Why medical assistance in dying must treat mental and physical illness equally
People with mental illness in Canada are being denied a voice as MAID is amended
This column is an opinion by John Scully, a former CBC, CTV and BBC journalist. He suffers from depression, general anxiety disorder and PTSD (from covering 36 wars), and has attempted suicide twice. He wants to see the option of medical assistance in dying (MAID) offered to those with mental illness. For more information about CBC's Opinion section, please see the FAQ.
It's a clear case of basic human rights: the mentally ill must be treated as equals to the physically ill.
On Monday, the federal government tabled a proposed amendment to Canada's medical assistance in dying (MAID) legislation. According to the Department of Justice, "This Bill would retain all existing eligibility criteria, but would remove the requirement for 'reasonable foreseeability of natural death.' It would also expressly exclude persons suffering solely from mental illness."
A statement from the department adds, "eligibility for persons suffering solely from mental illness ... could be considered during a broader parliamentary review of MAID legislation expected to begin by June 2020."
This proposed legislation ignores the fact that some with mental illness suffer terrible pain, even though it's a different pain, and modern psychiatric medicine has few or no answers. It doesn't have a pill that'll stop you from wanting to kill yourself. It struggles to stop the incessant, unrelenting brain pain of severe depression, bipolar disorder, schizophrenia and other life-threatening mental illnesses.
For many of us, pills are a miserable flop, as are shock therapy and its memory annihilation, other electronic interventions, even holistic treatments like acupuncture or Omega 3 supplements. Talk therapy sometimes offers relief. But a cure? Nowhere on the horizon.
So what's left? For some of us, death. And yet, even in death, those with mental illness in Canada are denied a voice.
A 43-member panel assembled by the Council of Canadian Academies advised the federal government with recommendations on three levels of Medical Assistance in Death, one of which includes the still-illegal MAID for the mentally ill. In an earnest and responsible foreword to the three reports, the Council extolled the breadth of the expertise of the panel members: "The CCA was mindful of the need to gather abundant expertise for this project: we invited specialists with clinical, legal, and regulatory expertise to the table; we sought authoritative scholars and practitioners from the fields of law, medicine, nursing, mental health, bioethics, anthropology, and sociology; and we included input from Indigenous elders."
Great, inclusive list, eh? But would I cast my fate to this group's whims? No way. The elitism implicitly demonstrated by the Council is, if I may use what I think is an apposite cliché, another nail in the coffin of progress for the mentally ill.
Why?
Take a look at that list again. Notice who's NOT on this life-or-death panel. Not one person with a mental illness. Not one caregiver. Not one loved-one who has seen the torture endured by their kin.
The hubris of many mental health professionals is profound. Frightening. They demonstrate a distressing ignorance not just of those of us who suffer from mental illness, but of mental illness itself.
Many on the panel averred that loss of hope is merely temporary and can be restored over time, which defies reality. Loss of hope when you're suffering cruelly and there is no cure is a terminal knell. That's what depression does. That's why people kill themselves.
I've known at least five souls who lost hope. And with hope so went their dignity and their reason to live. Daryl couldn't get a job, the rejection gutted him. He was bipolar and very sick. No-one could ease his pain. No-one, no treatment, could give him any hope. Daryl took his own life.
If you're thinking about suicide or are concerned about someone, there are people you can talk to:
- In an emergency situation, dial 911
- Crisis Services Canada: 1-833-456-4566, text 45645, chat at crisisservicescanada.ca
- In French, Association québécoise de prévention du suicide: 1-866-APPELLE (1-866-277-3553)
- Kids Help Phone: 1-800-668-6868, chat at kidshelpphone.ca
Utter loss of hope, dignity, and self-esteem are not clinical aberrations. They cannot, must not, be cavalierly dismissed as "easily treated conditions."
They're brutal realities of the viciousness of depression. And they defy the pious assertions of academics and panels and medical journals.
It's not for their own amusement that psychiatrists sugar-coat incurable refractory depression as "treatment-resistant depression." No. They do it because it means they're at the end of the road for their pills, potions, chatter, and zapping. There's nothing left.
Of course, most refuse to admit this unpalatable and potentially deadly fact, because it exposes their helplessness.
In its Jan. 27 submission to the Department of Justice on the consultations around MAID, the Centre for Addiction and Mental Health (CAMH) alludes to what many say is necessary – a painstaking approach to considering the implications of MAID for people with mental illness by all those involved, especially government and academics.
But in its statement on assisted dying legislation and mental illness, it reaffirms that false assertion that "there is always the hope of recovery."
This point is appended by an expert at the National Institutes of Health. In a 2017 panel discussion co-hosted by CAMH, he said that for those with mental illness, with proper treatment, the desire to end one's life may abate.
May? How very scientific.
Those who oppose MAID for those with mental illness on these grounds are saying that when there's no hope of relieving the suffering, we'll pretend just the opposite — duplicity and pretence instead of the incontrovertible truth. This patient has the need and should have the right to die, but we medical gods aren't gonna do it. Our oath says "Do no harm," so we can't unless it's a terminally ill cancer patient — then it's okay, that shows compassion.
The mentally ill? We'd like to, but it's not the same.
So no compassion, no relief — unless the sufferer is then forced to die by suicide. This is one of the most undignified ways of dying, with botched attempts, finality by often brutal methods like guns and ties and trains, followed by shock and intolerable pain for unprepared loved ones.
That's the reality of denying MAID for the mentally ill.
- This column is part of CBC's Opinion section. For more information about this section, please read our FAQ.
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