Should doctors kill mentally ill patients who wish to die?
The rise of medically assisted death (MAID) has ignited intense debate, particularly concerning its extension to include mental health problems. While palliative sedation and end-of-life care have long been accepted norms, hastening death for individuals with mental health concerns raises serious ethical quandaries and practical implications.
Context is essential. There are historical precedents where medical interventions, such as the champagne prescribed to Russian playwright Anton Chekhov as he lay dying in 1904, were aimed at easing discomfort without raising ethical eyebrows. But the advent of MAID introduces a new dimension, where the line between alleviating suffering and hastening death becomes dangerously blurred.
Traditionally, palliative sedation, a form of medical assistance in life, has been integral to end-of-life care, focusing on improving quality of life for terminally ill patients. However, the premise of MAID diverges, advocating for the deliberate acceleration of death to pre-empt potential future suffering — a concept laden with ethical complexities.
Advocates of extending MAID to mental health conditions argue that unbearable suffering, whether physical or psychological, warrants the option of a dignified death. But the criteria for MAID eligibility in Canada — requiring a serious, incurable disease with intolerable suffering — raise questions as to whether those standards apply to mental health.
Unlike physical ailments with predictable trajectories, mental health conditions lack objective markers for prognosis, complicating assessments of eligibility for MAID.
There is little evidence that mental health practitioners understand, any better than the rest of us, motivations for death. Nor can they reliably predict which patients will continue to prefer death, not life, or which individuals will eventually recover from severe depressed states.
