Friday, Oct. 28
10:45 – 11:45 (1 hr)
Meeting Room: Willow (Mezzanine)
Alison Freeland*, MD, FRCPC, FCPA; Justine Dembo, MD, FRCPC; Grainne E Neilson, MD, MRCPsych, FRCPC, LLM; Tyler Black, MD, FRCPC; Dianne Godkin, PhD

CanMEDS Roles:

1. Medical Expert
2. Health Advocate
3. Communicator

At the end of this session, participants will be able to: 1) Describe recent legislative changes in Canada regarding access to medical assistance in dying (MAiD); 2) Appreciate some of the complexity regarding assessment for MAiD for those with a mental disorder as the sole underlying medical condition (MD-SUMC); and 3) Consider the role of psychiatrists in assessing patients with mental illness who are considering MAiD.

Medical assistance in dying (MAID) is a complex legal, clinical and ethical issue that has garnered diverse commentary and opinion from Canadian psychiatrists. Canada’s current MAID legislation, Bill C-7, temporarily excludes people whose sole underlying medical condition is a mental disorder (MD-SUMC) from being eligible for consideration for MAID until Mar. 17, 2023.

There are profound differences of opinion as to whether MAID should be permitted on the sole basis of a mental disorder, and if so, what safeguards should be invoked. Some are of the view that additional criteria for this circumstance is discriminatory, while others believe that the nature of mental illness justifies the need for added protections. Some argue for denying eligibility until more research is done. Specific areas of contention include irremediability, capacity and assessment of suicidality when requesting MAID. Assessment of decision-making capacity is essential, and can be challenging in any branch of MAID, whether mental illness is comorbid with a physical illness or is the sole underlying reason for the request. There is no broad consensus on the prediction of irremediability in each individual patient’s case, and prediction of irremediability is challenging given factors such as complexity of diagnosis, therapeutic alliance, access to appropriate treatment, hope, treatment refusal and possibility of spontaneous remission.

Participants will hear from four panel members with expertise in these three challenging areas as they relate to MAID for people whose sole underlying medical condition is a mental disorder. Following each presentation, participants will have an opportunity to ask questions. 

References:

1. Freeland A, Godkin D, Dembo J. Medical assistance in dying (MAiD) for persons whose sole underlying medical condition is a mental disorder: Challenges and considerations. CPA discussion paper. 2021. Available from: https://www.cpa-apc.org/wp-content/uploads/2021-CPA-Discussion-Paper-MAID-Challenges-and-Considerations-EN-web-Final.pdf.
2. van Veen SMP, Ruissen AM, Widdershoven GAM. Irremediable psychiatric suffering in the context of physician-assisted death: A scoping review of arguments. Can J Psychiatry. 2020;65(9):593–603.