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Opinion: Treatment, not assisted death, for mentally ill people

With the passage of Bill C-14 last year, medically assisted death, or assisted suicide, has become a reality for physically ill patients with intolerable suffering and for whom death is “reasonably foreseeable.”

The federal government is now exploring whether we should expand access to medically assisted death to include those suffering from mental illness. While the aim of reducing suffering for the mentally ill is a laudable one, the right road to take is far from clear.

Most Canadians support the concept of assisted suicide, originally based on the need to provide compassionate care for those with end-stage cancer or progressive neurological diseases. In the Netherlands and Belgium, the original “physical illness” concept now includes those suffering from mental illness or dementia, and recently has included children as eligible for medically assisted death. People living with autism, intellectual disabilities and early stage cognitive decline have been helped to die, with little oversight and review, as over 99 per cent of requests are granted.

In the current debate about medically assisted death for those suffering from mental illness, Canadian health-care providers have been unusually silent. Given the political undertones of this debate, this reluctance to speak out is not so surprising. We as a group typically regard ourselves as socially progressive and patient-centred, but those who have publicly expressed concerns have often been cast as regressive, patriarchal professionals who do not care about the suffering of their vulnerable patients. This political reframing of the debate does little to facilitate meaningful dialogue.

As a psychiatrist with a long record of promoting the rights and well-being of my patients, I understand that suffering does not need to be physical, and the anguish that I have seen in my patients with severe mental illness is powerful, no less so than the suffering I have seen in patients with terminal physical illness.

But my concern is that those studying this issue will be looking at it from a narrow perspective. I worry that they will quickly arrive at the “obvious” conclusion that those with mental illness need the option of euthanasia and assisted suicide to end their suffering in the same way as do those with “physical” illness. The reality is that this is a much more complex issue.

Many with severe mental illnesses such as depression, bipolar disorder or schizophrenia suffer from uncontrolled symptoms, anguish, suicidal thoughts and meaninglessness in their lives. Comprehensive treatment includes specialized individual or group therapies, community treatment programs, along with medications. These treatments are effective and can lead to dramatic reduction in symptoms and a much-improved quality of life. But many patients do not have access to treatments beyond a prescription and out the door. It is not surprising to see that they have poor outcomes, resulting in anguish and despair.

In the same way that proper access to palliative care improves the quality of life and reduces suffering for cancer patients, proper treatment for mental illness is also effective in improving quality of life, reducing symptoms and suffering and helping people find meaning in their lives.

The predicament is that these treatments are expensive to provide, and our governments have not been willing to provide sufficient funding that would ensure access to treatments that are truly effective.

There is now a call to make medically assisted death available to those with mental illness, seeing this as a socially progressive step forward. But isn’t a more progressive and patient-centred agenda one in which we first demand that our governments be held accountable for withholding funding of effective treatments that actually help patients live good and meaningful lives?

Unfortunately, the political equation is that it costs a lot less to help people with mental illness die than it does to help them live.

Warren Steiner is past psychiatrist-in-chief of the McGill University Health Centre and an associate professor of psychiatry at McGill University.