Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition
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| Dr Mark Komrad |
Komrad, who is well known for his opposition to psychiatric euthanasia, analyses how euthanasia for people with mental illness affects psychiatry.
Komrad comments on the laws in Belgium, the Netherlands and Luxembourg (Benelux countries) that permit euthanasia and assisted suicide for people with physical and psychological suffering. The term psychological suffering has led to approximately 200 people per year dying by euthanasia based on a psychological condition.
He then compares the Benelux countries acceptance of euthanasia for psychiatric reasons to the American Psychiatric Association position statement from 2016 which states:
“A psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.”
Psychiatrists traditionally have done all they could to prevent suicide. Should they really facilitate it instead?
Initially, Bill C-7 clearly excluded psychiatric disorders, as it did in the original C-14 law. However, there was ambiguity in this proscription, because psychological suffering (which is not defined in either legislation) continued to be a criterion for eligibility. In addition, many protested that such an exclusion discriminated against those with mental illnesses. The Canadian Psychiatric Association (CPA) was one such voice, declaring broadly that, in the interest of parity: “Patients with a psychiatric illness should not be discriminated against solely on the basis of their disability, and should have available the same options regarding MAID as available to all patients.”Komrad comments on the expert panel that over next two years will establish standards for evaluating patients and procedures to distinguish between those patients with psychiatric disorders whose suicide should be prevented and those for whom it should be provided. Komrad quotes me as stating:
This led to a dramatic turn of events in the (unelected) Canadian Senate when it considered Bill C-7 in February 2021. In an unprecedented move, Senator Stan Kutcher, MD, who is also a psychiatrist, declared that the exclusion of individuals with psychiatric disabilities would be discriminatory. He introduced an amendment that would allow MAID for mental illness 18 months following the passing of the bill. When the modified legislation was returned to the House of Commons, discussions were shut down after 3 hours by a liberal coalition and the bloc party from Quebec (a province that has promoted euthanasia and aimed to restrict conscientious objection to euthanasia by health care professionals). As a result, the vote was forced and, on March 17, 2021, the C-7 expansion of euthanasia in Canada became the law of the land complete with a last-minute amendment to sunset the mental illness exclusion after 2 years.
“there isn’t a prosecutor in the land who would prosecute someone for doing euthanasia for mental illness before the 24-month time frame has passed because it is technically legal.”Komrad emphasizes that legalizing euthanasia for mental illness is a serious change. He points out that many psychiatrists in Canada are deeply concerned by the recent developments. In the face of Bill C-7, the psychiatrist editor of the Journal of Ethics in Mental Health reported:
A few days ago, a 30-year-old patient with very treatable mental illness asked me to end her life. Her distraught parents came to the appointment with her because they were afraid that I might support her request and that they would be helpless to do anything about it. It’s horrific they have to worry that by going to a psychiatrist, their daughter might be killed by that very psychiatrist.Komrad also shows how the Canadian law may become far more permissive than the euthanasia laws in Belgium and the Netherlands he states:
Moreover, as with C-14, there is no requirement that additional, evidenced-based treatments be implemented, although patients are urged to give all treatments serious consideration Yet, despite its liberal approach, Belgium recently established a requirement that individuals applying for euthanasia due to a mental disorder must not have refused any evidenced-based treatments.Komrad ends his article by stating:
The American Medical Association has repeatedly concluded that MAID practices are “fundamentally incompatible with the physician’s role as a healer,” and the World Medical Association “is firmly opposed to euthanasia and assisted suicide.” Nevertheless, these laws have been adopted around the world, most recently in Victoria Australia, New Zealand, Spain, and Portugal. In US states, there have been attempts to expand initially strict criteria and practices. The justifications for euthanasia and assisted suicide (eg, autonomy, self-determination, intolerable suffering, and irremediability) are now being applied to psychiatric disorders, despite lack of any widespread agreement that treatments for psychiatric disorders are ever futile.
Concluding Thoughts
Bill C-7 and similar laws would represent a terrible shift in the deep ethos of psychiatry. Psychiatrists would have to decide which suicides should be prevented and which should be abetted.
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