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Published on April 6th, 2016 | from CAMH

How do mental health clients feel about Physician Assisted Death?

By Lucy Costa, Deputy Director at the Empowerment Council

The following blog is from The Empowerment Council, a non-profit organization affiliated with CAMH that advocates on behalf of CAMH clients and provides representation of the client’s voice on various CAMH committees, focus groups and task forces. All views expressed below are those of the Empowerment Council, and may not necessarily reflect those of CAMH, its staff or leadership.

On February 6, 2015, the Supreme Court of Canada (SCC) issued a unanimous decision in a case called Carter v. Canada (2015). The Carter ruling struck down a 21 year old prohibition on physician assisted death in the Criminal Code. Inevitably, this decision evokes a number of strong and polarizing opinions. As an organization representing the interests of clients, the Empowerment Council would like to canvass the views of mental health and addiction service users on this topic.

This decision of the court is significant particularly in light of an earlier precedent set in the SCC case Rodriguez v British Columbia (1993). Like Lee Carter, Sue Rodrigues also requested assisted death, but the SCC upheld the prohibition back in 1993 for Rodrigues. To read the Carter case and the judgment please click here. The new law(s) are to be in place by June 6, 2016 in order to implement the necessary changes and the ‘Carter Criteria’.

Essentially in Carter, the court  struck down sections 14 and 241(b) (“the prohibition”) of the Criminal Code arguing that it unjustifiably infringed on Ms. Carter’s section 7 Charter rights and should therefore be voided because they deprive a competent adult of assistance where:

  • the person affected clearly consents to the termination of life;
  • the person has a grievous and irremediable medical condition that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition (Please see Carter, paragraph 4).

With these new amendments, people with psychiatric disabilities are able to request physician assisted death. Suffering that is “intolerable” and “enduring” includes physical or psychological suffering.  A determination of competency still must be made before allowing a request to move forward and while we do not anticipate many requests to come forward from people with psychiatric disabilities, there have in fact been some general inquiries already.

Is there a difference between what we typically think of as suicide versus assisted death?

Our new legislation permits the state to legally “help” people to die should they meet the criteria, and are deemed “competent.”  While mental health service users have often written and shared thoughts about death and suicide (for example here or here), there has been an absence of writing related to physician assisted death and too many others are stepping in to speak for us. Unlike the physical disability community, mental health service users haven’t yet substantively weighed in from a legal, policy perspective, or with regard to long term implications.

How do we discuss and support each other’s views on this difficult topic, especially if there have been times when we ourselves have felt the call and temptation to die amidst immense suffering?  Correspondingly, how do we honour friends, lovers, and relatives whom we have personally lost to suicide and who we wanted to love/live longer? Psychological suffering should never be trivialised but how do we understand assisted death as the same or different across different experiences – terminal (physical) illness, degenerative (physical) illness, and psychiatric disability?

How should the right to die and the right to life be simultaneously protected?  Is it fair to assume that someone who has been in/ out of the mental health system, has tried numerous treatments, but still desires to die should be denied the right?  Are all requests “irrational” or “insane” ? These are clearly important debates especially given the times that others impose their views on people with disabilities.

As we work our way through these considerations, please share your views. Some questions for your consideration:

  1. Is there ever a “rational suicide” or will all requests (absent physical illness) be deemed irrational by individuals who have a psychiatric disability?
  2. What safeguards and procedural regulations need to be in place to protect people with psychiatric disabilities?
  3. If a tribunal is struck in order to determine capacity for people with psychiatric disabilities, how should it work?
  4. What should the government consider when monitoring and evaluating assisted death across Canada in the next five to ten years?
  5. How should persons with psychiatric disabilities be involved in government monitoring and evaluation processes in the future?

Please share your views below or email me at: lucy.costa@camh.ca.

Thank you.

 

Here are just a few of many documents on assisted death that may be of interest: 

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3 Responses to How do mental health clients feel about Physician Assisted Death?

  1. In the chronic Illness or imminent death with Paliative care I feel the client has the right to choose assisted death.My only concern is will it affect ones Kharma?

  2. Candida says:

    It is unfortunate for physicians to make that last call. I think we should not put physicians in that spot unless they feel it’s necessary. Physician can give advise based on their best judgement but not decide. The client or substitute decision maker should make that call.

  3. Ami says:

    This article from the Journal of Medical Ethics summarizes my thoughts nicely.

    http://m.jme.bmj.com/content/41/8/577.full.pdf

    ABSTRACT
    Competent patients suffering from treatment-resistant
    depressive disorder should be treated no different in the
    context of assisted dying to other patients suffering from
    chronic conditions that render their lives permanently not
    worth living to them. Jurisdictions that are considering,
    or that have, decriminalised assisted dying are
    discriminating unfairly against patients suffering from
    treatment-resistant depression if they exclude such
    patients from the class of citizens entitled to receive
    assistance in dying.

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