With the start of National Suicide Prevention Week, we can expect a chorus of federal politicians releasing boilerplate statements about the importance of seeking help if you are depressed or suicidal.
This year more than ever, those statements will ring hollow. And not just because of the absence of meaningful federal supports for mental health, but because the federal government now looks to facilitate suicide — not prevent it.
At least, that’s what one would assume with the looming expansion of Medical Assistance in Dying (MAiD) to those whose sole condition is mental illness slated to come into force March 17, 2024.
The federal government’s decision raises serious ethical questions, distinct from MAiD in the context of palliative care. People living with mental illness are not dying, and as such, are not being “assisted in dying.” They are being assisted in suicide.
This decision will bring substantial challenges to our capacity to prevent suicide. Imagine an individual speaking with their physician about their suicidal intention on March 16, 2024. Under existing standards, they would likely be admitted for emergency psychiatric care. But had their appointment been the next day, they might be assessed for MAiD eligibility.
To offer MAiD for mental illness is particularly perverse in a country that does so little in terms of mental-health care. In Canada, wait times for psychiatrists can range from months to years and access to psychotherapy and pharmaceuticals remains unaffordable for many.
In addition to facilitating the premature deaths of vulnerable people, the government is implicitly saying that suicide is a legitimate option for those who no longer feel life is worth living. We cannot presume to know the social impact this implicit endorsement will have on Canadian society.
None of this suggests that those who consider suicide do so without reason. Their lives may seem bleak, their pain feels unbearable, and their hope is gone. In desperation they may ask and plead for a way out. The government has opted to offer a sanitized form of what is inherently a violent act.
Suicide has always carried several uncomfortable disincentives: it may be frightening, it may be violent, it may not work, and your loved ones may be the ones to find you. In a time of great mental anguish, these can serve as the guardrails needed for an individual to choose life, or at least not to choose death. In other words, suicide needs to be difficult.
By outsourcing suicide to health-care providers, we remove these barriers and create a seemingly favourable alternative to the suffering of mental illness. Add in the prospect of donating one’s organs to the sick, and we have given a tragic act of self-harm the patina of moral self-sacrifice.
Anyone working in mental health will have heard testimonies from patients of how these barriers are in fact the reason that person is still alive and that they are grateful these barriers existed. We will never hear the testimonies from those who opt for MAiD for mental illness. We will never hear from those who would regret it.
One might ask why people suffering so deeply shouldn’t be allowed to end their life. No one is arguing that people cannot end their life — rather, that those of us fortunate enough to see the value in life have a responsibility to support and protect those who have lost sight of it.
There are also serious issues with the eligibility criteria. Can someone wanting to end their life even provide informed consent? Likewise, it is impossible to predict whether a mental illness is in fact irremediable. There are near infinite combinations of medical, pharmaceutical and psychotherapeutic treatments. Saying nothing of spontaneous remission or the prospect of emerging treatments that will prove effective.
It is not too late for the government to change course and to take suicide prevention seriously. Until then, we can tell our friends and family we love them, that they matter, and that we are grateful they are in our lives.
Justin Bergamini is a registered psychotherapist based in Ottawa.
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