Psychiatrists’ clinical expertise and input are vital to establish appropriate safeguards, evidence-based guidance and protocols for medical assistance in dying (MAiD) on the sole basis of a mental disorder, says a new Canadian Psychiatric Association (CPA) discussion paper released today.

People whose sole underlying medical condition is a mental disorder (MD-SUMC) are temporarily excluded from eligibility for MAiD under Bill C-7 until Mar. 17, 2023. The federal government has assembled and just announced an expert panel to examine the issue and to recommend safeguards by March 2022.

“Balancing the commitment of psychiatrists to provide treatment, care and hope for recovery with a person’s lived experience of suffering and right to enact personal choice in health-care decisions, including MAiD, is a fundamental challenge, particularly where natural death is not reasonably foreseeable,” said Dr. Grainne Neilson, CPA president and spokesperson.

In addition to providing an overview of eligibility for MAiD in Canada and the role of the psychiatrist, the CPA’s discussion paper focuses on irremediability and eligibility for MAiD, particularly where natural death is not reasonably foreseeable, informed consent and capacity to consent, and potential safeguards for MAiD for MD-SUMC.

With respect to safeguards, the CPA’s most recent member consultations in 2020 suggest that a majority of psychiatrists (78 per cent) agree or strongly agree that a formal oversight (review) process should be required for all requests on the basis of a mental disorder. Sixty-eight per cent of member respondents agreed or strongly agreed that the reflection period should also be longer for MD-SUMC requests, and 87 per cent agreed or strongly agreed that collateral history should be obtained from others who know the patient.

“Equitable access to clinical services for all patients is an essential safeguard to ensure that people do not request MAiD due to a lack of available treatments, supports or services. Poor access to care is particularly relevant for people of low-socioeconomic status, those in rural or remote areas, or members of racialized or marginalized communities,” said Dr. Neilson.