Just over 40 per cent of member respondents agreed or strongly agreed that persons whose sole underlying medical condition is a mental disorder should be considered for eligibility for medical assistance in dying (MAiD), says results from the most recent Canadian Psychiatric Association (CPA) survey.

In comparison, 27 per cent of respondents to the CPA’s 2016 survey did not support the exclusion of mental illness as a sole indication for MAiD.

“While there appears to have been a shift in psychiatrists’ perspectives on access to MAiD solely for mental disorders, it is important when interpreting these data to keep in mind that the 2020 and the 2016 survey questions were not identical,” said Dr. Grainne Neilson, CPA president and spokesperson.

The October 2020 survey was part of CPA’s latest member consultation, which also included two town halls and a call for written comments. This consultation was bolstered by feedback from members of the provincial psychiatric associations, as well as the subspecialty academies of child and adolescent, geriatric, forensic, and consultation-liaison psychiatry. The survey was available for completion in English or in French, and the response rate was 23 per cent. (The 2016 member survey garnered a 13 per cent response rate.)

The problem of translating legal terms such as “mental disorder,” “grievous,” “suffering” and “irremediable” into objective psychiatric or medical language was a common issue noted by respondents who support access to MAiD for mental illness alone as well as by those who oppose it.

Similarly, respondents were concerned about MAiD legislative criteria that allow patients to refuse evidence-based treatments such as medications and how any 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.

Among respondents who do not support MAiD for mental illness alone, some felt that providing the option will further devalue and stigmatize people by sending the implicit message that certain lives are not worth living. Respondents who support access to MAiD solely on the basis of a mental illness expressed a belief that having a mental disorder should neither be equated with a lack of competence nor unilaterally disqualify someone from consideration, and it is stigmatizing to suggest otherwise.

“MAiD is a complex issue that has many moral, legal, ethical, clinical and practical aspects; it is an evolving landscape in Canadian medicine. The CPA is not surprised at the vigorous and constructive debate that has arisen within the Canadian psychiatric community. We look forward to further contributing to that debate with a forthcoming discussion paper,” said Dr. Neilson.