In the Carter v. Canada case, the Supreme Court of Canada ruled that consenting and competent adults suffering from serious and irreversible medical conditions should have access to some format of medical assistance in dying [1]. Most Candians support medically assisted dying for patients with terminal/physical illnesses that often lead to some form of physical decline. In fact, a 2016 Angus Reid poll found that 90% of Canadians believe that some form of assisted dying should be legalized in the healthcare system [2]. However, the same poll found that Canadians perceive a clear distinction between psychological suffering and physical suffering, as nearly 75% of respondents agreed that assisted death should be granted to patients with non-terminal injuries/diseases that are in severe physical pain, whereas almost 80% believed that individuals suffering from psychological illnesses should not have access to assisted suicide [2]. The topic of allowing similar access to assisted dying for patients suffering from severe mental disorders is considered extremely controversial and a source of tension for many individuals in Canada [3].

There are many different forms of euthanasia that are dictated by actions a doctor takes (or doesn’t take) and a patient’s consent. In an essay published in the New England Journal of Medicine, ethics and animal rights philosopher James Rachels stated that active euthanasia is where a doctor does some form of “direct action designed to kill their patient” (assisted suicide/dying) [4]. Passive euthanasia is the act of witholding life-prolonging treatments, allowing the patient’s death to take its natural course (it is the absence of life-saving action) [4]. Euthanasia can also be voluntary, involuntary, and/or nonvoluntary. Voluntary euthanasia, the most common for of euthanasia, is when a person give consent to be euthanized. Involuntary euthanasia is when someone who does not want to die is put to death (a form of murder). Nonvoluntary euthanasia is when a person is when a person is put to death without their wil (e.g., taking a comatose patient off of life support).

In an assessment of the legal and ethical dilemmas of euthanasia, forensic psychiatry professor Alexander Ian Frederic Simpson explains the perspective of those opposing euthanaisa for people with mental illness. These proponents would argue that mental health disorders cause people to make distorted judgments and that suicide is often a desperate step made by those who consider their situations to be hopeless and irreparable [5]. These arguments against allowing people with mental illness to be euthanized are true, in some cases. However, it is questionable to deny everyone with a mental disorder the “right to die” based solely on these reasons. It is often inaccurate to equate having a mental disorder to not being sane or of sound mind. In reality, there are plenty of mental disorders that cause mental suffering to a person while leaving them fully rational to make decisions for themselves and others (e.g., depression, anxiety, eating disorders, etc.) [5].

Dr. Simpson points out that another reason why individuals are against euthanasia for people with mental illness is because they themselves cannot justify wanting to die due to mental suffering [5]. It is far easier for people to understand someone’s desire for death when they are in constant pain, with medication having little to no effect in relieving their distress, compared to when a person is suffering mentally. This is especially true when the individual did not suffer through a (mentally) traumatic event to cause the mental disorder in the first place (e.g. traumatic event(s) that cause PTSD). With physical illnesses, we can see what is happening to one’s body and sometimes imagine what they are going through to the point in which we physically “feel” the pain they are experiencing (to a certain degree). Mental illnesses do not always have physical manifestations meaning most people who have a mental illness are able to conceal their disorder from others. Some even taking drastic measures to do so in order to avoid stigmatization and discrimination from the general public.

When the argument for assisted suicide is proposed for people with mental illness, the focus is largely geared towards severe depression [1]. This focus, however, has proven to be too narrow and fails to take into account other mental disorders that are real (physical and mental) threats to patients with mental illness [1]. If psychiatric conditions were to be considered in terms of assisted dying, severe depression would not be the only mental disorder that would be examined [1]. An example of this comes from Belgium and the Netherlands, medically assisted suicide is being provided to people with chronic schizophrenia, posttraumatic stress disorder, severe eating disorders, autism, personality disorders, etc. [1]. Most people (with a mental illness) that request assisted suicide have compromised abilities to cope with adversity [1]. This in turn causes them to suffer as they do not know how to manage difficulties that occur in their lives. Jeanette Linda Hewitt, a nursing professor at the University of Swansea and a registered mental health nurse, defines suffering as “any enduring experience of pain or distress that significantly impairs a person’s subjective satisfaction with his or her quality of life [2].” This definition of suffering illustrates that the impairments caused by mental illness are just as harmful as the one’s caused by physical illness [2]. The suffering caused by depression or PTSD can be just as bad, if not worse than that caused by cancer and should not be dismissed or downplayed [2].

Mental illness affects people to varying degrees and not everyone will (knowingly) suffer from a mental disorder or explicitly know someone that does. Due to subtle and often overlooked symptoms of mental illness, those not affected have a hard time sympathizing with mental suffering and don’t holistically understand the pain it causes. Based on this inability to understand the adversity people with mental illnesses face and misinformation of the capability of rational thought from individuals with mental disorders, the public often believes that people with psychiatric conditions do not/should not be given access to medically assisted suicide. The “right to die” is a component of a person’s right to bodily autonomy. Yet, this concept repeatedly excludes individuals with mental disorders.

References

1. Kim, S. Y. H., & Lemmens, T. (2016). Should assisted dying for psychiatric disorders be legalized in canada?. Canadian Medical Association Journal, 188(14), E337-E339. https://dx.doi.org/10.1503%2Fcmaj.160365
2. Tanner, R. (2018). An ethical-legal analysis of medical assistance in dying for those with mental illness. Alberta Law Review, 56(1), 146-179. https://doi.org/10.29173/alr2500
3. Yarascavitch, A. (2017). Assisted dying for mental disorders: Why Canada’s legal approach raises serious concerns. 1-30. https://ssrn.com/abstract=2988535
4. Rachels, J. (1975). Active and passive euthanasia. The New England Journal of Medicine, 292, 78-80. https://sites.ualberta.ca/~bleier/Rachels_Euthanasia.pdf
5. Simpson, A. I. F. (2018). Medical assistance in dying and mental health: A legal, ethical, and clinical analysis. Canadian Journal of Psychiatry. 63(2), 80-84. https://journals.sagepub.com/doi/10.1177/0706743717746662