Psychological aspects of medical assistance in dying: A personal reflection.

Abstract

Bill C-14 introduces a new era in end-of-life care by permitting death to be hastened through medical assistance in dying (MAiD). This article reviews those aspects of MAiD that are of particular relevance to psychologists, as seen through the perspective of the author's research. It includes a brief overview of the major legal cases that led the Supreme Court of Canada to overturn the laws against assisted suicide. It addresses such issues as the prevalence of the desire for death in the terminally ill, reasons for requesting MAiD, the concept of "intolerable suffering," and the association between MAiD, depression, and suicide. Findings from the Canadian National Palliative Care Survey are highlighted, which document the attitudes of patients receiving palliative care for cancer. Data from the Netherlands, Belgium, and Oregon are also reviewed briefly and contrasted; differences in the incidence of MAiD in these jurisdictions point to the im-portance of permitting MAiD to be provided by clinicians (euthanasia) rather than requiring patients to self-administer lethal medication (assisted suicide). It is concluded that Bill C-14 aligns with the opinions expressed by the majority of terminally ill participants in the National Palliative Care Survey. It remains to be seen whether new legal challenges will lead to the extension of MAiD to other patient groups.

Ethical issues when working with terminally ill people who desire to hasten the ends of their lives: a western perspective

“…Psychologists working with terminally-ill people should anticipate that their clients might want to talk to them about hastening their deaths. Qualitative researchers found that terminally-ill people frequently think about death, dying and suicide (Courage et al, 1993) and quantitative researchers found that 25% of terminally-ill people desire to hasten their deaths (see Brown, Henteleff, Barakat, & Rowe, 1986;Wilson, 2018). Courage et al (1993) found that they rarely mention their thoughts about hastening deaths to their supporters (also see Pallative Care Australia, 2018).…”

“…Psychologists should therefore cautiously explore their terminally-ill clients' desire to die (Gupta et al, 2005) taking into account the theories of suicide and how to interpret such ideation (see Wilson, 2018). Most terminally-ill people do not desire to die (Wilson, 2018), but some without mental health diagnoses have genuine and consistent desires to die because they are ready to die (Nissim et al, 2009) or for a variety of other reasons (Muskin, 1998).…”