'teeny tiny' or thousands will die? psychiatrists divided over how many would get maid for mental illness
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thousands could choose to die by maid if euthanasia is opened to people experiencing mental suffering alone, or perhaps only a small handful, parliamentarians heard this week.
a special joint committee struck to revisit canada’s readiness for doctor-assisted death for those whose sole underlying condition is a mental disorder heard opposing prognoses from prominent psychiatrists tuesday, with one side warning any such expansion would be “inappropriate and dangerous,” while the other said those with severe mental illness can experience distress as profound as those with physical illnesses and shouldn’t be treated “like second-class citizens.”
experts were divided over several core issues, including whether it’s possible to predict with any degree of certainty whether someone will get better or not, and just how many people might seek, and ultimately be granted, maid for mental illness if it becomes lawful, as scheduled, in march 2027.
dr. claire gamache, of the quebec association of psychiatrists, said a “very, very small percentage” of people have mental disorders severe enough to qualify for maid such as schizophrenia, severe obsessive-compulsive disorder and recurring depression.
she described a case involving a 70-year-old woman who has lived with serious ocd since her teens and an “irrational fear of contaminating her family with feces.” she washes herself 15 times daily, has been hospitalized multiple times and has undergone multiple therapies including electroconvulsive therapy.
“one day she said she no longer wanted to see her grandchildren. she’s too afraid of contaminating them and she refused to come back to the hospital and she requested maid,” gamache said.
“maid will never be for someone in a temporary crisis, or someone who has lost their job,” gamache said. “that’s not the situation. there’s a certain dishonesty” to suggest so.
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gamache said that, in her 27 years of practice, two patients at most would qualify for maid. “it’s really a very minimal number of patients.”
“our organization believes that people with mental disorders should not be treated as second-class citizens, deprived of the right to the same health-care options as anyone else,” she said.
“i don’t know how many maid evaluations will take place exactly, but in my opinion, like my colleague, this kind of treatment, maid, would really be reserved for a teeny, tiny percentage of patients, really the most mentally ill patients,” psychiatrist dr. guillaume barbes-morin, who works in a small community in northwestern quebec, told the committee.
liberal mp james maloney said the numbers are irrelevant. “it makes no difference to me whether it’s a small percentage or a large percentage. the issue we have to deal with is getting it right.”
in a brief submitted to an earlier iteration of the special joint committee on maid, psychiatrist and bioethicist scott kim, a senior investigator with the u.s. national institutes of health, estimated that, based on dutch data, canada could see 2,500 to 5,000 annual requests for maid for mental illness, and an approval rate as high as 50 per cent.
“limited prognostic accuracy” means that at least half would have gotten better, said dr. harvey max chochinov, a distinguished professor of psychiatry at the university of manitoba.
“there is no neutral position,” he told the committee.
“if we wrongly tell patients that they will never get better and open the gate to ending their lives for them, many who walk through will have recovered.”
chochinov said he’s spoken with mental health providers who are frightened “that the minute those guardrails have lifted patients they’ve worked with for years or decades are simply going to choose maid.”
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alberta has moved to ban maid for all non-terminal conditions, including mental illness.
when asked whether sufficient safeguards are in place, a justice canada official said it’s the role of parliament to decide. some experts believe fervently enough safeguards exist. others aren’t convinced.
conservative mp tamara jansen raised concerns over “hundreds” of possible criminal code violations in assisted dying that have been flagged by the ontario coroner’s maid death review committee over the last five years, “no police involvement, no national tracking and no clear line of accountability.
“and now with some of the most complex, subjective and difficult-to-diagnose cases in all of medicine — mental illness — we are being told this same system will somehow suddenly function just fine?”
jansen is the author of a private members’ bill making its way through the house of commons that would permanently ban assisted suicide where the sole underlying medical condition is a mental illness.
before maid is further expanded, “we need to be honest about what’s already happening,” jansen said, pointing to the december death of 26-year-old kiano vafaeian, who struggled with vision loss from diabetes and depression. vafaeian died by euthanasia in a vancouver funeral home, despite being denied an assisted death multiple times in ontario, his home province. his death has raised concerns over people “doctor” or “jurisdiction” shopping for maid.
“he did not move to b.c. he flew to b.c.,” jansen said. “the more testimony we hear the more it seems clear that we’re not ready and likely never to be ready” to expand maid to mental illness, she said.
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