Death With Dignity For Mental Health Sufferers

Perhaps no issue divides Canadians more than the debate over the right to die with dignity.

And just to be clear, I am writing today about medically assisted suicide, which, beyond the core moral issue, also challenges medical practitioners to make decisions on what it means to “do no harm.” A little background first:

The Supreme Court of Canada in 2015 decided that the Criminal Code of Canada was inconsistent with the Charter of Rights And Freedoms; the prohibition on medical practitioners to assist terribly ill patients in the end-of-life process was challenged. What the Court, in essence, said to Parliament was: “Write a new law.” That was done, and today, we live in a land where “eligible” Canadians seeking to end their lives because of intractable, painful misery may do so – if they can find legally sanctioned medical practitioners to provide that most intimate final care.

So, what does “eligible” mean?

Currently, people suffering endless pain and terminal illness, who live with a “grievous and irremediable medical condition,” “unbearable . . . suffering,” and who “may be at a point where . . . natural death is reasonably foreseeable.” These are words from our federal government policy document on the matter.

There is a grey area, and that is the case of mental illness.

As the law is currently written, folks suffering a mental illness who no longer wish to live must also have a physical condition to justify their “eligibility” for a dignified, medically supervised passage from this life.

So, if I get this right, and I think I do, it is not enough to suffer the tortures of bipolar disorder or schizophrenia or depression to warrant the right to explore leaving this Earth in a dignified fashion – and at the right time. You’ve got to have a tangible, x-ray-able, blood-testable disease to allow you to even think about that terminal choice.

There are many issues that cloud our public (and personal) thinking about this.

The first (fogged by social stigma, as always) is that mental illness is somehow less painful – less onerous – than something like cancer, or diabetes. The invisibility of mental illness punishes those who live with it, and leaves them un-loved and un-supported by their communities.

Another is the legally and medically ethically mandated issue of permission.

Informed consent is very much at the centre of our medical system. We choose – or give approval to – medical procedures because our doctors explain them to us and because the professionals who make decisions respect our knowledge and permissions.

In the case of folks living with an unbearable mental illness, who may be considering the dignified end to their corporeal existence, the “system” presents a Catch-22. It says “Yes, you have a terrible condition that will dog you for the rest of your years and we will attempt to treat you with your informed consent, but no, we don’t trust your judgment about your end-of-life plans because, by definition, you are unable to form a rational opinion about your future.”

“First, do o no harm.”

What is allowing and enabling tortured lives to continue? It a question we and our medical community are unable to answer.


  1. If a person with a certain mental illness is deemed unfit to enter into a legal contract, how can they be fit enough to make such a decision? How can a doctor be expected to put them out of their suffering when it is so unclear whether they can be helped? Should you be able to terminate someone without knowing what is wrong with them? Should you or they be allowed to have someone put out of their pain when it’s not really clear what is causing it and whether it can be fixed or not? If it was a stomach ache but no one could determine it’s cause, is that grounds? I don’t think so. Unfortunately, I’m not in agreement as I don’t believe enough is known about mental illness and how to treat it. In most things I’m more of a pessimist but when I see how little is known about mental illness and how to treat it, I think it’s premature to assist people to turn out their lights before more is known and in case there is a chance they can be helped enough to enjoy some moments. I’m optimistic that if there was more care, coordination, research, funding, and long term help, things should improve so it’s wrong to give up now.

  2. People with mental illnesses don’t represent the only grey area. Folks suffering from Huntington’s disease or M.S. also cannot make this choice because their deaths are not “foreseeable”. People fearful of contracting dementia are also not permitted to make the decision to choose assisted suicide ahead of time–and, of course, they can’t choose after they’ve become ill, for the same reason choice is denied to the mentally ill. There are still lots of holes.

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