Tuesday, January 30, 2024

Euthanasia (MAiD) for those with mental illness should not be on the table.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Ramona Coehlo
Dr Ramona Coehlo wrote an excellent article that was published by The Province on January 29, 2024. Coelho, a family doctor whose practice predominantly serves marginalized patients in London, Ontario.

Coelho begins her article by explaining why she is concerned about patients with mental illness:
My family medicine practice predominantly serves low-income and marginalized patients. Many of my patients face discrimination, isolation and a lack of access to needed services, which are causes of considerable distress and hardship. Inadequate services, the direct result of government failures, cause many Canadians to struggle with demoralization — and sometimes death wishes.

It was in this context that our federal government had been planning to expand medical assistance in dying (MAiD), a lethal cocktail administered to induce death, to those whose only medical condition is mental illness, beginning March 2024. A recently released parliamentary report has now advised that this expansion should not go forward at this time. MAiD should never have been an option for mental illness. It is a travesty that we ever considered going down this path. It should be abandoned permanently.
Coelho explains that MAiD (euthanasia) was legalized in Canada in 2016 as an exceptional act to end the lives of physically disabled persons who were near death, suffering intolerably and wanting assistance to die. The government expanded MAiD in March 2021 to people who are not terminally ill. The expansion of MAiD to led to the many stories of people seeking MAiD based on a lack of access to services.

Coelho continues:
I was recently interviewed for a documentary which included the life and MAiD death of Rosina Kamis, a story which should make Canadians think twice about administering death for life’s suffering. She explains in her recordings and writings that she was poor and lonely and chose MAiD because she wasn’t being provided with the necessary support. Many disabled Canadians, like Rosina, are similarly considering dying by MAiD, and, no doubt, many with mental illness as their only medical condition would also choose this route for lack of access to services and care.

Canadian bioethicists have tried to justify this practice, asserting that providing MAiD driven by “unjust social circumstances” is akin to “harm reduction.” Let’s call it what it is — the furthering of injustice towards people already deprived of the means to live.
Coelho comments on how these issues affect euthanasia for mental illness.
Many Canadian psychiatrists have raised concerns about an expansion, testifying during Parliamentary committee meetings that we are not ready for this.

Medicine is supposed to operate with strict safeguards and evidence-based eligibility requirements for all treatments to ensure public safety. We simply do not understand how to distinguish those who would benefit and recover from suicide prevention and services and those very few who might not. Such an expansion would have put Canadians’ lives at risk and the medical community in an impossible dilemma of arbitrarily deciding who is fit for life or death.
Coelho continues
Following the Parliamentary Committee on MAiD over the past years has been a disturbing experience, where concerns raised by the disability and mental health community and medical and legal experts have been routinely ignored. At the same time, we are told that MAiD providers are professionals who should be trusted to get it right every time. This was never good enough.

...However, in this instance, powerful lobby groups have controlled the public discourse around MAiD expansion. Regardless, Canadians are increasingly recognizing the risks.
Coelho finishes by reinforcing that death is not the answer to mental illness.
Thomas Insel, former head of the National Institute of Mental Health, wrote a book called Healing in which he confirms the unknown prognosis of mental health disorders and discusses how community life, supports and purpose dictate positive outcomes. That the federal government even considered expanding MAiD to provide death for mental health suffering, while simultaneously failing its duty to provide timely care, counselling, community-enriching funding and livable income is unconscionable. Death is not the answer.

Canadians deserve better from their government.
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