Without adequate supports, MI under MAiD could be a death sentence.
By Amy Hasbrouck
The central question when considering if Euthanasia and Assisted Suicide (E/AS) should be allowed for people whose requests arise solely from a psychiatric disability is whether mental illness is irremediable. The answer depends on many factors; the origins, causes and history of the mental illness, the infrastructure in place to support healing, whether the treatment approach is holistic or symptom-focused. Possibly the most important predictor of success is the ability to retain hope that recovery is possible. As a starting point, hope requires trust in the therapeutic relationship, but trust and the hope of recovery are both undermined by allowing E/AS for psychiatric disability alone.
While my physical and sensory disabilities might or might not qualify me for euthanasia under Canada’s Medical Assistance in Dying (MAiD) regime, it is my psychiatric disabilities (mental illnesses) that are most likely to induce me to request euthanasia.
Evolving diagnoses
The day after I graduated from secondary school in 1979, I realized that the “childhood abuse” I had experienced might be connected to the exhaustion, low self-esteem, and depressed mood I had struggled with as far back as I could remember. Since then, I’ve had two hospitalizations, and a series of diagnoses – from depression, to PTSD, to dissociative identity disorder – and I’ve been prescribed at least 15 psychiatric medications. At the moment I’m taking five meds with (unofficial) diagnoses of Complex PTSD,1 Treatment Resistant Depression,2 along with the complicating and compounding effects of ableism.
My experience supports the conclusions reached by Mark Konrad and Catherine Ferrier in their recent article “MAID: No Evidence Base for Futility and Irremediability in Psychiatric Disorders”;3 that “diagnosis and prognosis of mental disorders are unreliable,” and there is an “enormous and nonspecific variety of treatments for mental disorders.”
Origins, Causes and History
Nearly 2/3 (63.9%) of adults report having at least one Adverse Childhood Experience (ACE) such as divorce or death of a parent, physical, emotional or sexual abuse or neglect, or substance abuse by family members.4 Studies have found “a strong relationship between exposure to abuse or household dysfunction during childhood and multiple health risk factors for the leading causes of death in adulthood.” The 17% of adults with an ACE score of four or more (of which I am one) have a “12 times higher prevalence of health risks such as alcoholism, drug use, depression, and suicide attempts,” chronic illness (such as fibromyalgia and chronic fatigue) and autoimmune disorders (such as Lupus or Crohn’s disease). Yet when I asked my primary care doctor about whether Québec used ACE scores to screen for physical and mental health risks, she didn’t know what I was talking about.
I have been unable to see a psychiatrist to adjust the medications I am prescribed for symptoms of my mental illnesses since I arrived in Canada more than 22 years ago. The meds are only partially effective in managing symptoms related to Complex PTSD and depression, but I don’t know what my official diagnosis is, and despite several referrals, I have never actually spoken to a psychiatrist. I have been referred for counseling twice to professionals who had no background in working with people who have experienced disability discrimination; in one case, the therapist’s insensitivity led me to abandon the sessions, while the other therapist left a few months into the treatment. I have had limited success finding qualified therapists on my own, and I must pay for my own therapy since I do not have insurance aside from the provincial health plan.
Infrastructure for Healing
Physical security promotes healing
For me, successful treatment of mental illness depends on diverse, often intangible elements, some of which I already have in place. I have physical security in that I am lucky enough to have a home, a loving and beloved spouse, and economic stability.5 I have some social support through Adult Survivors of Child Abuse (ASCA), an online community with a focus on recovery from the effects of complex trauma. I am looking for a well-matched, skilled and respectful therapist to work with me on managing my nervous system’s dysregulation and hypervigilance. I am hopeful that someday I may recover some self-esteem and lose some of the chronic depression that drains and immobilizes me. I am aware, however, that my situation is precarious; that I am one setback away from suicidal depression, and that I do not have the full range of supports I need to meet the inevitable hazards of life.
Emotional healing
Healing from complex PTSD is – not to put too fine a point on it – complicated when you also have a disability. The usual feelings of shame and self-blame that come from long-term emotional and sexual abuse were magnified by my parents’ profound discomfort with my blindness. The discovery of my cataracts during a hospital stay for pneumonia at four months precipitated a major domestic crisis (with accompanying violence); my father thought the condition was caused by (and was therefore the financial responsibility of) the treatment I received for pneumonia, while my mother believed that the cataract diagnosis while I was hospitalized precluded the possibility that the oxygen treatment was the causal factor. Regardless, I was expected to keep up with my siblings in household chores, academics and play, even as I was shamed for blindness-related behaviours (like rocking or turning my head from side to side). These “self-soothing” behaviours, and accompanying shame, metastasized with the sexual abuse which started when I was about three years old.6
When my mother told me the bullies at school were wrong to say I was “blind as a bat” I thought she must be right because I had usable vision. I figured comments about my vision problem meant that I was just too stupid to learn how to see, since “seeing” generally meant being able to predict events based on applying learned experience. My father’s insistence that I learn touch-typing at the age of 10 – though invaluable when I studied journalism and the Law – was a double-edged sword. He wanted to be sure I would have “something to fall back on” because, after all, “boys seldom make passes at girls who wear glasses;” the response of my classmates suggested I probably wouldn’t land a husband/provider/protector. My father’s plans for my security, while insulting, also seemed sensible, since I was too stupid to see and unworthy of being seen.
Validation in a world gone mad
I left the U.S. in 2003 because I experienced the collapsing democracy and military imperialism of that era as an existential threat and profound cognitive dissonance. My job (advocating for the rights of disabled people), was threatened by state budget cuts and the failure to recognize health care as a human right. I had also been harassed and assaulted by a stranger in what was clearly a disability and gender-based hate crime, yet was denied the opportunity to report it as such at the (state) police station where I fled after the event.
My first 20 years in Canada were taken up with (re)learning French, making a marriage work and following my spouse to foreign postings, bringing the disability rights-based opposition to E/AS to Canada and Québec, and observing the continued political and social deterioration in the United States.7
I was aware of the negative effect of the E/AS work on my mental health, and did what I could to mitigate the damage. The situation was aggravated with the pandemic (and its triage policies that threw disabled people under the bus) and the inauguration of Trump 2.0; I became unable to manage the writer’s block that had been getting worse for years. This substack has taken me more than two months to write. But as I said, I got no support from provincial health services for managing psych meds or getting effective treatment.8
Treatment approaches
Holistic v. symptom-based
Recently I was reminded of the importance of a holistic approach (in the realm of physical health), when I awoke on March 14 with a 50% loss of usable vision in my “good” eye. I took it easy that day, and (to my great relief) the problem cleared up after about 36 hours. (10% of normal vision is a lot better than 5%). I am at a loss as to how to address the underlying problem; I suspect I may have had a partially detached retina due to ocular pressure caused by Continuous Positive Airway Pressure (CPAP) treatment I’ve used for 33 years to control obstructive sleep apnea. The ophthalmologist who prescribes the eyedrops for my glaucoma has never asked about the possible cause of the glaucoma, or whether it might be related to the CPAP, nor has my primary care doctor. So I don’t know which professional to consult, or how to raise my concerns, without giving the impression I am trying to tell the medical professionals how to do their job.
The same principle applies to mental health care; I believe that I probably need to do some sort of somatic-based therapy to bypass my tendency to intellectualize and avoid feeling, but am I asking too much by insisting on psychiatric support for medications specifically for Complex PTSD, or a therapist who can provide a treatment such as EMDR,9 and who understands my trauma history and experience of disability oppression?
The most appropriate therapies, the best-suited provider(s)
In November, the counsellor I had been working with for three years (who had the requisite expertise and background) abruptly terminated the therapy relationship. Since then I have interviewed several possible therapists, only to discover either that they do not provide the treatment I am looking for, or that they cannot work with me because of my location. I am searching for a therapist who is trauma informed and can work online, who is certified in EMDR and who works from a disability justice perspective.10
I have been sending the following introductory email to counsellors I find on therapist referral cites: “I’m a 64-year-old disabled, cis, white woman looking for a counsellor to work with me on complex PTSD from full-spectrum child abuse, medical trauma and ableism, as well as grown-up issues like lawyer recovery, expat status/second language self-expression, and burn out from 30 years of (draining and triggering) work opposing the legalization of assisted dying from a disability rights perspective. Specifically, I’m hoping to use adapted EMDR (I’m legally blind, so the EM part doesn’t work for me) to deal with the CPTSD; I’m open to suggestion on the other stuff.”
Hope and trust in the therapeutic relationship
Recently I got some feedback on the introductory email; I was told that it could be off-putting, or even intimidating to some potential therapists. I responded by saying “That’s kind of the point.” I don’t want to waste my time interviewing counsellors who do not understand complex trauma, or who hold medical-model views of disability, or who see assisted dying as a good idea for disabled people.11 I’m also not confident I could gain much insight in talk therapy when my nervous system reacts like a three-year-old kid who can’t see if my rampaging father is about to attack me, every time someone raises their voice. Each time I question myself about one of my criteria (“do I really need a therapist who understands ableism?” or “Do I really need to do nervous system regulation?”) I have to remind myself that I’m not asking for too much, and that I deserve to get the help I need.
Back to the question of irremediability
Is my mental illness irremediable? I hope not, and I don’t think so. I’m hoping I can cobble together the pieces of a treatment and support system into a coherent care plan for myself. But given the lack of support and help I have received from Québec’s health providers, I cannot feel assured that if I experience a sudden setback (major vision loss, death in the family) I will get the support I need without having my trauma exacerbated by the intervention of an ableist, paternalistic mental health system.
In 2022, Québec decided not to legalize euthanasia for mental illness alone, but what guarantee do I have that some well-meaning doctor or nurse practitioner might not decide that losing my remaining vision, combined with the effects of childhood trauma and any other crisis that pops up, isn’t enough to justify substituting euthanasia for suicide prevention?
Bill C-218
Disability rights activists oppose E/AS because we understand that, while cloaked in “good intentions” the state only intervenes to end disabled lives, because of the belief that disability is a fate worse than death. Bill C-218, which would prohibit MAiD for people whose request is based only on a mental illness, is a small step toward redressing the deadly, eugenic, ersatz form of “care” that is MAiD.
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| Amy Hasbrouck |
The central question when considering if Euthanasia and Assisted Suicide (E/AS) should be allowed for people whose requests arise solely from a psychiatric disability is whether mental illness is irremediable. The answer depends on many factors; the origins, causes and history of the mental illness, the infrastructure in place to support healing, whether the treatment approach is holistic or symptom-focused. Possibly the most important predictor of success is the ability to retain hope that recovery is possible. As a starting point, hope requires trust in the therapeutic relationship, but trust and the hope of recovery are both undermined by allowing E/AS for psychiatric disability alone.
While my physical and sensory disabilities might or might not qualify me for euthanasia under Canada’s Medical Assistance in Dying (MAiD) regime, it is my psychiatric disabilities (mental illnesses) that are most likely to induce me to request euthanasia.
Evolving diagnoses
The day after I graduated from secondary school in 1979, I realized that the “childhood abuse” I had experienced might be connected to the exhaustion, low self-esteem, and depressed mood I had struggled with as far back as I could remember. Since then, I’ve had two hospitalizations, and a series of diagnoses – from depression, to PTSD, to dissociative identity disorder – and I’ve been prescribed at least 15 psychiatric medications. At the moment I’m taking five meds with (unofficial) diagnoses of Complex PTSD,1 Treatment Resistant Depression,2 along with the complicating and compounding effects of ableism.
My experience supports the conclusions reached by Mark Konrad and Catherine Ferrier in their recent article “MAID: No Evidence Base for Futility and Irremediability in Psychiatric Disorders”;3 that “diagnosis and prognosis of mental disorders are unreliable,” and there is an “enormous and nonspecific variety of treatments for mental disorders.”
Origins, Causes and History
Nearly 2/3 (63.9%) of adults report having at least one Adverse Childhood Experience (ACE) such as divorce or death of a parent, physical, emotional or sexual abuse or neglect, or substance abuse by family members.4 Studies have found “a strong relationship between exposure to abuse or household dysfunction during childhood and multiple health risk factors for the leading causes of death in adulthood.” The 17% of adults with an ACE score of four or more (of which I am one) have a “12 times higher prevalence of health risks such as alcoholism, drug use, depression, and suicide attempts,” chronic illness (such as fibromyalgia and chronic fatigue) and autoimmune disorders (such as Lupus or Crohn’s disease). Yet when I asked my primary care doctor about whether Québec used ACE scores to screen for physical and mental health risks, she didn’t know what I was talking about.
I have been unable to see a psychiatrist to adjust the medications I am prescribed for symptoms of my mental illnesses since I arrived in Canada more than 22 years ago. The meds are only partially effective in managing symptoms related to Complex PTSD and depression, but I don’t know what my official diagnosis is, and despite several referrals, I have never actually spoken to a psychiatrist. I have been referred for counseling twice to professionals who had no background in working with people who have experienced disability discrimination; in one case, the therapist’s insensitivity led me to abandon the sessions, while the other therapist left a few months into the treatment. I have had limited success finding qualified therapists on my own, and I must pay for my own therapy since I do not have insurance aside from the provincial health plan.
Infrastructure for Healing
Physical security promotes healing
For me, successful treatment of mental illness depends on diverse, often intangible elements, some of which I already have in place. I have physical security in that I am lucky enough to have a home, a loving and beloved spouse, and economic stability.5 I have some social support through Adult Survivors of Child Abuse (ASCA), an online community with a focus on recovery from the effects of complex trauma. I am looking for a well-matched, skilled and respectful therapist to work with me on managing my nervous system’s dysregulation and hypervigilance. I am hopeful that someday I may recover some self-esteem and lose some of the chronic depression that drains and immobilizes me. I am aware, however, that my situation is precarious; that I am one setback away from suicidal depression, and that I do not have the full range of supports I need to meet the inevitable hazards of life.
Emotional healing
Healing from complex PTSD is – not to put too fine a point on it – complicated when you also have a disability. The usual feelings of shame and self-blame that come from long-term emotional and sexual abuse were magnified by my parents’ profound discomfort with my blindness. The discovery of my cataracts during a hospital stay for pneumonia at four months precipitated a major domestic crisis (with accompanying violence); my father thought the condition was caused by (and was therefore the financial responsibility of) the treatment I received for pneumonia, while my mother believed that the cataract diagnosis while I was hospitalized precluded the possibility that the oxygen treatment was the causal factor. Regardless, I was expected to keep up with my siblings in household chores, academics and play, even as I was shamed for blindness-related behaviours (like rocking or turning my head from side to side). These “self-soothing” behaviours, and accompanying shame, metastasized with the sexual abuse which started when I was about three years old.6
When my mother told me the bullies at school were wrong to say I was “blind as a bat” I thought she must be right because I had usable vision. I figured comments about my vision problem meant that I was just too stupid to learn how to see, since “seeing” generally meant being able to predict events based on applying learned experience. My father’s insistence that I learn touch-typing at the age of 10 – though invaluable when I studied journalism and the Law – was a double-edged sword. He wanted to be sure I would have “something to fall back on” because, after all, “boys seldom make passes at girls who wear glasses;” the response of my classmates suggested I probably wouldn’t land a husband/provider/protector. My father’s plans for my security, while insulting, also seemed sensible, since I was too stupid to see and unworthy of being seen.
Validation in a world gone mad
I left the U.S. in 2003 because I experienced the collapsing democracy and military imperialism of that era as an existential threat and profound cognitive dissonance. My job (advocating for the rights of disabled people), was threatened by state budget cuts and the failure to recognize health care as a human right. I had also been harassed and assaulted by a stranger in what was clearly a disability and gender-based hate crime, yet was denied the opportunity to report it as such at the (state) police station where I fled after the event.
My first 20 years in Canada were taken up with (re)learning French, making a marriage work and following my spouse to foreign postings, bringing the disability rights-based opposition to E/AS to Canada and Québec, and observing the continued political and social deterioration in the United States.7
I was aware of the negative effect of the E/AS work on my mental health, and did what I could to mitigate the damage. The situation was aggravated with the pandemic (and its triage policies that threw disabled people under the bus) and the inauguration of Trump 2.0; I became unable to manage the writer’s block that had been getting worse for years. This substack has taken me more than two months to write. But as I said, I got no support from provincial health services for managing psych meds or getting effective treatment.8
Treatment approaches
Holistic v. symptom-based
Recently I was reminded of the importance of a holistic approach (in the realm of physical health), when I awoke on March 14 with a 50% loss of usable vision in my “good” eye. I took it easy that day, and (to my great relief) the problem cleared up after about 36 hours. (10% of normal vision is a lot better than 5%). I am at a loss as to how to address the underlying problem; I suspect I may have had a partially detached retina due to ocular pressure caused by Continuous Positive Airway Pressure (CPAP) treatment I’ve used for 33 years to control obstructive sleep apnea. The ophthalmologist who prescribes the eyedrops for my glaucoma has never asked about the possible cause of the glaucoma, or whether it might be related to the CPAP, nor has my primary care doctor. So I don’t know which professional to consult, or how to raise my concerns, without giving the impression I am trying to tell the medical professionals how to do their job.
The same principle applies to mental health care; I believe that I probably need to do some sort of somatic-based therapy to bypass my tendency to intellectualize and avoid feeling, but am I asking too much by insisting on psychiatric support for medications specifically for Complex PTSD, or a therapist who can provide a treatment such as EMDR,9 and who understands my trauma history and experience of disability oppression?
The most appropriate therapies, the best-suited provider(s)
In November, the counsellor I had been working with for three years (who had the requisite expertise and background) abruptly terminated the therapy relationship. Since then I have interviewed several possible therapists, only to discover either that they do not provide the treatment I am looking for, or that they cannot work with me because of my location. I am searching for a therapist who is trauma informed and can work online, who is certified in EMDR and who works from a disability justice perspective.10
I have been sending the following introductory email to counsellors I find on therapist referral cites: “I’m a 64-year-old disabled, cis, white woman looking for a counsellor to work with me on complex PTSD from full-spectrum child abuse, medical trauma and ableism, as well as grown-up issues like lawyer recovery, expat status/second language self-expression, and burn out from 30 years of (draining and triggering) work opposing the legalization of assisted dying from a disability rights perspective. Specifically, I’m hoping to use adapted EMDR (I’m legally blind, so the EM part doesn’t work for me) to deal with the CPTSD; I’m open to suggestion on the other stuff.”
Hope and trust in the therapeutic relationship
Recently I got some feedback on the introductory email; I was told that it could be off-putting, or even intimidating to some potential therapists. I responded by saying “That’s kind of the point.” I don’t want to waste my time interviewing counsellors who do not understand complex trauma, or who hold medical-model views of disability, or who see assisted dying as a good idea for disabled people.11 I’m also not confident I could gain much insight in talk therapy when my nervous system reacts like a three-year-old kid who can’t see if my rampaging father is about to attack me, every time someone raises their voice. Each time I question myself about one of my criteria (“do I really need a therapist who understands ableism?” or “Do I really need to do nervous system regulation?”) I have to remind myself that I’m not asking for too much, and that I deserve to get the help I need.
Back to the question of irremediability
Is my mental illness irremediable? I hope not, and I don’t think so. I’m hoping I can cobble together the pieces of a treatment and support system into a coherent care plan for myself. But given the lack of support and help I have received from Québec’s health providers, I cannot feel assured that if I experience a sudden setback (major vision loss, death in the family) I will get the support I need without having my trauma exacerbated by the intervention of an ableist, paternalistic mental health system.
In 2022, Québec decided not to legalize euthanasia for mental illness alone, but what guarantee do I have that some well-meaning doctor or nurse practitioner might not decide that losing my remaining vision, combined with the effects of childhood trauma and any other crisis that pops up, isn’t enough to justify substituting euthanasia for suicide prevention?
Bill C-218
Disability rights activists oppose E/AS because we understand that, while cloaked in “good intentions” the state only intervenes to end disabled lives, because of the belief that disability is a fate worse than death. Bill C-218, which would prohibit MAiD for people whose request is based only on a mental illness, is a small step toward redressing the deadly, eugenic, ersatz form of “care” that is MAiD.
1 World Health Organization’s International Classification of Diseases for Mortality and Morbidity Statistics, 11th Edition, (2022), 6B41 Complex Post Traumatic Stress Disorder https://icd.who.int/browse/2024-01/mms/en#585833559.
2 Oliveira-Maia AJ, Bobrowska A, Constant E, Ito T, Kambarov Y, Luedke H, Mulhern-Haughey S, von Holt C.; Treatment-Resistant Depression in Real-World Clinical Practice: A Systematic Literature Review of Data from 2012 to 2022. Adv Ther. 2024 Jan;41(1):34-64. doi: 10.1007/s12325-023-02700-0. Epub 2023 Oct 26. https://pmc.ncbi.nlm.nih.gov/articles/PMC10796703/.
3 Konrad, M., and Ferrier, C., “Commentary: MAID: No Evidence Base for Futility and Irremediability in Psychiatric Disorders,” Psychiatric Times, April 6, 2026, https://www.psychiatrictimes.com/view/maid-no-evidence-base-for-futility-and-irremediability-in-psychiatric-disorders.
4 The ACE survey is far from complete; it does not account for medical trauma, discrimination, bullying, witnessing domestic violence, or the effects of war, natural disasters, displacement and migration. The World Health Organization’s ACE International Questionnaire takes more factors (such as discrimination, bullying and collective violence) into account, but does not include medical trauma.
5 One fly in my security ointment comes from the fact that my husband, who can no longer work and is losing mobility, finds meaning in life through helping homeless and marginalized people (some of whom are active alcoholics and drug addicts), who come to the house for loans emotional support or to do odd jobs. We have agreed that, for my sense of safety, they will only come between 1 and 5 in the afternoon, and that people who are intoxicated may not come into the house.
6 In 1991, at a workshop I gave (along with colleagues in a support group of disabled women survivors of child sexual abuse) called “Adding Incest to Injury” we presented on the multiplier effects of ableism and child sexual abuse. We described how being trained to compliance and treated as objects of medical care increased our vulnerability to sexual abuse, while the loss of control during sexual violation made us more susceptible to shame and existential confusion caused by disability discrimination.
7 Forever wars, anti-immigrant policies, the #MeToo movement in response to the predator-in-chief and the Epstein files, the failure of democracy and the backlash against diversity, equity, inclusion and accessibility.
8 From what I can gather, the only way to get comprehensive mental health services in Québec is to be in crisis, which would precipitate a response from the system that would deprive me of control over what treatment I receive and where and how I received it. This is highly triggering for a person with Complex PTSD, as I learned when I was hospitalized in 1991 and 1997, and can do more harm than the beneficial effects of the treatment.
9 Eye Movement Desensitization and Reprocessing (EMDR) therapy is an extensively researched, effective psychotherapy method in which the person focuses briefly on the traumatic memory while simultaneously experiencing bilateral stimulation, which can reduce the vividness and emotion associated with the trauma memories. Ongoing research supports positive clinical outcomes, showing EMDR therapy as a helpful treatment for disorders such as anxiety, depression, OCD, chronic pain, addictions, and Complex PTSD (Maxfield, 2019). EMDR therapy has even been superior to Prozac in trauma treatment.)
10 Disability justice is an intersectional framework and movement, coined in 2005 by queer disabled people of color, that centers the lives and leadership of marginalized disabled people. It moves beyond legal rights to address how ableism, racism, colonialism, capitalism, and heteropatriarchy intersect to harm people, the biome, and the environment)
11 FN One therapist wondered why I was working so hard to prevent people from having euthanasia if they wanted to be dead. It made me wonder if she provided suicide prevention intervention to all clients who were suicidal, or just non-disabled ones.
Amy Hasbrouck is the director of Toujours Vivant - Not Dead Yet and a past-President of the Euthanasia Prevention Coalition.
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