The Montréal Clinical Research Institute (IRCM) applauds the work of its Pragmatic Health Ethics Research Unit in creating a new directory of international resources which brings much-needed clarity to the complex and sensitive issue of medical assistance in dying when a mental disorder is the sole underlying medical condition (MAiD-MD). This marks the first structured effort to compile, categorize, and analyze relevant international resources on this challenging topic.
Understanding the Landscape to Fill the Gaps: A Global MAiD-MD Resource Overview
Developed as part of a participatory action-research project in bioethics, this literature review identifies and organizes existing resources into six major categories: 1) legal frameworks; 2) resources for healthcare professionals; 3) resource compilations; 4) training, discussion, and experience-sharing resources; 5) resources for patients, families, and the general public; 6) resources to support reflection and practice development
The goal: to make existing resources more visible and accessible, identify unmet needs, and guide the development of new tools and support resources for stakeholders directly or indirectly affected by MAiD-MD.
Key Findings: Diversity, Fragmentation, and Clear Needs
The review highlights several important conclusions:
- There is a wide range of resources available internationally, but many remain scattered, little-known, or hard to access, sometimes held by professional organizations and not available to the general public.
- The resources touch on 20 major thematic areas, but coverage is uneven: some topics are frequently mentioned yet underexplored, while other highly relevant themes are seldom addressed.
- Despite the existence of many information resources, there is a significant lack of concrete support resources to help stakeholders navigate the emotionally and ethically challenging situations related to MAiD-MD.
- There is a clear need to structure, centralize, and improve access to current and future resources, to better meet the practical and emotional needs in the field.
Informing the Path Forward
The findings from this literature review directly informed the development of a new ethical support tool — a reflection and discussion guide — co-developed as part of a broader participatory action research project. The guide is designed to help stakeholders reflect on and navigate ethically complex situations, while also highlighting relevant resources that address needs expressed by stakeholders throughout the project.
Acknowledgments
This work was made possible thanks to the support and collaboration of many partners and contributors: the Fonds de recherche du Québec (researcher and doctoral funding); the Quebec Network on Suicide, Mood Disorders and Related Conditions; international key informants who supported the identification of resources: Mona Gupta (Canada), Angela Castelli (Switzerland), Rosalie Pronk (Netherlands), Nicole Gallus (Belgium); as well as members of the working group supporting this project: Simon Courtemanche, Luc Vigneault, Catherine Perron, and Jocelyne Saint-Arnaud for their contribution to the search strategy.
