As Canada prepares to lift the exclusion that prevents people whose only claimed medical condition is a mental disorder from accessing the option of medical aid in dying, the issue remains a complex, divisive and sensitive one. Recent work by the team at the IRCM’s Pragmatic Health Ethics Unit, led by Dr. Eric Racine, has addressed the crucial issue of ethical, clinical and scientific concerns related to medical aid in dying for people living with a mental disorder. In an extensive literature review led by Caroline Favron-Godbout, a doctoral candidate in bioethics at the Université de Montréal's School of Public Health, the team sought to understand the nature of these concerns, as well as proposed solutions to address them.
The project
This literature review is part of a research project involving people living with mental disorders, their loved ones, healthcare professionals and other key players in the co-construction of an accompanying guide addressing some of the major concerns surrounding medical aid in dying in mental health.
A wide variety of concerns
These many and varied concerns about access to medical aid in dying in this context have been divided into five categories, according to as many contexts:
1) In society, 2) In the healthcare system, 3) Across the continuum of care, 4) In discussions about medical aid in dying, 5) In medical aid in dying practices. For example, societal concerns include the stigma experienced on a daily basis by people living with mental disorders, as well as the societal responsibility to help these people live with their condition as a priority over helping them to die. In the context of discussions on medical aid in dying, it is reported that people living with mental disorders may not be taken seriously if they request medical aid in dying, and that it can be difficult for healthcare professionals to receive and welcome requests for medical aid in dying, particularly if this practice is not in line with their values.
Solutions discussed and documented include improving access to mental health care and services, providing social support for people living with mental disorders, and setting up processes to help people get better while their request for medical assistance in dying is being assessed.
Conclusions
Concerns about medical aid in dying practices are the most frequently reported, for example in relation to the assessment of requests, the quality of assessment processes, and the impact on the people concerned. However, some of these concerns could be alleviated or dispelled through additional information and dialogue.
Acknowledgements
This work was made possible thanks to the Fonds de recherche du Québec - Santé, the Réseau québécois sur le suicide les troubles de l'humeur et les troubles associés, the team at the Unité de recherche en éthique pragmatique de la santé and the collaborators consulted for this review: Catherine Perron, Jocelyne Saint-Arnaud, Simon Courtemanche, Luc Vigneault and Julie Lafond.
