This past year I cared for a young woman in her early 20s. Carole (pseudonym) has extreme anxiety and depression which has been going on for years. Carole is a community worker who works with the homeless. During the COVID pandemic her symptoms were exacerbated to the point that she has become anorexic. Unfortunately access to dieticians, psychiatrists and psychologists has been extremely difficult and limited. By seeing her on a regular basis and making myself readily available, I have kept her from giving up hope. Because of her long term psychological suffering, the recent law of Medical Assistance in Dying [MAID] could make Carole a candidate for euthanasia.
The Canadian Parliament passed Bill C-7 in February, 2021 adding mental illness as a criterion for MAID [coming into effect in 2023].
Accordingly, those who only have mental health problems and no physical ailments with years to live could be euthanized.
I recently participated at Quebec’s Parliamentary hearings with Montreal attorney Me Natalia Manole. http://m.assnat.qc.ca/fr/video-audio/archives-parlementaires/travaux-commissions/AudioVideo-90901.html] Mental illness includes the following disorders: anxiety, depression, bipolarity, obsession-compulsion, psychosis, substance abuse, anorexia, and Asperger’s syndrome spectrum.
The causes of these mental disorders include: stress, substance abuse, low self-esteem, difficulty in adapting, personal loss, abuse, homelessness, isolation, job loss, and low income. Treatment of mental illness includes social supports, psychotherapies and psychiatric medications. A 2017 Canadian Psychiatric Association study indicates that only 29% of Canadian psychiatrists support MAID in cases of mental illness.
Even in the Netherlands, where euthanasia is practiced on the mentally ill, two-thirds of psychiatrists are opposed to it. In addition, studies show that at least 90% of people who have ended their lives by suicide were affected by mental health problems. Needless to add, most people who have attempted or committed suicide do not necessarily want to die; rather, they want to escape from their overwhelming emotional pain.
In order to be euthanized, you must give a “free and clear” consent. But how can a mentally ill person give a free and clear consent when the desire to die is a symptom of mental illness? Even for basic contracts such as buying a car or renting an apartment, the contract can be cancelled because of the absence of free and clear consent of a mentally ill person.
According to a study from Harvard School of Public Health, 9 out of 10 people who attempted suicide and failed in their attempts and subsequently survived did not ultimately kill themselves following treatment. [https://www.hsph.harvard.edu/means-matter/means-matter/survival/]. There would have been no survivors if they had been euthanized. MAID is a road of no return. There are no survivors and no second chances to be treated and live.
We need to communicate to those contemplating suicide that we do not want them to die, that they are valuable to us, there is always a reason to live, and we will help them solve their problems. We need to provide more psychological, social and financial help for those who are in distress. We must improve their living conditions by providing affordable housing, food, and basic life supports. Those with dependency problems need access to care. We need to care for those with mental health problems- not support or endorse MAID.
Dr. Paul Saba is a family physician practicing in Montreal, co-founder of Physicians for Social Justice and author of “Made to Live” https://www.madetolive.com/.