The legalisation of assisted dying in Canada may start a chain of events that will culminate in the premature death of non-terminally ill psychiatric patients who are already vulnerable, experts argued.

The country has recently seen the passing of a bill that allows physician-assisted dying for patients with “grievous and irremediable” illness. However, there is no clear definition as to what constitutes this criterion.

Bill C-14 restricts “grievous and irremediable” to terminally ill patients for whom “natural death has become reasonably foreseeable.” On the other hand, the Parliamentary Special Joint Committee on Physician-Assisted Dying proposed inclusion of patients with non-terminal medical conditions such as psychiatric disorders.

“There is a gap between the idealised basis upon which medical assistance in dying is advocated for patients with psychiatric conditions and the reality of its practice,” said Drs. Scott Kim and Trudo Lemmens in a commentary published recently in Canadian Medical Association Journal. Scott is a physician and bioethicist at the National Institutes of Health, while Lemmens is a professor at the University of Toronto Faculty of Law & the Dalla Lana School of Public Health.

Although discourses concerning eligibility among psychiatric patients limit access to physician-assisted dying for those with severe refractory depression, real world evidence suggests that this is not the case, they said.

In Belgium and the Netherlands, where assisted dying is legal, physicians extend medical assistance to patients with posttraumatic stress disorder, chronic schizophrenia, autism, personality disorders, severe eating disorders, and prolonged grief in some cases, they noted.

“A policy for access to assisted dying by non-terminally ill patients with psychiatric conditions will put many vulnerable and stigmatised people at risk,” they said.

They questioned the assumption that physicians always make accurate eligibility evaluations and that no ineligible patient may receive assisted dying. This was in consideration with the findings of Belgian and Dutch euthanasia review bodies that physicians almost never breach the due care criteria, with failure to meet the criteria only occurring in 1 out of more than 10,000 recorded euthanasia cases.

In a recent survey of 1,517 Canadians, less than a quarter of respondents or 22 percent supported legalisation of assisted dying for psychological conditions. In a similar survey in the Netherlands, 1 out of 3 healthcare professionals and 28 percent of the public gave their approval.

"Perhaps those who advocate for extending access to people with psychiatric disorders may be willing to tolerate a number of potentially avoidable premature deaths as acceptable because access to assisted dying is felt to be so important in principle. However, that argument must be made explicit and debated publicly," Scott and Lemmens said. MIMS