Monday, October 16, 2023

Society of Canadian Psychiatry: Brief on MAiD and Mental Illness Expansion

Society of Canadian Psychiatry: Brief on MAID and Mental Illness Expansion
October 13, 2023

This Brief reviews key areas related to Canada’s planned 2024 expansion to provide medical assistance in dying (MAID) for sole mental illness conditions. The Board of Directors of the Society of Canadian Psychiatry (SocPsych) does not have an a priori opinion on whether or not MAID for sole mental illness should be provided. The intent of this document is to review the evidence and processes to date regarding Canada’s plans to expand* eligibility for MAID to sole mental illnesses in 2024, and make recommendations based on that review.

Based on its review of evidence outlined further in the Brief, the Board of Directors of the Society of Canadian Psychiatry concludes the following (note: abbreviated conclusions and recommendations are presented in the Executive Summary, refer to the full Brief for complete text)
CONCLUSION 1: At this time, it is impossible to predict in any legitimate way that mental illness in individual cases is irremediable. A significant number of individuals receiving MAID for sole mental illness would have improved and recovered. 

CONCLUSION 2: Evidence shows that individuals with suicidal ideation symptomatic of mental illness cannot be differentiated or identified as distinct from those seeking MAID for sole mental illness. Suicidal individuals who could benefit from suicide prevention will receive psychiatric MAID instead.
CONCLUSION 3: Non-dying disabled marginalized Canadians suffering from poverty and other social distress are at higher risk of premature death by MAID, with their disability allowing them to qualify for MAID while their social suffering fuels their MAID request. 

CONCLUSION 4: Key consultations from the Canadian Psychiatric Association and Association des médecins psychiatres du Québec informing the sunset clause failed to provide essential relevant evidence and due diligence that would normally be expected of expert professional bodies informing public policy discussions.

CONCLUSION 5: Most psychiatrists oppose expanding MAID for mental illness, despite not being conscientious objectors to MAID. 

CONCLUSION 6: The political process leading to the planned expansion of MAID for mental illness has not followed a robust and fulsome process, has not reflected the range of opinions and evidence-based concerns on the issue, and has been selectively guided by expansion activists. 

CONCLUSION 7: Reassurances of safety have been provided but safeguards have not been implemented to substantiate those reassurances. The lack of safeguards in planned MAID for mental illness expansion allows suicidal Canadians afflicted by mental illness, who could get better, to receive MAID for social suffering.

SUMMARY RECOMMENDATION: Based on review of evidence, the Board of Directors of the Society of Canadian Psychiatry believes the process leading to the planned 2024 MAID for mental illness expansion was flawed, insufficiently responsive to evidence-based cautions, and resulted in a lack of safeguards. The Board of the Society of Canadian Psychiatry recommends that the planned 2024 MAID for mental illness expansion be paused indefinitely, without qualification and presupposition that such implementation can safely be introduced at any arbitrary pre-determined date; and that any future potential consideration of MAID for sole mental illness policy be informed by evidence, guided by experts reflecting the range of views rather than being driven exclusively by ideological advocates, and only be potentially considered following fulsome and unbiased review of the issues and process flaws identified in this Briefing.

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