Kaitlin Deans
Dr. Geoffrey Emerson
IDMD 101-004
6 Oct 2023
Physician-Assisted Suicide in Canada
In 2016, Canada implemented a national law that prohibits physicians from suggesting Medical Assistance in Dying (MAID) to patients that only suffer from mental illness. Currently, the rule stipulates that the only patients eligible for MAID are those who are older than 18 and have a serious and incurable condition that will lead to death. However, a physician at a Vancouver hospital recently offered MAID to a patient suffering from chronic depression and suicidal thoughts. I was unable to find the original Canadian report, but there is no mention of the patient having any physical ailment.
This means that a physician in Vancouver broke Canadian law by offering assisted suicide to a patient who was suffering purely from a psychiatric diagnosis. This could set a precedent of physicians ignoring the law in order to give a treatment that may or may not be right morally or legally. Not only that, but it could even harm the patient further by giving them a sense of hopelessness that a professional believes it is futile to help cure them.
This touches on informed consent, because the law states that in Canada, patients who only have a psychological problem with no physical underlying condition are ineligible for physician-assisted suicide. Not only does offering the treatment to an ineligible patient make them think that they are eligible, but patients who are receiving this as an option (psychiatric patients with no terminal physical condition) are not generally considered mentally sound enough to make this kind of decision for themselves.
It also touches on medical futility, because only patients who have a terminal physical condition may be offered the treatment. This better defines what Canada believes is a medically futile case; patients with psychiatric disorders, even those that are severe, are not considered futile and therefore cannot receive the treatment.
A patient could misconstrue this as the physician thinking they are a medically futile patient, which could lead to a hopeless mindset due to the idea that a so-called expert in health does not believe they will get better. If a medical professional that society tends to idolize doesn’t believe a patient will get better, then why should they believe they will? I realize that isn’t the case with every patient, but there are those who would give up hope based on everyone around them giving up too. This could push them to attempt to end their own life through unsafe means, which is why many doctors discuss the option with the family first, before bringing it up to the patient.
This could also lead to misinformed consent because the patient is now considering a futile option rather than the viable options they actually have. Once someone in the hospital realizes the patient’s situation and that this is the treatment being offered for that situation, it will no longer be on the table. Not only is a doctor projecting their view of futility on a patient and thus affecting the outcome of their treatment considered paternalism, but it can also fall under lying to a patient because they are telling them of an option that they can’t actually use.
More often than not, those two seem to go hand in hand. If a doctor wants to override a patient’s free choice, whether they have a sound mind or not, it is very easy for the doctor to misrepresent statistics or even omit information altogether to influence a patient’s decision towards what the doctor wants them to do.
From a patient’s perspective, offering this treatment to a patient and their subsequent acceptance or denial of the treatment would depend largely on their personal beliefs, both surrounding the treatment itself and the law. Some would refuse to accept the treatment on religious grounds, or they would refuse the right of a doctor to give it in the first place. Some would accept the treatment, especially if they have planned it for a while (as in the case of someone with progressive illness). Finally, though it seems paradoxical and is likely very uncommon, I believe that it is possible for patients to refuse the notion that a doctor should offer it, but since they are offering it accept the treatment anyways. Overall, if they are of sound mind, the doctor must accept their beliefs and choice, otherwise they would be engaging in paternalism.
The average public reader’s response to this would be dependent on their beliefs. They could lose trust in the medical field for giving patients a treatment that they do not believe in, or they could be perfectly okay with the treatment because they agree with the practice. Furthermore, if a patient is aware of the law surrounding MAID, they might lose trust in their doctor because they would see the doctor ignoring the law to advise them in care that they can’t receive. If a patient is unaware of this law, depending on the severity of a patient’s psychological state, they still cannot make an informed decision on this, and this treatment could hurt them in the long run. This brings up a different legal issue in not gaining informed consent before treatment, which could lead to lawsuits and loss of license.
As I am discussing the average reader, I should clarify my opinion on the subject, and how my opinion and that of a reader might differ. As far as I am concerned, I believe that since there is little understanding of psychological disorders and how to truly cure them, Canada’s approach is logical, and I can understand it. For personal and religious reasons, I would never give MAID as a treatment, but I would still discuss it with the patient and refer them to a physician who would give it to them, assuming the patient is of sound mind and has discussed this at length with me and the other medical professionals involved in their care.
This article could help close the expertise gap between patients and doctors because it emphasizes how most patients know their own bodies better than a doctor does. This is instinctive to most mentally sound patients, and it has even been a cause of debate between doctors and individual patients in a wide variety of settings. In most cases, if a patient is mentally sound, they are the ones to make the ultimate decision about treatment, not the doctor. If the doctor believes the patient not to be of sound mind, then the patient cannot make an informed decision and it is decided that the doctor (in the absence of family and emergency contacts) is in a better position to make that decision for them. This, I believe, is Canada’s reasoning behind imposing such a law that only patients with futile physical ailments can even be considered for the treatment.
Works Cited
Kornick, Lindsay. “Vancouver hospital discusses ‘medical assistance in dying’ treatment to suicidal patient.” Fox News, https://www.foxnews.com/media/vancouver-hospital-discusses-medical-assistance-dying-treatment-suicidal-patient. Accessed 6 Oct 2023.