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Medical assistance in dying for people with mental illness is divisive

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Psychiatrists fear abuses linked to the expansion of medical assistance in dying.

The Canadian Press

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The federal government's intention to expand medical assistance in dying (MAID) to people with mental illness continues to divide despite a one-year pause intended to establish adequate protections for patients as well as guidelines for healthcare personnel.

Hope is what kept Laurel Walker alive as suicidal thoughts overwhelmed her. If Canada moves forward with plans to expand medical assistance in dying to people with mental health disorders, people struggling with the same darkness would be deprived of access. #x27;hope, she believes.

People in favor of expanding medical assistance in dying, scheduled for March 17, argue that providing medical assistance in dying to people with medical conditions physical illness without granting the same rights to people suffering from an incurable mental illness constitutes a form of discrimination based on disability. Opponents counter that there is not enough evidence to predict whether or not a person will recover from mental illness.

Recent comments from Ottawa suggest enlargement is not a certainty. Justice Minister Arif Virani said on Wednesday the cabinet would take into account the opinions of a committee of medical experts and other stakeholders before deciding whether the government will move forward. x27;before March 17.

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Federal Minister of Justice Arif Virani (File photo)

Walker's biggest concern is that vulnerable people are stuck on long waiting lists and cannot afford to pay for psychological care that is not covered by government programs.

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There is a disconnect and, for this reason, I think it is irresponsible to move forward with the ;medical assistance in dying in certain cases of mental illness.

A quote from Laurel Walker, a Halifax resident who suffered from mental health disorders

Ms. Walker is a 44-year-old Halifax resident who suffered from depression, anxiety and post-traumatic stress disorder for 20 years before being hospitalized. She does not want MAID to be extended next March to people whose only medical problem is mental illness.

Her struggle with depression began in high school, but she said the care she needed was not available in her home province of Nova Scotia. It took him about 20 years to get treatment at a private hospital in Ontario.

I attempted suicide in 2005. I ended up in hospital. I wouldn't have been able to make a rational decision, but I could have applied for MAID soon, said Ms. Walker, who added that she wouldn't have been able to do so soon. has required no mental health services in the public system since completing treatment ten years ago.

I remember my dark times and it was hopeless. The fact that I considered ending my life and tried is terribly sad to me. People who have a mental health problem, who would even consider medical assistance in dying, suffer enormously.

A quote from Laurel Walker, a Halifax resident who suffered from mental health issues

Allow medical assistance in dying without Adequately funding the treatment of people who are at risk of repeatedly ending up in emergency rooms is tantamount to saying there is no hope, she said.

Canadians have had access to medical assistance in dying since 2016 for physical illnesses or incurable disabilities. Since 2021, following a decision by a Quebec court, the law no longer requires that the natural death of a person be reasonably foreseeable.

As for people with mental illness, they were to become eligible from March 2023, to give time for a group of experts on mental illness to make recommendations.

However, the expansion was suspended last February for a year after some national psychiatrists and groups, including the Center for Addiction and Mental Health (CAMH) Toronto, the largest university psychiatric hospital in the country, expressed their concerns, particularly about the need for better access to care.

Since then, a curriculum has been introduced to guide MAID assessors and providers.

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The Center for Addiction and Mental Health in Toronto (CAMH)

A parliamentary committee on MAID, which is expected to submit its recommendations to the Senate and House of Commons by January 31, reconvened in November when it heard the testimony from experts, particularly psychiatrists, who want an indefinite cessation of MAID for people with mental illness.

A commonly expressed concern was that doctors and nurse practitioners use their personal values ​​to assess patient eligibility. It is also difficult to distinguish a request for MAID from a person who wishes assisted suicide, we argue.

The Center for Suicide Prevention says there is a need to reach consensus on the definition of irremediable for any mental disorder affecting people who are not dying.

In a statement sent by email Friday, CAMH said it was pleased that the government is considering delaying the expansion of eligibility for medical assistance in dying to people whose only medical condition The underlying underlying condition is mental illness.

At present, the health system is not ready and health care providers do not have the resources they need to provide high-quality, standardized, and equitable MAiD services.

A quote by Dr. Tarek Rajji, Chair of the CAMH Medical Advisory Committee

However, Dr. Konia Trouton, president of the Canadian Association of MAID Evaluators and Providers (CAEPA), argues that the training program on medical assistance in dying, which includes a section on mental illness, will help doctors and nurses determine if a person is seeking suicide.

We believe the health system is ready for [next March], when we anticipate the current restrictions will be lifted, Dr. Trouton said in an email Friday.

ACEPA, as an organization that represents the professionals who do this work, believes that clinicians are ready, argued this family doctor who has been an assessor and provider of the x27;MAID in British Columbia, Alberta and Ontario.

Physicians and nurse practitioners new to MAID would benefit from 27 hours of online training as well as 12 hours of workshops. Those with experience benefit from six hours of training, Dr. Trouton specified in a previous interview.

The program trains clinicians to differentiate between an acute concern for suicide and a request for assistance in dying by taking into account the type of treatment the patient received and whether the person tried to help themselves. going out, especially with medication, for an appropriate length of time, detailed Dr. Trouton.

People whose death is not reasonably foreseeable must already be assessed by two independent doctors or nurse practitioners. If neither party is an expert in the applicant's state of health, the applicant is required to consult a specialist. The same guarantee will apply to people who suffer from mental illness, said Dr. Trouton.

Dr. Jitender Sareen, head of the department of psychiatry at the University of Manitoba, said he and many of his colleagues believe a psychiatrist should be involved in this assessment. He noted that the expert panel's draft regulatory standard did not require this measure.

Dr. Trouton said that provinces and territories could decide whether they want a psychiatrist involved in the MAID process, but that remains to be seen.

Provincial and territorial governments say they will not implement their plans until Ottawa introduces legislation. Quebec, however, prohibited the expansion of medical assistance in dying, maintaining that mental illness does not give rise to medical assistance in dying.

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Observers want psychiatrists to take part in the evaluation process of patients who request medical assistance in dying.

As for concerns about a lack of treatments, applicants would be informed of possible options, Dr. Trouton said, and those without a family doctor would be connected with a primary care provider.

A survey conducted by the Canadian Psychiatric Association in 2020 showed that 41% of responding members agreed or strongly agreed that people with mental illness should be considered eligible for MAID. The survey was sent to 2,056 members and 474 responded.

Dr. Sonu Gaind, Head of Psychiatry at Sunnybrook Health Sciences Center in Toronto is among those opposing the expansion of medical assistance in dying.

He stated that Belgium has legislative requirements for appropriate care and that there must be no reasonable alternatives before a person is admitted to receive MAID but that Canada does not has no such warranty.

He highlighted that data from Europe suggests that women with mental illness, particularly those marginalized by social suffering due to poverty, lack of housing and shortage of community support, would be at greater risk if medical assistance in dying were expanded without strong legislative safeguards.

The federal government said in 2021 that it would better track who has access to medical assistance in dying and how it is provided. However, no such information was included in the latest annual report on MAID, published in October, which showed that 13,241 people died due to MAID last year. last.

Health Canada said it is working with provinces and territories to collect data on services – including psychological monitoring and accommodation – that were offered to people when they were assessed for MAID.

This new data will be included in future annual reports , the agency said in an email.

If you are thinking about suicide or if you are worried about a loved one, counselors are available to help you anywhere in Quebec 24 hours a day, seven days a week.

Telephone: 1 866 CALL (277-3553)

Text: 535353

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