The Supreme Court of Canada Ruling on Physician-Assisted Death: Implications for Psychiatry in Canada

Abstract

On February 6, 2015, the Supreme Court of Canada ruled that the prohibition of physician-assisted death (PAD) was unconstitutional for a competent adult person who “clearly consents to the termination of life” and has a “grievous and irremediable (including an illness, disease, or disability) condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition.”1 The radically subjective nature of this ruling raises important questions about who will be involved and how this practice might be regulated. This paper aims to stimulate discussion about psychiatry's role in this heretofore illegal practice and to explore how psychiatry might become involved in end-of-life care in a meaningful, patient-centred way. First, I will review existing international legislation and professional regulatory standards regarding psychiatry and PAD. Second, I will discuss important challenges psychiatry might face regarding capacity assessment, the notion of rational suicide, and the assessment of suffering.

Implementation of Medical Assistance in Dying: A Scoping Review of Health Care Providers' Perspectives

“…For instance, given the complexities of MAiD, which are subject to psychosocial influences, such as individual-, family-, and social-level factors, several studies highlighted the inclusion of mental health providers and social workers, who may be better equipped to evaluate the impact of personal and contextual factors on motivations for hastened death. 27,30,34,35,37,38 Consequently, the need for a multidisciplinary approach to MAiD is warranted in the same manner that led to the formation of interprofessional hospice/palliative care programs that attend to the holistic needs of dying patients and their families. 26,27 Rather than treating each professional as isolated and independent actors in the compendium of MAiD care, more effort is needed to consolidate roles and foster collaboration to ensure that all necessary protocols, safeguards, and respective legal requirements are met for each and every MAiD case.…”

“…Absence of Clear Professional and/or Legal Guidelines and Role Ambiguity. Seventy-six percent (25/33) of articles discussed the absence of clear professional and/or legal guidelines framing MAiD, which traversed the nursing, 14e23 physician, 24e26,43,44 mental health, 30,31,35,36 pharmacy, 32,39e41 and social work 19,33,34 professions. The consequence of this absence was role ambiguity, whereby 42% (14/33) of articles discussed how their profession lacked clarity and consistency in practice.…”

Eutanasia, suicidio asistido y psiquiatría

“…Pero eso no parece ser una opinión actual mayoritariamente respaldada por los psiquiatras canadienses y, según autores, no sería tampoco bioética ni necesaria (30). Otros han estimado que la psiquiatría podría involucrarse en la asistencia al final de la vida de modo más significativo y centrado en el paciente (31,32). Según una encuesta online de 2016, la mayoría de los psiquiatras canadienses no apoya la legalización de la asistencia médica en la muerte para los trastornos mentales con "sufrimiento intolerable", a pesar de avalar en términos generales esa modalidad de intervención (12).…”

Medical Assistance in Dying and Mental Health: A Legal, Ethical, and Clinical Analysis

“…In some other jurisdictions, notably Belgium and the Netherlands, mental illness may qualify for MAiD. 7 The Court in Carter heard evidence about this but did not consider it, saying at paragraph 111, ‘Professor Montero’s affidavit reviews a number of recent, controversial, and high-profile cases of assistance in dying in Belgium which would not fall within the parameters suggested in these reasons, such as euthanasia for minors or persons with psychiatric disorders or minor medical conditions’. 1 It is unclear if the constitutional arguments that were found to apply for terminal illness and for those so gravely disabled as to be unable to exercise their right to end their own life hold in these other situations.…”