New (MAiD) euthanasia rules put psychiatrists in an impossible position

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In March 2021, Canada's parliament passed Bill C-7 which expanded (MAiD) euthanasia to people who are not terminally ill, but living with chronic conditions. Bill C-7 also approved euthanasia for people with chronic mental illness, but the government put the application of euthanasia for mental illness on hold for two years to enable them to develop protocols.

On December 28, the Globe and Mail published an opinion article by psychiatrists Mark Sinyor and Ari Zaretsky titled: Changes to assisted dying rules put psychiatrists in an impossible position.

Sinyor and Zaretsky begin the article by bringing the readers up to speed about the fact that euthanasia for chronic mental illness may soon be available to Canadians. In their concern they state:

This is destined to create a massive legal quagmire, which, unfortunately, hasn’t got the attention it deserves. Importantly, these are not issues that the government’s forthcoming recommendations, set to be released by this coming March, will be able to resolve.

They present the following scenario:

A 22-year-old woman with bipolar disorder has struggled with her illness for a decade with no relief despite treatment. She sees a psychiatrist who decides that there is no way to relieve her suffering and a doctor ends her life against the wishes of her parents. Her parents then sue the psychiatrist for malpractice. Their lawyers call scientific experts, who testify that the psychiatrist’s assessment that there was no way to relieve her suffering really couldn’t be made with existing evidence. With the psychiatrist on the stand, their lawyer offers a stinging challenge: “Doctor, you made a determination that is considered medically impossible, given the best available science, and now my clients’ daughter is dead.”

They continue:

The issue is that, despite much discussion and rhetoric, there is essentially no science behind the practice of physician assisted death for mental illness. There has never been a study examining how often intolerable suffering exists after comprehensive psychiatric treatment, let alone whether psychiatrists have any ability to accurately predict when that might be the case (as would be required by Canadian law). We don’t even have a proper scientific definition for the concept of “enduring and intolerable suffering,” which is at the crux of the legislation.

I restate, there is essentially no science behind the practice of physician assisted death for mental illness. Sinyor and Zaretsky then state, allowing euthanasia for mental illnes contradicts the dictum of medicine - Do No Harm.

Sinyor and Zaretsky then state:

The Centre for Addiction and Mental Health, the Canadian Mental Health Association, the Canadian Association for Suicide Prevention and the Expert Advisory Group on Medical Assistance in Dying have all released statements highlighting that we currently lack the knowledge to determine whether a particular person’s suffering in mental illness can be remedied. This means that, on a practical level, physician assisted death for mental illness cannot be legal in Canada. But a relatively small group of vocal psychiatrists is readying to push forward as soon as the law is expanded (likely in early 2023). This is a broken process.

In other words, a few philosophically and politically motivated psychiatrists have been placed into the position of deciding that euthanasia for mental illness alone will happen.

Sinyor and Zaretsky conclude:

When patients come through our doors, they correctly expect to be speaking to experts. If we tell them that their suffering cannot be relieved, they ought to be confident that such determinations have a basis in evidence and science, especially when the alternative offered is death. An appeal for proper scientific investigation prior to implementation of a proposed medical treatment should not be controversial in the 21st century.

Mark Sinyor is a psychiatrist and suicide prevention researcher at Sunnybrook Health Sciences Centre. Ari Zaretsky is chief of the department of psychiatry at Sunnybrook.

Previous articles on this topic:

• Quebec committee opposes euthanasia for mental illness (Link). 
• Canadian Psychiatric Association's dangerous position on euthanasia (Link).
•  The complexity of assessing mental health and capacity (Link). 
• As difficult as it is sometimes, there is always hope. Euthanasia for mental illness is abandonment (Link).