiously and carefully to make sure (medical aid in dying) is not being used as something instead of equitable access to good care.”
Canada began allowing those with a terminal illness to seek medical aid in dying in 2015 after a high court ruled adults suffering from a “grievous and irredeemable” medical condition were entitled to a quicker death.
The ruling paved the way for Canada to pass Bill C-14 in 2016 enshrining the practice in law.
Under the legislation, doctors must check the patient has mental capacity to make the decision and is not being coerced.
In 2019, a Quebec Superior Court declared that even those whose death was not “reasonably foreseeable” should be entitled to seek medical aid in dying (MAiD).
In March 2021, the Canadian parliament passed a law changing who was eligible to include those whose death wasn’t “reasonably forseeable”. It has a two year sunset clause.
Stefanie Green, President of the Canadian Association of MAiD Assessors and Providers, has been offering end of life options at her practice in British Columbia since 2016.
She told the Canadian Broadcasting Corporation that doctors needed to get better at talking to patients and their families about death.
In her new book, This is Assisted Dying: A Doctor’s Story of Empowering Patients at the End of Life, Dr Green writes about patients she helped with medical aid in dying.
She says family members can become upset at the decision, but it is ultimately up to the patient to decide.
“The majority of times people can come to a respectful resolution together, maybe not agreeing with each other, but agreeing to at least disagree,” Dr Green told the CBC.
“I will not be bullied into not doing my job and I will not allow my patients to be bullied.”
In the United States, 10 states and Washington DC have adopted aid-in dying laws for patients suffering terminal illness who have less than six months to live.
More than a dozen more states are considering passing legislation.
The deaths of Arizona sister Lila Ammouri, 54, and Susan Frazier, 49, at the Pegasos assisted dying clinic in Switzerland in February sparked a debate about the rights of physically healthy patients to choose to end their lives.
The issue is often fiercely contested between right to die organisations and opponents, who say the laws are open to exploitation of vulnerable citizens who may suffer from a disability.
US woman Krista Atkins died at the Pegasos clinic to Switzerland in 202 after suffering severe depression.
