mental illness

Editorial Cartoon by Graeme MacKay, The Hamilton Spectator – Thursday February 8, 2024

Striking a Balance: Examining the Pros and Cons of Expanding MAID

Canada is on the verge of becoming a global leader in Medical Assistance in Dying (MAID), but recent concerns raised in the Toronto Star editorial prompt a closer look at the potential benefits and drawbacks. While MAID offers a dignified choice for those dealing with chronic diseases, the proposal to extend it to individuals with mental illness alone has sparked worry, leading Ottawa to consider delaying the decision until 2027.

Editorial: Why the surge in medically assisted deaths?

MAID has become a compassionate option for those facing the challenges of chronic illnesses, allowing them autonomy over their end-of-life decisions. However, the editorial rightly raises concerns about the significant increase in MAID cases in Canada and the lack of clarity on why this is happening. The statistics show a rapid adoption of MAID, with over 13,000 Canadians opting for it in 2022 alone, comprising four percent of all deaths in the country. This swift adoption is concerning, especially when compared to the Netherlands, which took 14 years to reach a similar milestone.

The editorial mentions reports indicating that economic and social factors may influence some individuals to choose MAID. If people are resorting to assisted death due to a lack of support systems, it raises questions about the effectiveness of our broader healthcare and social structures. The editorial also highlights that 17 percent of MAID recipients cited loneliness or isolation as a contributing factor, emphasizing the need to assess the availability and accessibility of social support services.

A notable concern is the potential conflation of MAID with a substitute for unavailable palliative care. Nearly 20 percent of recipients did not receive palliative care, and one in eight faced barriers in accessing it. This raises an ethical dilemma – is MAID becoming an unintended escape for those deprived of proper end-of-life care? The inadequate provision of palliative care for patients with brain illnesses and serious mental health issues further complicates this concern.

The editorial mentions the emerging field of palliative psychiatry, offering hope for improved end-of-life care for those with severe, persistent mental illnesses. However, the editorial highlights the novelty of this field, indicating a significant gap between the provision of palliative care for physical and mental disorders. This suggests that we may not be adequately prepared to extend MAID to those dealing with mental health challenges.

Lastly, the editorial cautions against a potential perfect storm if MAID is extended prematurely, intertwining mental illness, homelessness, and a lack of palliative healthcare. With homelessness disproportionately affecting individuals with mental health issues, the hurdles in accessing critical health services, including palliative care, could lead to an increase in MAID requests.

In conclusion, while MAID remains a valuable option for those facing unbearable suffering, the editorial urges caution in extending its scope. It calls for a thorough evaluation of the societal factors contributing to the surge in MAID cases, ensuring that the expansion aligns with principles of compassion, dignity, and a robust healthcare system. Striking a balance between supporting individual choices and guarding against unintended consequences within our healthcare framework is crucial as we navigate this delicate path. (AI)