Euthanasia (MAiD) for People with Psychiatric Disorders is dangerous

By Alex Schadenberg, Executive Director, Euthanasia Prevention Coalition

On September 11, 2019, Justice Christine Baudouin of the  Quebec Superior Court  struck down the section of Canada’s euthanasia law limiting euthanasia to people whose natural death is “reasonably foreseeable.” The Truchon decision was not appealed by the federal or provincial governments, creating a new debate concerning the limits for euthanasia (Medical Assistance in Dying–MAiD) in Canada.

In my commentary on the Truchon decision, I stated:

Previously a person didn’t qualify for euthanasia based on psychological reasons alone since the law required that the person’s “natural death be reasonably foreseeable.” Now the court has struck down this important safeguard

In other words, the Truchon decision opened the door to euthanasia for psychological reasons alone. A further problem is that Canada’s euthanasia law does not define the term psychological suffering.

On March 10, the board of the Canadian Psychiatric Association (CPA) changed its position on euthanasia from negative to being supportive of MAiD. The change in position happened without consulting the members of the CPA and without doing a review of the literature.
 
On May 26, 2020, The Canadian Journal of Psychiatry published a research paper titled: The Lack of Adequate Scientific Evidence Regarding Physician Assisted Death for People with Psychiatric Disorders is a Danger to Patients  by Mark Sinyor and Ayal Schaffer. 

Sinyor and Schaffer do an extensive literature review and conclude:

We cannot quantify, according to any of the usual scientific standards, whether PAD [Physician-Assisted Death]  for PPD [Patients with Psychiatric Disorders]  will benefit or harm patients and to what degree. …We believe that the only rational approach is to insist on further study before expanding legislation.

They then state:

Earnest people may disagree philosophically in this area, but personal opinions cannot bypass the usual scientific process and, in this regard, those proposing expansion of the use of PAD have fallen woefully short. The fact that they have not been held to the usual requirements of medical science is absurd and even shameful. Sadly, no one in power seems to have noticed.

The conclusions by Sinyor and Schaffer are backed by their research. They state:

The problem with the limited and low quality scientific evidence available to date is compounded by imprecision and spurious reasoning within the conceptual articles which really should not have been called “studies.”

The researchers examine many questions such as how permitting MAiD for psychiatric patients will affect the suicide rate for this patient group, especially since suicide is the most common cause of death for this patient group. They state:

Nevertheless, there have been no studies rigorously testing the impact of legalizing PAD for PPD on routine psychiatric care or suicidal patients.

Sinyor and Schaffer then examine the suicide contagion effect:

Furthermore, the Canadian Psychiatric Association (CPA) guidelines for responsible media reporting ask that journalists: “[avoid] portraying suicide as achieving results and solving problems.” This is because of what is now robust literature on suicide contagion showing that messages of death result in more suicides across a population while stories of resilience and mastery of suicidal crisis can have the opposite impact. Whether legalization of PAD for PPD might lead to a similar social contagion phenomenon also remains unexplored… Whether legalizing PAD for PPD and associated media exposures in at-risk patients might result in a suicide contagion phenomenon is once more a testable yet unanswered question.

The researchers challenge the CPA’s recent change in position on MaiD:

The CPA recently released a position statement which is agnostic to whether PAD should be allowed in PPD. This was most unfortunate. The CPA is not obliged to take a moral stand but it ought to advocate for adequate scientific evidence to inform public policy. Its position statement is an abdication of that responsibility.

Recently two past CPA Presidents published an Open Letter challenging the position of the CPA and the process that was followed to change the position.

If you consider the nature and condition of many psychiatric patients, Psychiatrists should never kill their patients. killing should be viewed as antithetical to their care.

I am concerned about the good psychiatrists who I have come to know who believe that killing is not a treatment for psychiatric conditions. Where is our country headed?

Editor’s note. This appeared on Mr. Schadenberg’s blog and is reposted with permission.