Opinion: Canadians face major barriers to access mental health care, which can lead to wanting death as the most accessible option
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My family medicine practice predominantly serves low-income and marginalized patients. Many of my patients face discrimination, isolation and a lack of access to needed services, which are causes of considerable distress and hardship. Inadequate services, the direct result of government failures, cause many Canadians to struggle with demoralization — and sometimes death wishes.
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It was in this context that our federal government had been planning to expand medical assistance in dying (MAiD), a lethal cocktail administered to induce death, to those whose only medical condition is mental illness, beginning March 2024. A recently released parliamentary report has now advised that this expansion should not go forward at this time. MAiD should never have been an option for mental illness. It is a travesty that we ever considered going down this path. It should be abandoned permanently.
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MAiD was introduced in Canada in 2016 as an exceptional act to end the lives of physically disabled persons who were near death, suffering intolerably and wanted state assistance to die. MAiD was expanded in 2021 to physically disabled persons who are not dying. This has already resulted in many disturbing stories of people receiving MAiD due to lack of access to services.
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I was recently interviewed for a documentary which included the life and MAiD death of Rosina Kamis, a story which should make Canadians think twice about administering death for life’s suffering. She explains in her recordings and writings that she was poor and lonely and chose MAiD because she wasn’t being provided with the necessary support. Many disabled Canadians, like Rosina, are similarly considering dying by MAiD, and, no doubt, many with mental illness as their only medical condition would also choose this route for lack of access to services and care.
Canadian bioethicists have tried to justify this practice, asserting that providing MAiD driven by “unjust social circumstances” is akin to “harm reduction.” Let’s call it what it is — the furthering of injustice towards people already deprived of the means to live.
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Canadians face major barriers to access mental health care, which can lead to wanting death as the most accessible option. Many Canadian psychiatrists have raised concerns about an expansion, testifying during Parliamentary committee meetings that we are not ready for this.
Medicine is supposed to operate with strict safeguards and evidence-based eligibility requirements for all treatments to ensure public safety. We simply do not understand how to distinguish those who would benefit and recover from suicide prevention and services and those very few who might not. Such an expansion would have put Canadians’ lives at risk and the medical community in an impossible dilemma of arbitrarily deciding who is fit for life or death.
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Following the Parliamentary Committee on MAiD over the past years has been a disturbing experience, where concerns raised by the disability and mental health community and medical and legal experts have been routinely ignored. At the same time, we are told that MAiD providers are professionals who should be trusted to get it right every time. This was never good enough.
It is a challenge to map out all the potential consequences of a policy — and this is because no society is a monolith, but instead is made of people with wildly varying histories and with differing access to capital, political power, media representation and so forth. However, in this instance, powerful lobby groups have controlled the public discourse around MAiD expansion. Regardless, Canadians are increasingly recognizing the risks.
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Thomas Insel, former head of the National Institute of Mental Health, wrote a book called Healing in which he confirms the unknown prognosis of mental health disorders and discusses how community life, supports and purpose dictate positive outcomes. That the federal government even considered expanding MAiD to provide death for mental health suffering, while simultaneously failing its duty to provide timely care, counselling, community-enriching funding and livable income is unconscionable. Death is not the answer.
Canadians deserve better from their government.
Ramona Coelho is a family doctor whose practice predominantly serves marginalized patients in London, Ontario.
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