Date of publication: 4 Apr 2022 • 23 minutes ago • 14 minutes reading • Join the discussion In March 2023, Canada will become one of the few nations in the world to provide medical assistance in death, or MAID, for people whose only Underlying condition is depression, bipolar disorder, personality disorders, schizophrenia, PTSD or any other mental illness. Photo by Getty Images
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Most people who seek medical help to die are already dying of cancer.
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With end cancer, “there is something inside the body that can be seen,” says Dutch psychiatrist Dr. Cisco van Veen, tumors and tissues that can be measured, scanned, or punctured to identify cells and help guide prognosis. You can not see depression in a scan. With the exception of dementia, where imaging can show structural changes in the brain, “in psychiatry, all you have is the patient’s history and what you see with your own eyes, what you hear and what your family tells you,” says van. Veen. Most mental disorders lack “predictability”, which makes it difficult to determine when psychiatric distress has become “irreversible”, virtually incurable. Some say practically impossible. That’s why van Veen says the difficult debate is ahead, as Canada approaches the legalization of physician deaths for people with mental illness whose psychological pain has become unbearable.
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One year from now, in March 2023, Canada will become one of the few nations in the world to provide medical assistance in death, or MAID, for people whose only underlying condition is depression, bipolar disorder, personality disorders, schizophrenia, PTSD or any other mental illness. In the Netherlands, the MAID for irreversible psychiatric pain has been regulated by law since 2002, and a new study by van Veen and colleagues highlights how complex it can be. How do you define “sad and irreparable” in psychiatry? Is it possible to conclude, with certainty or certainty, that a mental illness has no prospect of ever improving? What has been done, what has been tried and is it enough?
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“I believe there will be a lot of uncertainty about how to implement this in March 2023,” she said. Grainne Neilson, former President of the Canadian Psychiatric Association and Halifax Medical Examiner. “I hope psychiatrists will move carefully and cautiously to make sure that MAID is not used as a substitute for fair access to good care.”
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In the field of mental health, opinions are deeply divided. Mental illness is never irreversible, says one side. There is always hope for a cure, always something more to be tried, and a person’s ability to think logically, to seek an assisted death when he can have a life expectancy of decades, can not be obscured by the fact that he is struggling psychologically.
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In psychiatry, really all you have is the patient’s history and what you see with your own eyes and what you hear and what your family tells you Others argue that despite the benevolent days of “Bell Let’s Talk”, there is still a profound lack of understanding and fear of mental illness and that resistance reflects a long history of paternalism and a reluctance to accept that suffering that can come from mental illness can to be as torturous as suffering from physical pain.
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Sometime in April, a group of experts knocked out by the Liberal government to propose recommended MAID protocols for mental illness will present its report to the government. A joint parliamentary committee studying the new MAID bill has been instructed to submit a report by 23 June. The chair of the panel of experts declined an interview request, but the 12-member assembly undertook to set out proposed parameters for how people with mental illness should be assessed and – if deemed eligible – given MAID, not if they should be eligible. Those familiar with the literature say that the panel probably looked at a number of hard and difficult questions: Should a person seeking death with the help of a doctor have tried all possible evidence-based therapies? All sensible treatments? At least some? How long should the “reflection” period be, the time between the first assessment and the death grant? If MAID cases of mental illness require the approval of a supervisory committee or court, how abortions in this country once had to be considered medically necessary by a three-doctor “medical abortion committee” before abortion was decriminalized before more than three decades?
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The idea that mental illness can make someone eligible for assisted death approved by the state has long been banned in the euthanasia debate in Canada and the journey from there to here has been complicated. The Supreme Court of Canada ruled in 2015 that a total ban on physician-assisted death violated the Charter, that competent adults suffering from a “serious and irreparable” medical condition causing unbearable physical or psychological distress had a constitutional right to . This decision was the impetus for Canada’s MAID Bill Bill C-14, which allowed assisted death in cases where natural death was “reasonably foreseeable.” In 2019, a Quebec Supreme Court judge ruled that the reasonably foreseeable restriction of death was unconstitutional and that people who suffered unbearably but did not die were still constitutionally entitled to be eligible for euthanasia.
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In March 2021, Law C-7 was passed, making changes to the eligibility criteria. The criterion of “reasonably predictable” is gone and, from March 17, 2023, when the two-year clause expires, MAID will be extended to able-bodied adults whose only underlying condition is a mental illness. Already, the removal of impending death has made MAID requests much more complicated, providers say. These are known as “Track Two” requests. At least 90 days must elapse between the first evaluation and the administration of MAID. Most include chronic, relentless physical pain – nerve entrapment, significant muscle spasms, neuropathic pain, chronic headaches. Ottawa MAID providers have received about 80 Track Two requests in the past year. “I think we only had two actions,” said Dr. Viren Nike, MAID Medical Director for the greater Ottawa area. Of The Ottawa Hospital’s 30 providers, only four are willing to see Track Two patients, and Naik says he is likely to miss two more. Many people clash when people are not close to death. “Making sure they do not ask for MAID because they are vulnerable in any way was also a challenge. “If I take this to my mental health, I think these issues will get worse.”
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The expert group has been instructed to propose safeguards. For Dr. Sonu Gaind, a former president of the Canadian Psychiatric Association, the most fundamental safeguard has already been circumvented because there is no scientific evidence, he says, that doctors can predict when a mental illness will be irreversible. Everything else comes out of the window. Gaind is not a conscientious objector to MAID. He is the medical chair of the MAID team at Humber River Hospital in Toronto, where he is the head of psychiatry. Works with cancer patients. He has seen the positive, the value that MAID can bring. But unlike cancer or progressive, neurodegenerative diseases like ALS, “we do not understand the fundamental underlying biology that causes most major mental illnesses.”
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“We recognize them by grouping different symptoms. We try to target the treatments as best we can. “But the reality is that we do not understand what is happening, at a fundamental biological level, as opposed to the vast majority of these other predictable conditions.” Without understanding the biological backgrounds, on what do you base your predictions, he asks. Without understanding the biological basis, on what do you base your predictions, he asks? He has heard the argument that it is difficult to make solid predictions about anything in medicine. But there is a big difference between the degree of uncertainty between advanced cancers and mental illnesses such as depression, he argues. “There is no doubt that mental illness leads to painful suffering, as painful, even more painful in some cases than others …
