Recently, Canada’s Medical Assistance in Dying, MAID, was in the news, because of its anticipated expansion in eligibility to include those with mental illness as a primary diagnosis. Essentially, that means that anyone over 18 with a primary diagnosis of mental illness can request medical assistance in dying if they so choose. As you read that last sentence, you can probably intuitively see the issues that could arise. But it’s more than just a diagnosis of mental illness that may lead to ethical issues, it’s chronic issues in general. The understanding of something being “terminal” or someone being “near the end” is much more ambiguous when we consider mental disorders and chronic illnesses versus something like end-stage cancer.
In a recent episode of Causes or Cures, I chatted with Dr. Madeline Li about Canada’s Medical Assistance in Dying Law or MAID. The Parliament of Canada passed MAID in 2016, allowing eligible Canadian adults to request medical assistance in dying. In 2021 the law was revised to allow for more chronic conditions to be included, and now they are in discussions to expand eligibility to those with a diagnosed mental disorder.
Dr. Li is a psychiatrist specializing in cancer and palliative care who also has clinical expertise in applying MAID. She has done eligibility assessments for MAID and helped develop the MAID program for the University Health Network in Toronto, Canada.
In the podcast, she tells us more about what MAID is, how the original eligibility criteria evolved since 2016, and describes how the law is applied to people who request MAID. She discusses the reasons put forth for expanding MAID to include those with chronic conditions, including mental disorders, and how she personally feels about that. She talks through some of the key challenges and ethical concerns. Finally, she offer her suggestions for improving MAID to overcome some of the challenges. Keep in mind that these are her personal views, and not those of the Canadian government.
I also shared a bit of my own history in the podcast…a period of time when I felt like, perhaps, ending my life is the best thing. I don’t feel that way anymore, but I used my historical breakdown to highlight what I saw as one of the ethical issues with the medical assistance in dying law.
Some folks are uncomfortable chatting about death, dying and assisted suicide, so if you are contemplating listening to the episode, just know that we discuss these issues. Personally, I think chatting about our own mortality normalizes it and helps us accept it more, but that’s me. And not everyone is me.
To listen to the episode, please click here.
In addition, and as always, I invite you to check out some of the other episodes, including this one on who is to blame for the high price of insulin.