By: Hailey Miller, Staff Writer
Content warning: mentions of ableism, death, Medical Assistance in Dying, substance use.
In June 2016, Canada introduced Medical Assistance in Dying (MAiD). It provides medically-assisted death for those with chronic, terminal health conditions and patients who cannot benefit from other treatment options. As of March 17, 2024, access will be expanded to those with mental illnesses, and includes those who have a history of substance use disorders. Expanding MAiD instead of investing in other treatment options sends the message that it’s not worth the government’s effort to support these individuals, or that their struggle has no other means of treatment. This is not true in most instances. There are other support options available that should be invested in before expanding MAiD.
MAiD should only be available to patients in extreme circumstances. However, some individuals are offered MAiD when they don’t need or want it. In 2022, someone was trying to get a “wheelchair ramp installed at her home for the past five years” and was instead offered MAiD. Patients need to have complete autonomy over MAiD, and not be offered it unprompted. From 2019 to 2022, there were at least four confirmed cases of veterans being offered MAiD through Veterans Affairs Canada. An investigation took place as offering MAiD is completely unacceptable in these cases, and is not allowable through a non-medical circumstance. MAiD should not be used to devalue a disabled person’s worth or quality of living.
MAiD includes a patient being told about the process, giving informed consent, being assessed by at least two practitioners, and exhausting all treatment options where applicable. To be eligible, the individual must be mentally competent, defined as “being capable of making health care decisions for yourself.” This is to ensure informed consent — typically throughout the assessment process, as well as immediately prior to administration. In the event that someone can’t give consent immediately before administration, they must sign a form ahead of time stating and allowing such consent. This is part of the issue.
Since informed consent must be granted, it may be more difficult for some individuals with mental illnesses and substance use disorders to give their consent if they are not mentally competent, and are influenced by illicit substances or prescribed drugs. Though there are certain instances for which MAiD is appropriate for individuals with mental illness, this should only be considered in extreme circumstances where one’s mental illness is completely debilitating for the individual, or they have other severe, terminal diseases or health issues on top of the matter.
Canadians face compounding issues of housing instability, on top of a lack of support services, medications, overdose prevention, and employment opportunities. When it comes to mental health and the cost and quality of living, better access to resources must be implemented to grant people the help they need. The same goes for people with physical disabilities and chronic health conditions where they also need access to health care resources to help with treatment, prevention, and overall accessibility. Why does the government cover the cost of death, but not the “cost of medications needed to live?”
In October 2022, an Ontario man, Amir Farsoud, applied for MAiD due the risk of becoming houseless and qualifying for medically-assisted death. He isn’t the only one. Others turn to MAiD out of desperation as a last resort. When patients say poverty is the number one reason for MAiD — there’s an obvious issue. This is completely unethical, and the lack of support is unacceptable. Although Farsoud has physical health conditions alongside depression and anxiety, his conditions are not severe or life-threatening. Farsoud stated he didn’t want to die, but feared he had no other choice aside from houselessness. Luckily, people fundraised over $60,000 for him. Farsoud later posted an announcement thanking everyone for their contributions and stating that he had reconsidered his decision. However, this isn’t always the case. The fact he was even able to access MAiD in the first place, more easily than affordable housing, is completely appalling.
Rather than expanding access to MAiD for individuals with mental illness, there are many other, more appropriate resources that should be implemented. Mental health services often fail Canadians because there is lack of access — patients may not be able financially afford services or face barriers like racism and ableism while seeking support. Access to supports such as mental health care, counselling services, and medications — including prescribed drugs specific to certain disorders, and agonists such as Methadone (a “medication-assisted treatment” for opioid addiction) should be increased. Safe injection alongside overdose prevention sites, and better access to subsidized and affordable housing are resources that must be expanded to aid in mental health support and help alleviate associated challenges. These systemic issues must be addressed before expanding MAiD, and it’s been shown that the lack of access to resources directly correlates to mental health and substance use.
MAiD should not be used as a way to mask or eliminate certain conditions that can otherwise be treated — whether this be through pain management, medications, therapies, medical appointments, or other supports. There is a certain time and place for MAiD, and offering it as a “solution” for people before addressing systemic issues is not the right thing to do.
