Medical assistance in dying | Access for people with mental illness divides the country

The federal government’s intentions to expand medical assistance in dying (MAID) to people with mental illness continue to be divisive despite a year-long pause aimed at establishing adequate protections for patients and guidelines for staff. health.

Hope is what kept Laurel Walker alive as suicidal thoughts overwhelmed her, and it’s exactly what she believes would deprive people battling the same darkness if Canada went south. forward with his plans to expand medical assistance in dying to people with mental health disorders.

Those in favor of expanding medical assistance in dying, scheduled for March 17, argue that providing medical assistance in dying to people with an incurable physical illness without granting the same right to those with a irremediable mental illness amounts to discrimination based on disability. Opponents counter that there is not enough evidence to predict whether or not a person will recover from mental illness.

Recent comments from Ottawa suggest expansion is not a certainty. Justice Minister Arif Virani said on Wednesday that the cabinet would take into account the opinions of a committee comprising medical experts and other stakeholders before deciding whether the government moves ahead on March 17 or s he paused.

M’s biggest concern^me Walker is that vulnerable people languish on long waiting lists and cannot afford to pay for psychological care that is not covered by government programs.

“There is a disconnect, and for that reason I think it is irresponsible to move forward with medical assistance in dying for mental health,” Ms.^me Walker.

M^me Walker is a 44-year-old Halifax resident who suffered from depression, anxiety and post-traumatic stress disorder for 20 years before being hospitalized. She does not want medical assistance in dying (MAID) to be extended in March to people whose only medical problem is mental illness.

Her struggle with depression began in high school, but she said the care she needed wasn’t available in her home province of Nova Scotia. It took him about 20 years to get treatment at a private inpatient facility in Ontario.

“I attempted suicide in 2005. I ended up being committed to hospital. I would not have been able to make a rational decision, but I could have applied for MAID soon,” confided M^me Walker, adding that she has not required any mental health services in the public system since completing treatment a decade ago.

Allowing medical assistance in dying without adequately funding the treatment of people who risk repeatedly ending up in emergency rooms is tantamount to saying there is no hope, she said.

The irremediable aspect of mental illness

Canadians have had access to medical assistance in dying since 2016 for incurable physical illnesses or disabilities. Five years later, following a decision by a Quebec court, the law no longer required that a person’s natural death be reasonably foreseeable. But people with mental illness would not be eligible until March 2023, giving time for a panel of mental illness experts to make recommendations on safeguards and guidance.

However, the expansion was put on hold in February for a year after some national psychiatrists and groups, including Toronto’s Center for Addiction and Mental Health (CAMH), the country’s largest psychiatric teaching hospital, expressed concerns, particularly on the need for better access to care.

Since then, a curriculum has been introduced to guide MAID assessors and providers.

A parliamentary committee on MAID, which is expected to submit its recommendations to the Senate and House of Commons by January 31, met again in November, when it heard testimony from experts, including psychiatrists, wanting an indefinite cessation of MAID for people suffering from mental illness. A repeated fear was that doctors and nurse practitioners would use their personal values ​​to assess eligibility, even though it may not be possible to distinguish a request for MAID from someone seeking assisted suicide.

The Center for Suicide Prevention agrees, saying there is a need to reach consensus on the definition of irremediable for any mental disorder affecting people who are not dying.

In an emailed statement Friday, CAMH said it was “pleased that the government is considering delaying the expansion of eligibility for medical assistance in dying to people whose only underlying medical condition is mental illness.” “.

“Currently, the health system is not ready and health care providers do not have the resources they need to provide high-quality, standardized and equitable MAiD services,” said the D^r Tarek Rajji, Chair of the CAMH Medical Advisory Committee.

However, the D^D Konia Trouton, president of the Canadian Association of MAID Evaluators and Providers (CAEPA), says the training program on medical assistance in dying launched in September, includes a section on mental illness, will help doctors and nurses to determine if a person is trying to commit suicide.

“We believe the health system is ready for March when we anticipate the current restrictions will be lifted,” the D. said in an email.^D Trouton, Friday.

“ACEPA, as an organization representing the professionals who do this work, believes that clinicians are ready,” argued the family physician, who has been a MAID assessor and provider in British Columbia, in Alberta and Ontario.

Physicians and nurse practitioners new to MAID would benefit from 27 hours of online training, as well as 12 hours of workshops. Those who have experience benefit from six hours of training, specified the D^D Trouton in a previous interview.

The program trains clinicians to differentiate between “an acute concern for suicide and a request for assistance in dying” by taking into account factors such as the type of treatment the person received, how they coped and if she tried it, with medication, for an “appropriate duration”, detailed the D^D Trouton, adding that it depends on the particularities of the disease.

Involve a psychiatrist in the assessment

People whose death is not reasonably foreseeable must already be assessed by two independent doctors or nurse practitioners. If neither is an expert on the applicant’s state of health, the applicant is required to consult a specialist. The same guarantee will apply to people suffering from mental illness, indicated the D^D Trouton.

The D^r Jitender Sareen, head of the department of psychiatry at the University of Manitoba, said he and several of his colleagues believe a psychiatrist should be involved in the assessment. He stressed that the expert group’s draft regulatory standard did not require this measure.

The D^D Trouton said provinces and territories could decide whether they want a psychiatrist to make a MAID referral or be involved in a patient’s care, but that remains to be seen.

Various jurisdictions say they won’t put all of their plans in place until Ottawa introduces legislation. Quebec, however, has banned the expansion of medical assistance in dying, maintaining that mental illness does not give rise to medical assistance in dying.

As for concerns over lack of treatment, applicants would be informed of available options, the D^D Trouton, and those without a family doctor would be connected with a primary care provider.

The D^r Gary Chaimowitz, former president of the Canadian Psychiatric Association, said that while lack of access to treatment is a “major and very important problem,” he does not believe it would be “an avenue to get the medical assistance in dying” for those seeking suicide.

A poll conducted by the association in 2020 showed that 41% of responding members agreed or strongly agreed that people with mental illness should be considered eligible for AMM, indicated the D^r Chaimowitz. The survey was sent to 2,056 members, and 474 of them responded.

The D^r Sonu Gaind, head of the department of psychiatry at Sunnybrook Health Sciences Center in Toronto, is among those who oppose the expansion of medical assistance in dying.

He said Belgium had legislative requirements for appropriate care and that there must be “no reasonable alternative” before a person is approved to receive MAID, but that Canada did not have such a guarantee.

He pointed out that data from Europe suggests that women with mental illness, particularly those marginalized by “social suffering” due to poverty, lack of housing and community support, would be at greater risk if medical assistance in dying was expanded without strong legislative guarantees.

The federal government said in 2021 it would better track who has access to medical assistance in dying and how it is provided. But no such information was included in the latest annual report on MAID, released in October, showing that 13,241 people died via MAID last year.

Health Canada said it is working with provinces and territories to collect data on what was discussed and what services — such as counseling and accommodation — were offered to people when they were assessed for AMM.

This new data will be included in future annual reports, the agency said in an email.

With information from Nicole Ireland

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