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Medical Assistance in Dying (MAID)

 Medical Assistance in Dying is Canada's new law, effective March 17, 2021. Dying with Dignity explains it well.

Eligibility for persons suffering from mental illness

Canadians whose only medical condition is a mental illness, and who otherwise meet all eligibility criteria, will not be eligible for MAID until March 17, 2023. This includes conditions that are primarily within the domain of psychiatry, such as depression and personality disorders. It does not include neurocognitive and neurodevelopmental disorders, or other conditions that may affect cognitive abilities.

This temporary exclusion will provide the Government of Canada with more time to study how MAID on the basis of a mental illness can safely be provided and to ensure appropriate safeguards are in place to protect those persons. To support this work, the law requires the Ministers of Justice and Health to initiate an expert review, which will be tasked with considering protocols, guidance and safeguards for MAID for persons suffering from mental illness, and to make recommendations within the next year (by March 17, 2022).

Other issues

Other outstanding important questions related to MAID—such as eligibility of mature minors, advance requests, mental illness, palliative care and the protection of Canadians living with disabilities—will be considered during a Parliamentary review of the MAID legislation that would commence within the next 30 days. The committee responsible for the parliamentary review process will be required to submit its report to Parliament no later than one year after the start of the review.

Yet another bit of GoC news.

I find the delay in in this legislation to be abhorrent. There are no doctors, especially psychiatrists, who are going to sign away on a MAID just to alleviate someone's mental suffering and, perhaps, their desire to die by suicide.

I am one of the people who will be affected not only by the mental illness aspect of the legislation, but also an advance request for the procedure. Bipolar disorder is a progressive, brain disease. Each mood swing or episode (manic, hypomanic, depressed) causes more damage to the brain. This will eventually lead to a dementia-type of illness that will leave me incapable of communicating or caring for myself. At the point when I am no longer able to care for myself, I will also be beyond the threshold of making a decision for MAID. Without advance requests, or the capability of my guardian to request the same, I will be left to suffer, my family slowly coming less and less, sitting in a chair, looking out a window, waiting for death. The worst part is that I would have the choice for MAID if not for my mental illness. 

The underpinning of MAID

The fundamental underpinning of all MAID requests is supposed to be the presence of “a grievous and irremediable medical condition.” The blunt and indisputable reality is that, unlike for much more predictable medical conditions with better understood biologies, it remains currently impossible to predict whether mental illness is irremediable.

The Centre for Addiction and Mental Health has concluded: “There is simply not enough evidence available in the mental health field … to ascertain whether a particular individual has an irremediable mental illness.”

After 15 months of studying global evidence, the Council of Canadian Academies came to the same conclusion, as did the Expert Advisory Group on MAID. Both the American Psychiatric Association (APA) and Royal Australian and New Zealand College of Psychiatrists (RANZCP) have also concluded that there’s no evidence to support providing MAID solely for mental illness.

Do any of the people debating MAID have mental illness? Have any people with mental illness been consulted on what they think? People who are stable in their diagnosis and are able to form a full sentence (I'm being facetious because I hate how mentally ill people are automatically assumed to be idiots). Is society not comfortable enough with the competencies of our doctors in being able to make a decision on whether a mentally ill person has other co-morbidities that would preclude them from MAID?

Here is an infographic comparing suicide vs MAID.


Here is an infographic giving an overview of the MAID program.





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