Achi news desk-
Until you consider the context.
It was made by Mark Holland, Canada’s health minister, as he confirmed in February that legislation expanding the country’s remit for assisted suicide for people with “severe and irreversible” mental illness would be delayed until 2027 .
The “question here is readiness”, he said: the health care system was not ready to accept the demand and the additional complications.
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Canada already has the highest rate of assisted suicides in the world (13,241 in 2022) and in August last year the president of the Quebec commission on end-of-life care, Dr. Michel Bureau, warned in an interview “more and more. ..the cases receiving medical aid in dying are approaching the limits of the law”.
He issued a memo to doctors in the province reminding them that only patients with serious and incurable diseases causing unbearable suffering were eligible for Medical Assistance in Dying (MAID), and that applications had to be approved by two doctors .
The Bureau also warned doctors not to “shop around” for a favorable second opinion, adding that it was concerned that some doctors were being pressured by elderly patients who wanted to die but whose medical problems did not meet the criteria legal proof.
“Medical aid in dying is not there to replace natural death,” he added.
It was against this background that the plan to expand MAID was delayed.
Psychiatrists who gave evidence to government committees also warned that it would be difficult to tell whether someone had a psychiatric disorder beyond treatment and to interpret “rational” requests from those driven by suicidal ideation.
This was the second time in 18 months that the law – which was due to come into force on March 17 – has been delayed.
Meanwhile, on the other side of the Atlantic, there has been growing concern about what is behind the growing number of psychiatric-related euthanasia cases in the Netherlands – where the practice has been legal, albeit rare, for over 20 years.
In 2010, a total of 3,136 deaths by physician-assisted suicide or euthanasia were registered in the Netherlands, of which only two were in response to mental illness.
By 2023, psychiatric causes accounted for 138 of the 9,068 deaths registered – a 25-fold increase in the rate.
“The trend is undeniable,” says Sisco van Veen, a psychiatrist and end-of-life ethics researcher at the University of Amsterdam Medical Center.
“The trend is up.”
However, only 10% of psychiatric applications are granted.
Terminal cancer still accounts for the vast majority of cases (56% last year), and more than 70% of all patients are over 70 years old.
However, a series of recent high-profile cases from the Netherlands involving physically healthy young people choosing to end their lives for mental health reasons has sparked an ethical conundrum: is it an alarm bell for a failing healthcare system, or a sign that the misery of psychiatric illness is being taken seriously?
In Scotland, the debate is essentially background noise.
However, it comes as MSPs weigh up proposed legislation that could make Scotland the only part of the UK to provide assisted dying on the NHS.
The Bill – tabled in the Scottish Parliament on March 28 by Liberal Democrat MEP Liam McArthur – would limit the provision to adults who are terminally ill, of sound mind, living in Scotland for at least a year, and can self-administer the drugs until the end of their life.
Two independent doctors would have to assess the patient and approve their application.
Critics argue that when Canada’s MAID program was introduced in 2016, it was also limited to the terminally ill.
It was extended in 2021 to people living with “severe and irreversible” medical conditions following a successful legal challenge by civil liberties campaigners who argued that the previous law unfairly excluded people with long-term disabilities, such as degenerative diseases.
The “slippery slope” argument says that once you open the door to assisted dying, more and more groups of people will demand the right to walk through it.
The counter is that there are other examples – such as the state of Oregon in the US – where assisted dying has remained limited to mentally competent terminally ill adults since it came into being in 1997.
No one can predict with certainty where Scotland might end up in the long term.
The Netherlands – which legalized euthanasia in 2002 – stated from the outset that it covers “unbearable suffering without any hope of relief”, whether the cause is mental or physical.
In 2023, there were 336 cases for dementia, which falls somewhere in the middle.
It was the case of 28-year-old Zoraya ter Beek, who went viral, however, after she went public on April 1 to discuss her impending euthanasia in early May.
She said she was looking forward to being “liberated” from crippling depression, autism and borderline personality disorder after psychiatrists told her there was “nothing else I could do”.
She plans to die on her couch at home. A doctor will give a sedative, and then a drug to stop her heart.
The case has divided opinion, with some comparing the rise in such suicides to an “infection” caught by social media.
Others blame a plague of loneliness, the closure of specialist hospital units for teenagers, or “traumatic” psychiatric treatments.
Boudewijn Chabot, a psychiatrist who emphasized that he was “not against euthanasia in psychiatry or severe dementia”, added that he was nevertheless “extremely concerned that doctors are trying to solve social distress due to lack of treatment and care, by opening the gate to the end”.
NVVE, a Dutch pro-euthanasia lobby group, demands a “death wish from people suffering from a psychiatric condition [must be] taken as seriously as the death wish of people who suffer from a physical one”.
And so we get back to this strange medical dichotomy: if you accept equality, does it have to extend to assisted suicide?
Is it a dereliction of duty to enable such deaths – or a form of discrimination to deny them?
