Thursday, Oct. 27
14:30 – 15:30 (1 hr)
Meeting Room: Birchwood Ballroom (Mezzanine)
Marie Gojmerac*, BSC, MD, MA, FRCPC; Suze Berkhout, MD, PhD, FRCPC; Joseph Rasimas, PhD, MD, FACPsych; Elyse Platt, MD, MA, BAH
Supported by the Section on History and Philosophy of Psychiatry

CanMEDS Roles:

1. Scholar
2. Health Advocate
3. Professional

At the end of this session, participants will be able to: 1) Appreciate the mismatch between criteria for decision-making capacity assessments and the relevant neuropsychology of choice mechanisms; 2) Know that medical assistance in dying (MAiD) can be understood as part of a “curative imagery,” which facilitates individualist values and obscures structural contributors; and 3) Understand how ideas around authenticity versus disease in psychiatry create unacknowledged divides around the rightness of MAiD.

Medical assistance in dying (MAiD) for people with the sole underlying conditions of mental illness will become legal in Canada in 2023. The psychiatric community, inclusive of the Canadian Psychiatric Association, is engaged with various political bodies to provide guidance and critique of this process; however, these discussions tend to focus on the legal and operative frameworks of MAiD provision. Many values at stake are noted, such as the existence of conscientious objectors, bias, stigma, and socioeconomic forces, but these value-laden complexities are eschewed in formal spaces in favour of protocols and assessment tools. This is because the psychiatric establishment considers values to be contextual or social and lacks the understanding that values play constitutive roles within such discussions. Ethics remains the only area of study that is targeted at answering questions of what ought to be done, but few medical trainees have extensive theoretical experience in this area. As a result, debates about MAiD are fraught discussions where the manifold effects of physician values are detrimentally ignored. A fuller analysis of the epistemic values at play in MAiD discussions would allow psychiatrists to truly speak to each other about what MAiD is and what should be done—in a strong ethical sense—and allow for formal advisements to address all issues at play in MAiD policy and legislation.

References:

1. Freeland A, Godkin D, Dembo J, et al. Medical assistance in dying (MAiD) for persons whose sole underlying medical condition is a mental disorder: challenges and considerations. Can J Psychiatry 2022;67(1):71–87.
2. Platt E. Depression and the desire to die—implications for medical assistance in dying. Journal of Ethics in Mental Health Open 2021;11:1–17.