A Values-Based Analysis of Recovery-Oriented Practice in Mental Health Care and Medical Assistance in Dying

Abstract

The Criminal Code of Canada has been amended to allow medical assistance in dying (MAiD) under prescribed criteria. There has been considerable debate regarding whether people with mental illness as the sole underlying medical condition should be eligible. It is argued that access to MAiD is not compatible with recovery-oriented care. Based on a comprehensive analysis exploring the ethical principles guiding decision making around MAiD, this paper offers a discussion of the compatibility between MAiD and recovery-oriented care and demonstrates significant overlap of these principles. The discussion around MAiD as an option in recovery-oriented care is legitimate and needs to continue.

Medical assistance in dying for people living with mental disorders: a qualitative thematic review

“…Whether the applicant is eligible or not, requests for MAiD-MD should be welcomed with openness and empathy, and should be considered seriously [ 70 ]. These requests can be received first as a demand for human connection and professional expertise to relieve suffering [ 70 ], but they must also be considered as real requests for assistance in dying to which it is important to respond in a meaningful way [ 42 ]. Feeling that their suffering is acknowledged and having the opportunity to talk about their request for MAiD-MD can ease the suffering of people living with mental disorders, give them hope, build trust in the therapeutic relationship, and lead them to consider new therapeutic avenues, or decrease their desire to die [ 20 , 58 ].…”

“…They may then feel helpless, which may lead them to seek MAiD-MD. This request can be well considered [42], but it can also be a cry for help in order to be seen and heard [20,70], or a request for communication [63]. The moral, cultural, or professional biases of healthcare professionals can alter the quality of the care experience [37].…”

“…A critical need is to help people live with their mental disorders before considering helping them die, which requires improving social support [ 40 ], reducing stigma [ 41 ], adapting work environments to mental health needs, and fostering a sense of community belonging [ 42 ]. It is essential to examine the legislative developments surrounding MAiD-MD [ 43 ] to ensure that the suffering of people living with mental disorders is not minimized [ 44 ] and to promote their empowerment in their care decisions as well as in their life trajectories, which may or may not include a request for MAiD-MD [ 38 ].…”

“…Among the proposed solutions, having better-resourced mental health services is necessary [16,40]. The need to show humility in the face of the limits of psychiatry in relieving mental suffering [24] is reported, and the need to improve access to mental health care and services is also expressed [34,42,45,57]. The importance of raising awareness of suicide risk and its management is mentioned too [37].…”

“…The importance of raising awareness of suicide risk and its management is mentioned too [37]. In addition, a glaring need is felt among healthcare professionals for training [42,56] and guidelines considering the complexity encountered in practice [59], and both healthcare professionals, MAiD-MD applicants, and their relatives would benefit from these resources being developed.…”