This article discusses mental illness and suicide and may be triggering for some readers. The Canadian Mental Health Association Crisis Line can be reached at 1-800-875-6213.
Canada’s aim to expand its Medical Assistance in Dying (MAID) laws to include mental health poses significant controversy, especially concerning those living with addiction. I believe that this decision would be an oversight from the government.
MAID was intended as a last resort to mitigate discomfort during one’s end of life care and requires informed consent. Informed consent is a major ethical concern in medicine, and must be approached with caution, especially when navigating MAID for individuals with suicidal ideations or substance use addictions.
Not only can suicidal ideation affect one’s capacity to make fully conscious decisions, but many ethicists are concerned those that might refer to MAID may be under the influence when giving consent. This could mean impaired cognition, and by extension, impaired consent.
More research should be done to ascertain whether there’s a true public desire for MAID to expand to those with substance use addictions.
Dr. David Martell, a physician and MAID provider, previously stated none of his patients have expressed the want to utilize assisted death, and cited it as the last option he would consider when providing care.
Many of those who struggle with substance abuse don’t get the adequate care they require due to their vulnerable population status. For instance, a 2013 study conducted in Saskatoon highlighted that despite many successful services, there are four major barriers preventing those who use drugs from accessing care: inefficient use of resources, stigma and discrimination, inadequate education, and the unique contextually sensitive nature of those who inject drugs.
Instead, the time and resources spent developing a framework for MAID laws should be redirected on improving both upstream and downstream treatments of substance use addictions, and these treatments should include overdose prevention sites, better access to opioid methadone treatments, improved housing and employment, and contextually relevant educational programs.
—Sina Sayyad, Assistant Lifestyle Editor
The Canadian government’s decision to expand the MAID law presents a dignified option to confront suffering experienced by individuals trapped in the cycle of addiction. Allowing these individuals to access assisted suicide is, in itself, an act of compassion. This extension recognizes a profound struggle and empowers individuals with support when making a deeply personal decision about their lives.
A compassionate approach embraces the harm reduction philosophy. Mental illness and substance use disorders are the leading causes of disability in Canada. Instead of pushing those with addiction to the margins of the Canadian healthcare system, the government can ensure the process is regulated, safe, and carried out under the supervision of medical professionals. This would serve as the antithesis of situations where addicts might resort to dangerous and high-risk methods to end their suffering.
It’s estimated 67,000 deaths per year are attributed to substance use in Canada. In Ontario, the disease burden of mental illness and substance use is 1.5 times higher than all cancers combined and more than seven times higher than all infectious diseases. The Canadian Government’s decision to exclude substance users from MAID legislation won’t lessen this death toll, nor will it explicitly incentivize users to get clean and live longer lives.
Substance use, like any other debilitating disease, doesn’t render an individual any less of an autonomous human being. This condition causes physical deterioration, mental anguish, and social isolation.
The Canadian government should still take a proactive approach to treat and rehabilitate addicts and resorting to medically assisted suicide should only be utilized in the eleventh hour, like it would be for anyone else undergoing the MAID process. However, denying an entire demographic of safe, responsible, healthy, and supervised alternatives to an abhorrent condition is unethical.
—Cordelia Jamieson, Contributor
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