We don’t need to kill our most vulnerable. We need to help them.
On medical assistance in dying (MAID) for serious mental illness.
I think of death a lot lately. My grandmother lost her battle with cancer in late February 2024. She was the light of my life. I feel lost without her mischievous laughter and nurturing words. In my darkest moments, I wish I could follow her to the other side.
But it’s hard to kill a human. I know. I’ve tried to die by suicide at least half a dozen times. Each attempt happened when I wasn’t in treatment. I felt death was my only option for relief. Frequent suicidal behaviours are common in people with borderline personality disorder (BPD), a mental illness I live with. BPD was among mental illnesses meant to qualify for medical assistance in dying (MAID) until recent legislation delayed the law’s expansion until 2027.
I might have turned to MAID if it were available and I didn’t have therapy to help me through my grief. And that’s what scares me. I have adequate mental health support but nearly half of Canadians don’t feel the same. People with mental illness might be more likely to consider MAID if they can’t find the help they need. The government can delay MAID for people with mental illness for as long as it wants but until it invests equal efforts into making mental health treatment accessible for all Canadians the controversy and concerns around the law should persist.
Don’t get me wrong. I believe euthanasia should be available to people who are suffering, including people living with mental illness. To pick and choose which illnesses qualify as debilitating could result in discrimination against certain disabilities. And I’ve witnessed the genuine physical toll a suicide attempt can take on a person’s body, which can increase that individual’s distress. There should be a safe option for people with mental illness to die if treatment is not successful.
But MAID for mental illness might not be that safe option if it supersedes efforts to improve social determinants of health or offer meaningful treatment options. And there is already evidence that MAID is being utilized when the country’s social safety net fails to catch its most vulnerable.
In June 2019, concerns that 61-year-old Alan Nichols might be a danger to himself led to his hospitalization. Within a month, health authorities granted Nichols MAID for hearing loss and he died. The AP reported that his family and a nurse practitioner said hospital staff “improperly helped him request euthanasia.” Two years after Nichols’ death, three UN human rights experts flagged that MAID for mental illness appeared to violate the UN’s Universal Declaration of Human Rights and could “have a potentially discriminatory impact on persons with disabilities.” This is exactly what happened in February 2022, when a 51-year-old woman diagnosed with multiple chemical sensitivities (MCS) chose MAID after her search for affordable housing that wouldn’t trigger her condition failed. Six months later, a Veterans Affairs Canada employee offered MAID (unprompted) to a Canadian Forces veteran seeking help for post-traumatic stress disorder and a traumatic brain injury. The people in these cases deserved help. Not death.
Finding help for a mental illness can be really difficult. A 2017 Canadian Journal of Community Health estimates mental health care is underfunded by $3.1 billion. Last year, the Canadian Mental Health Association (CMHA) expressed concern that Budget 2023 didn’t include the Canada Mental Health Transfer, a $4.5 billion federal investment in mental health over five years promised by the Liberal party. Underfunding contributes to lengthy wait times for mental health services. According to the Canadian Institute for Health Information, half of Canadians waited at least a month to start publicly-funded mental health counselling in 2022 and 2023. One in ten people waited five months—but this finding relies on incomplete data. In some parts of Ontario, one of the provinces lacking available data, wait times for mental health services are up to two-and-a-half years. The longer a person waits for mental health services, the poorer their health outcomes are likely to be. It’s irresponsible to offer MAID for mental illness alongside a system that can’t provide adequate treatment to people who need it. MAID should be the last stop in a robust continuum of care. Not the first.
There’s still a lot we don’t know about mental illness. And it’s likely to stay that way. Canada sorely underfunds mental health research. The Inequities of Mental Health Research Funding report published in 2020 found that mental health in Canada receives less research funding than cancer, neurological diseases, or infectious diseases. Authors of a 2023 Canadian Journal of Psychiatry article worked out the numbers. Funding per year lived with a mental illness in Canada was $126. Cancer research funding was $2257 per year, $403 for neurological diseases, and $3,275 for infectious diseases. Limited investment into mental health research means we’re less likely to discover therapeutic or medical treatments that could make symptoms more bearable or enable recovery, which would decrease the need for MAID.
If the government of Canada wants to implement MAID with caution, it needs only to look to other countries that have rolled out similar programs. Take the Netherlands. The Netherlands health care system is accessible and its euthanasia practices are transparent and regulated. Requesting death for psychiatric suffering is a long process. It involves meeting criteria laid out by the country’s 2002 Euthanasia Act, which includes informing the person requesting physician-assisted death (PAD) of alternate treatment options. Physicians must ensure there is no prospect for recovery or symptom improvement and that the person’s request is voluntary. A second expert, typically a psychiatrist who specializes in the disorder the person suffers from, needs to sign off on the request. During the request phase, goals include ensuring the person’s relatives are aware of their plans to pursue PAD. Under this model, people like Nichols, the woman with MCS, and the Canadian Forces veteran likely wouldn’t qualify for MAID. But, more importantly, health insurance covers all or part of the costs of primary and secondary mental health care in the Netherlands. Many psychological services are outside the scope of what Canada’s provinces and territories cover. Netherlands already has the blueprint for physician-assisted death for mental illness. Canada can simply copy it. But it needs better mental health care first.
We don’t need to kill our most vulnerable. We need to help them.
Recommended Reading
Rough Magic: Living with Borderline Personality Disorder
My first book, Rough Magic: Living with Borderline Personality Disorder, hits bookstores on Tuesday, April 16. The essay collection examines what it’s like to live with BPD, one of the most stigmatized mental health diagnoses. Rough Magic is weird, quite nerdy, confessional, and sad, but hopeful (like its creator). The book is for sale at local bookstores and major retailers throughout North America.
If you want to learn more, The Globe and Mail will run an excerpt from Rough Magic on Saturday, April 13. I’ll also be chatting about the book next week on the following programs:
Your Morning (CTV) on Wednesday, April 17 at 8:40 a.m. EST
The Social (CTV) on Friday, April 19 at 2:00 p.m. EST
At Your Best (Global) on Sunday, April 21 at 10:15 p.m. EST
It is a slippery slope, and as noted in your article, you are already having trouble deciding who we should have access to being killed. The State should never have this "right" as there is a rather large subset in the power hungry bureaucracy as well as elected officials that will have no problem in spreading the solution to everyone's woes. And even more sadly they will begin deciding who should be forced to be euthanized instead of taking up "valuable" resources.
I fear the genie is out of the bottle and we may never get it back in, until the Nation State of Canada is euthanized at least, which is quickly becoming the best option.