By Marvin Ross with an addendum by Dr David Laing Dawson

And that is a really big but. Some are upset that the Canadian government has postponed allowing mental illness to be used for medically assisted suicide. It should have been cancelled outright but a pause for now is better than moving ahead with it.

The most vocal in opposition is the Dying with Dignity organization who argue that this move violates “section 7 of the Charter, protecting against deprivations of life, liberty, and security of the person, and section 15, guaranteeing the right to equal protection and equal benefit of the law without discrimination.”

I would argue that this is the case but not because a mentally ill person cannot be killed by the state but because it is so hard for the mentally ill to get help with their illnesses in the first place. The Fraser Institute recently revealed that there are inadequate resources for serious mental illness – too few medical staff, insufficient psychiatric beds, too few community resources and little supportive housing. Compared to other developed, wealthy and progressive countries, Canada is at the bottom. Unless changes are made, we will be down with third world countries.

Care for physical problems are far more developed than they are for mental illnesses. The adequacy of those services are beginning to decline but that fact is the subject of numerous commentaries in the media. We see very few complaints about the absence of services for the mentally ill (except those from frustrated families).

What was interesting is that the Minister of Health, in making the pause announcement, said that Canada’s health system is still “not ready” for the MAID expansion. But, when you get down to it, our health system is not ready to properly treat and support those with mental illnesses. Maybe we should get that right so there are fewer people who are so desperate that they want to end it all.

Quite often, when medical staff learn that someone has a mental illness, they ignore all else. The example that takes the cake in discrimination towards those with mental illness seeking medical help for non psychiatric problems occurred in suburban Toronto and the video made the rounds on the internet. Once the hospital staff learned the man had bipolar disorder, they falsely made the assumption that there was nothing physically wrong with him and turfed him from the ER.

He was there to complain about severe pains in his legs but no one believed him. The pain was so bad that he could barely walk and so was forced to literally crawl on his hands and knees out the door. His progress was coached by a nurse who stood by him and watched his slow agonizing crawl out the front door of the hospital. When he was finally able to get medical help, it turned out that he was suffering from Guillain-Barré Syndrome.

This is the video of him trying to leave the ER http://www.cbc.ca/player/play/1843879491556

Writing about this discriminatory problem for those with mental illnesses in the Globe and Mail, Thomas Ungar, psychiatrist-in-chief at St. Michael’s Hospital of Unity Health in Toronto and Louise Bradley former president and CEO of the Mental Health Commission of Canada stated that:

Too often, having a mental illness stamped in your file is like having it tattooed on your forehead. It biases medical professionals – who, after all, are only human – and overshadows valid and serious physical symptoms, allowing them to be dismissed as nothing more than a figment of your diagnosis.

The people at Dying with Dignity conclude their argument with “Depriving someone of their legal and constitutional rights is a serious matter and should be done rarely and for as short a period as possible.”

I completely agree but allowing the mentally ill to be killed off by the state via MAID is not allowing their constitutional right. What is their constitutional right is providing them with the medical and social services they need to have as good and satisfying a life as possible.

This compassionate death solution is not limited to the mentally ill but to many with disabilities and few resources. In an earlier blog, I quoted David Lepofsky, a disability advocate and Visiting Professor of Disability Rights at the Osgoode Hall Law School saying “We’ve now gone on to basically solving the deficiencies in our social safety net through this horrific backdoor, not that anybody meant it that way, but that’s what it’s turned into.” According to a report by Canadaland “In Canada right now, there are people choosing medically-assisted death, not because their illnesses are killing them or the pain is unbearable, but because they can’t afford the cost of managing that pain and getting the care they need to live with dignity.”

In an op ed in the Toronto Star, psychiatrist Dr Sanu Gaind, a vocal critic of MAID for the mentally ill, noted that “over one third of the 13,000 Canadians receiving MAID in 2022 cited feeling a burden as a source of suffering fueling their request, nearly one-in-five cited loneliness, and over half cited loss of dignity as their reason to seek MAID”.

He added “If we’re serious about addressing these issues, Canada has a chance to be a forerunner in the world by, instead of striving to be number one globally in assisted suicide, establishing the world’s first portfolio for a Minister for Living with Dignity.”

I fully support MAID for the original intent to help someone who is terminal and suffering leave this world with some dignity and will use it myself if I wind up in that condition. I’ve already used it for three dogs and a cat whose times had come and were suffering but it should not be used to get rid of people who could continue with proper care, treatment and a humane social safety net.

Psychiatrist Dr. Dawson (now retired) added this:

Excluding mental illness as a basis for applying for MAID may seem discriminatory, but there are some very valid reasons to exclude mental illness as a sole basis for MAID.

Those reasons lie within the realities of human behaviour as well as the absence of resources to adequately treat and support people with severe mental illness.

There may exist people who have been fully treated for mental illnesses, with good financial and social support, but who still suffer to a degree that makes MAID a rational choice. But there are two other common situations faced by mental health staff and people suffering from mental illnesses.

1. For a variety of reasons (poor compliance, lost between services, aged out of child and youth services, no psychiatrist or psychiatric service available, very poor living arrangements and no transportation available, the illness itself preventing seeking help, ineligibility for programs, anosognosia (denial of mental illness), co-morbid illnesses, addictions….) a person with a mental illness may seek MAID even though better treatment, better social and financial support could or should be available.

Case illustration: A young man had been living in isolation in his mother’s basement for some years, having been discharged from psychiatric services to the care of a family physician who continued his prescription for one medication for schizophrenia. In despair, at the time it was announced that it would soon be made available for mental illness, he asked his family physician for MAID. He was referred back to a psychiatry clinic for assessment for MAID. The new psychiatrist ignored his MAID request and talked him into trying a different medication. A couple of months later he applied for admission to the local college.

2. Some psychiatric patients suffer from disorders that cause them to feel as if they have no control, no negotiating power in relationships, without resorting to extreme threats and oppositional behaviours. They often refuse whatever treatments or programs are offered, yet remain agitated and suffering. They demand help but often sabotage whatever is offered them. Helping these patients is a difficult needle for doctors, counselors, therapists to thread at the best of times. If MAID becomes an option it will provide another matrix for distorted and harmful negotiations.

Case illustration: When it became news that MAID may be offered to people suffering from mental illness, a woman in her forties asked her family doctor to refer her to a psychiatrist for an assessment for the eligibility for medically assisted death. She had a job (which at times she said she liked, even using the word “loved”); she had a house, a car, and two adult children living within the province; she even talked of enjoying some rare time with a grandchild. Her physical health was okay though she tired easily; she did not appear to have friends or fulfilling activities. She had been treated for depression, anxiety, PTSD, and migraine headaches in the past. She had been divorced for some time, and had no intimate relationships or, apparently, friends. She asked the new psychiatrist if he would refer her for MAID. She claimed she hated her life, and was filled with hatred for people in general. Life, she felt, was unbearable. The psychiatrist, over several sessions, attempted to develop some rapport with her, seeking ways to help her apart from offering MAID. After about six months she (angrily) asked to be referred onto a psychiatrist who would seriously consider MAID for her, and she stopped coming for her appointments.