The dangers of opening up medical assistance in dying to cases of mental disorder
Photo: iStock “In the midst of National Suicide Prevention Week, the paradox of proposing and endorsing that people suffering from mental disorders can take their own lives is both startling and deplorable”, think the authors.
Debates surrounding Bill C-7 (amending the Criminal Code to allow greater access to physician-assisted dying ) resume this week. In the Senate committee, many voices question the merits of withdrawing protective measures for people at the end of their life (the ten days of reflection, consent to lethal injection) as well as the opening of the medical assistance in dying (AMM) for people with physical disabilities and suffering. On this point, the words of Mr. Gerard Quinn, Special Rapporteur on the rights of people with disabilities (United Nations Human Rights Council), and Mr. Jonathan Marchand (Council of Canadians with Disabilities and Coop ASSIST) deserve wide media coverage.
Over the past few weeks, we have also heard various voices calling on the legislature to also offer MAID in cases of mental disorder. The Association des médecins psychiatres du Québec (AMPQ) has also published a discussion paper to this effect last November. Since this text risks being invoked to claim that the community of psychiatrists in Quebec is largely in favor of this expansion and that the implementation of the practice would be done without problem or controversy, we believe it is important to speak up.
No solid conclusion
We recognize the efforts of the committee mandated by AMPQ to tackle a difficult subject as well as the quality of the document presented. Note however that this is only the opinion of this committee and that it should not be perceived as representing the opinion of the majority of psychiatrists in Quebec. It refers to a survey (unpublished) to which only 21% of psychiatrists responded. So we can't really draw a solid conclusion. We also note that this report was discussed during a forum organized by the Quebec Ministry of Health and Social Services on December 14, 2020. This meeting, of which a main conference was presented by a pro-euthanasia activist from Belgium, has unfortunately been biased in favor of extending MAID.
Contrary to what the prevailing discourse might suggest, promoting medical assistance in dying for patients with mental disorders turns out to be a very bad idea in our eyes as specialists working for the good of our patients. It is initially inappropriate, because the desire to die and the refusal of care are often an integral part of the disease and are reduced with the treatment of the mental disorder. It is also a dangerous idea, because the desire to die fluctuates, corrects itself, is evacuated; the prognosis is uncertain, never irremediable, even often favorable, and is declined over years and not over days or months.
In addition, this option:
ignores the ethical duty of the doctor to offer appropriate and proportional care by immediately resorting
to an ultimate solution based solely on the patient's desire;
shows that the majority of patients who take advantage of it suffer from common and highly treatable mental
disorders, contrary to what advocates for euthanasia;
contributes to the elimination of patients who could be a burden on families and care teams;
represents an inappropriate short-circuit in modern medicine without resorting to palliative care adapted to mental disorders.
In the midst of National Suicide Prevention Week, the paradox of proposing and endorsing that people with mental disorders can take their own lives is both gripping and deplorable. We present these facts as psychiatrists and not as official representatives of the organizations to which we are affiliated. Not that we believe that our organizations would not have supported our position, but because the short deadline did not allow us to consult the members of our respective organizations. We hope that our brief, now available on the website of the Canadian Senate, will help prevent both Quebec and Canada from embarking on an operation opposed to our collective choice to treat people suffering from mental disorders.As we do with physical disorders, let us eliminate mental suffering, not people.
Over the past few weeks, we have also heard various voices calling on the legislature to also offer MAID in cases of mental disorder. The Association des médecins psychiatres du Québec (AMPQ) has also published a discussion paper to this effect last November. Since this text risks being invoked to claim that the community of psychiatrists in Quebec is largely in favor of this expansion and that the implementation of the practice would be done without problem or controversy, we believe it is important to speak up.
No solid conclusion
We recognize the efforts of the committee mandated by AMPQ to tackle a difficult subject as well as the quality of the document presented. Note however that this is only the opinion of this committee and that it should not be perceived as representing the opinion of the majority of psychiatrists in Quebec. It refers to a survey (unpublished) to which only 21% of psychiatrists responded. So we can't really draw a solid conclusion. We also note that this report was discussed during a forum organized by the Quebec Ministry of Health and Social Services on December 14, 2020. This meeting, of which a main conference was presented by a pro-euthanasia activist from Belgium, has unfortunately been biased in favor of extending MAID.
Contrary to what the prevailing discourse might suggest, promoting medical assistance in dying for patients with mental disorders turns out to be a very bad idea in our eyes as specialists working for the good of our patients. It is initially inappropriate, because the desire to die and the refusal of care are often an integral part of the disease and are reduced with the treatment of the mental disorder. It is also a dangerous idea, because the desire to die fluctuates, corrects itself, is evacuated; the prognosis is uncertain, never irremediable, even often favorable, and is declined over years and not over days or months.
In addition, this option:
ignores the ethical duty of the doctor to offer appropriate and proportional care by immediately resorting
to an ultimate solution based solely on the patient's desire;
shows that the majority of patients who take advantage of it suffer from common and highly treatable mental
disorders, contrary to what advocates for euthanasia;
contributes to the elimination of patients who could be a burden on families and care teams;
represents an inappropriate short-circuit in modern medicine without resorting to palliative care adapted to mental disorders.
In the midst of National Suicide Prevention Week, the paradox of proposing and endorsing that people with mental disorders can take their own lives is both gripping and deplorable. We present these facts as psychiatrists and not as official representatives of the organizations to which we are affiliated. Not that we believe that our organizations would not have supported our position, but because the short deadline did not allow us to consult the members of our respective organizations. We hope that our brief, now available on the website of the Canadian Senate, will help prevent both Quebec and Canada from embarking on an operation opposed to our collective choice to treat people suffering from mental disorders.As we do with physical disorders, let us eliminate mental suffering, not people.
Le Devoir
Bertrand Major, Pierre R. Gagnon, Dr Joël Paris, François Rousseau et Jean-Marie Albert
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Bertrand Major, Pierre R. Gagnon, Dr Joël Paris, François Rousseau et Jean-Marie Albert
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