Mental illness stigma hurts MAID expansion, patient and psychiatrist say


WARNING: This story includes discussion of suicidal thoughts

Canadians suffering from debilitating mental illness cannot yet legally qualify for medical assistance in dying, unlike almost everyone else with serious illnesses — a restriction that some advocates say is rooted in stigma.

Eligibility for MAID was to be expanded in March to include people with mental illness.

But On Monday, Health Minister Mark Holland accepted the majority recommendations of a parliamentary committee which warned that the Canadian health system was not ready to authorize medical assistance in dying for people suffering only from mental illness, because there was too much work to be done before the legislation was expanded.

“The question here is readiness,” Holland said. Ultimately, people “trapped in mental torture” who have exhausted all avenues to relieve their suffering should be entitled to medical assistance in dying, just like Canadians suffering from physical illnesses, he said .

Graeme Bayliss wants it right, at any given time, to a medically assisted death.

WATCH | A patient’s perspective on MAID:

What another delay means for people waiting for MAID

The federal government wants another pause in authorizing requests for medical assistance in dying (MAID) from people suffering solely from mental illnesses. CBC’s Christine Birak explains the divide among doctors and what it means for patients who have waited years for a decision.

Bayliss, 34, has lived with depression and obsessive compulsive disorder since he was a teenager and says he is currently coping.

But he says he finds the possibility of MAID comforting and that it makes him more willing to try new treatments and medications if he ever faces difficult times again.

“It can be very disappointing when a new treatment or method fails,” Bayliss said in an interview. “You are taking the risk of another failure, which in itself could be discouraging, which in itself could lead you to suicidal thoughts.”

As an advocate for MAID, Bayliss says he also considers that it is safer for someone to receive medical assistance in dying than to be traumatized following a suicide attempt or for family members to unexpectedly come across a body.

“People are sort of grouped together as having mental illnesses, in a way that you wouldn’t group people with physical illnesses,” Bayliss said.

Stigma, he says, is also reflected in a lack of knowledge of the differences between psychosis and mild depression.

A young woman with long hair, dressed in jeans and sneakers, sits on a bench, her face in her hands, as if in despair.
The federal government this week delayed a planned expansion of medical assistance in dying for people with mental illness, saying the country’s health system was not ready. (Paulius Brazauskas/Shutterstock)

“It’s this apparent lack of nuance in how we think about mental illness as a broader society,” Bayliss said.

“I think this lack of nuance…makes the mentally ill an undifferentiated mass who are not seen as having their own thoughts and experiences.”

Similarly, Dr. Derryck Smith, clinical professor emeritus of psychiatry at the University of British Columbia, questions why people with mental illness are treated separately from those who suffer from mental illness. physical illness when it comes to MAID.

Currently, someone can request MAID if their death is “reasonably foreseeable” according to what is called track 1, or if they suffer from a “serious and irremediable condition”, track 2.

Neither track includes mental illness.

If the legislation were to expand, doctors expect enough patients suffering from mental illnesses would be covered by part 2.

LISTEN | Faced with the “horror of suicide”:

The flow7:25 p.m.Canadian ‘dismayed’ by delay in medically assisted dying for mental illness

“We don’t have a special category for victims of stroke, kidney disease, cancer or anything like that,” Smith said. “We have a special group for mental illness. And that, to me, is evidence of the continued stigma that psychiatric patients face.”

Smith says Canada’s psychiatrists are currently divided on MAID, just as other doctors were before its introduction to the country.

On Wednesday, the Ontario Psychiatric Association released his investigation of psychiatrists and psychiatry residents across the country.

It suggests that 33 percent of respondents agree with expanding medical assistance in dying for mental disorders as the only underlying medical condition, and that 80 percent agree that the Canadian medical system is not ready to safely support this expansion. The electronic survey of 497 respondents was conducted between December 7, 2023 and January 23.

Smith expects that dissent will fade over time and that within 10 years, what is controversial today will no longer be debated.

Transparent discussions

He cites the most recent statistics from Health Canadaon why people requested MAID in 2022, to support his position.

“The reason most people wanted an assisted death was not because they were in intolerable pain,” Smith said. “That’s because they’ve lost the functional ability to do the things that brought them joy in their lives, and many psychiatric patients who have been ill for 20 or 30 years no longer have any joy in their lives.”

A woman wearing a red blazer and yellow pendant necklace gestures while speaking.
Dr. Madeline Li, a psychiatrist at the Princess Margaret Cancer Center in Toronto, has evaluated hundreds of patients for MAID for cancer. (CBC)

Dr. Madeline Li, a psychiatrist at the Princess Margaret Cancer Center in Toronto, has evaluated hundreds of patients. For MAiD due to cancer. She is not ideologically opposed to AMM for mental disorders, but would like the legislation to be more specific than it currently is for physical illnesses under track 2.

Initially, when MAID was introduced, Li says she took patients’ requests literally and did not ask why they made this request. She now digs deeper.

“I will discuss transparently with the patient whether I think MAID is the right choice for them, help them understand my reasoning, and let them convince me that it is the right decision for them,” she declared.

Li says she also would like federal legislation on Track 2 patients to be clearer on whether indirect factors — such as inability to access mental health care, poverty and lack of adequate housing — can compromise a person’s voluntariness in cases of medical assistance in dying .

Without this clarity, Li fears that marginalized people will experience preventable deaths that should not happen in medicine.

For his part, Bayliss recognizes his privilege as a white, middle-class heterosexual man with an insurance plan. this means that he does not have to pay directly for the medicines.

“I still think there are other treatments and medications that I would like to try long before I consider this step,” he said.

If you or someone you know is struggling, here’s where to get help:

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