Walking Alongside: Views of Family Members on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition

Abstract

Medical assistance in dying (MAiD) was introduced into Canadian federal legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is currently excluded from eligibility; such exclusion is scheduled to expire on March 17, 2024. Irremediability, capacity, quality of life, autonomy, family involvement, and healthcare system constraints have been debated intensively. Recent studies have not explored the views of family members of persons with mental illness on MAiD MI-SUMC. This study aimed to fill this knowledge gap. Twenty-five Ontario residents who had a loved one with mental illness participated. A persona–scenario exercise was designed to explore participants’ views on MAiD MI-SUMC in hypothetical situations. Reflexive thematic analysis was used to analyze the data. A lived experience-advisory panel was engaged throughout the study. Seven themes were developed: Witnessing suffering; A road with barriers and limitations; Societal barriers; The unknowns of mental illness; Individual choices: the life or death that a person wants; MAiD MI-SUMC as an acceptable choice when suffering cannot be relieved with available treatments and supports; and The emotional outcome. Participants constructed their views based on their experience of supporting a loved one with mental illness. MAiD MI-SUMC was perceived as a multifaceted issue, whose acceptability and potential introduction required a concurrent exploration and discussion of the challenges arising due to limitations of the healthcare system, the opportunities and limits to family involvement, and the value of patient autonomy.

Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives

“…This study, using rigorous qualitative methods and participatory engagement processes, adds to the limited literature on the perspectives of persons with mental illness and their families on MAiD MI-SUMC care processes, and their implications for practice. Persons with mental illness and family participants were aligned in their views on MAiD MI-SUMC service delivery, with a variety of perspectives expressed within both groups in our study [ 35 , 41 , 42 ]. Participants called for MAiD public awareness raising and patient psychoeducation, assessment teams and processes that unpack “the story” and minimize suffering, with special attention to the assessment aftermath.…”

Medical Assistance in Dying for Mental Illness as a Sole Underlying Medical Condition and Its Relationship to Suicide: A Qualitative Lived Experience-Engaged Study: Aide Médicale à Mourir Pour Maladie Mentale Comme Seule Condition Médicale Sous-Jacente et Son Lien Avec le Suicide: Une Etude Qualitative Engagée Dans l’Expérience Vécue

“…17,18 As Canada's debates about MAiD MI-SUMC evolve, it is important that we reflect on the implications for patients and families. 19,20 Historically, the perspectives of people with mental illness have not always been heard in service design and delivery, leading to interventions that they have ultimately deemed to be unethical or inappropriate, and with unintended consequences. 21,22 Evidence-based policymaking and patientoriented service planning require that the perspectives of people with mental illness and their families contribute to discussions and decisions about MAiD MI-SUMC.…”