Assisted dying for patients with psychiatric disorders

The article by Kim and Lemmens contains several important errors and omissions.1

First, it was Carter, not just the Parliamentary Special Joint Committee on Physician-Assisted Dying, that stated that patients are not required to accept all treatments to be considered “irremediable.”2

Second, the authors failed to reference the judgement from the E.F. case, heard by the Alberta Court of Appeal, which confirmed that Carter neither requires that death be “reasonably foreseeable” nor excludes people with primary psychiatric illness.3 E.F. was granted access to medical assistance in dying (MAID) by three judges, based exclusively on a psychiatric diagnosis.

Third, Kim and Lemmens reference a study stating that “most” patients with depression achieve remission if given high-quality treatment; however, that “most” was only 60.2%.4 We cannot ignore the remaining 39.8%.

Finally, the authors imply that MAID in refractory mental illness would only be acceptable with a zero error rate. Nowhere else in medicine do we require zero risk of error. Unnecessary deaths are tragic; yet so is the counterpart: ceaseless unbearable pain, deplorable quality of life, and loss of self. It is not MAID, but rather denying MAID, that puts “many vulnerable and stigmatized people at risk.” Without MAID, the most irremediable but competent patients would be consigned to years of suffering or a horrific death by suicide.

We must recall the intent of Carter and should trust doctors and patients to make careful decisions, collaboratively, that honour patient autonomy and reduce suffering in the most ethical manner.