In recent years, a small number of countries have authorized medically assisted dying in the form of active lethal injection or other interventions by a physician. In the United States, assisted dying still occurs only in the relatively passive form of “physician-assisted suicide,” in which a doctor prescribes a lethal dose of medication to be self-administered. The practice is legal in 10 states, and Washington, D.C., has supported a limited assisted dying program of this type.
However, the expansion of euthanasia that Canada is currently considering would go too far. The country already has one of the most permissive euthanasia systems in the world, with doctors administering lethal injections for patients with physical symptoms deemed intolerable, whether terminal or not. “Medical Assistance in Dying” (MAID) is permitted. And on March 17, unless there is a last-minute change in government policy, Canada will authorize MAID on request only for patients suffering from mental illnesses such as depression and schizophrenia.
Supporters frame this as an advance in patient autonomy and equal rights for the mentally ill. Indeed, it endangers the lives of vulnerable populations whose reality is by definition difficult to assess and whose symptoms and conditions are notoriously difficult for even experts to identify. Indeed, there may be some mentally ill patients who suffer from symptoms so debilitating and intractable that their options are uniformly dire. But it is at least extremely difficult, if not impossible, to design a system that reliably distinguishes them from other people with psychological distress who would benefit from treatment.
Indeed, the Canadian system is not up to the task. Her MAID regulations in this country are laxer than in Belgium and the Netherlands, where psychiatric euthanasia has been legal since 2002 and has raised serious concerns about the practice. Since Canada legalized euthanasia in 2016, approximately 44,958 Canadians have been granted permission to receive MAID for terminal or “serious and irreversible” medical conditions. Most of these incidents have occurred in the past three years, and are increasing by more than 30% each year. In 2022, authorities denied written requests for euthanasia in just 3.5% of cases. Last year, Quebec’s top end-of-life care regulator denounced widespread rule-breaking in the province. If a health care provider denies the request, there is nothing stopping Canadians from shopping around to find a health care provider who will say yes.
Mental suffering is certainly real, and for those suffering from it, it can be as subjectively intolerable as the pain of other types of illness. However, empowering the mentally ill to seek medical help to end their suffering by ending their lives itself is a fundamental part of psychiatry, which prevents rather than promotes suicide. This will reverse the goal. Many people who find themselves in emotional distress temporarily consider suicide the only way out, but later, in the depths of their suffering, they end up grateful that they did not commit suicide.
The official policy of the American Psychiatric Association is that psychiatrists “may not prescribe or administer any intervention to a non-terminally ill patient with the intent to cause death.” The two other English-speaking countries that allow assisted dying, Australia and New Zealand, exclude purely psychiatric cases. Many Canadian mental health professionals say it is particularly unwise to offer MAID to people with mental illnesses in a country where mental health systems struggle to provide treatment to everyone who needs it. claims. The Canadian Association for Suicide Prevention disagrees.
Last month, Canada’s Justice Minister Arif Virani said Prime Minister Justin Trudeau’s government had “options” to further delay implementation, pending a report on the issue from a parliamentary committee due Jan. 31. Ta. This was a welcome sign of rethinking. Belatedly.
There is no doubt that advocates in Canada seek to strengthen personal freedom and equality among people with physical and mental illness. Perhaps they have high confidence in the procedures they have developed to manage psychiatric euthanasia. They must remember that procedural protections are not perfect and building protections for psychiatric euthanasia is a major challenge. Good intentions tend to have unintended consequences. In the United States, Americans need to closely observe and learn from the experiences of their neighbors.