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| Kathrin Mentler sought help. Next came a distressing conversation. Photo: Source |
The Globe and Mail reports on an interview with a suicidal patient whose struggle seems to epitomises the abandonment under ideological pressure of health workers' most basic goal: do no harm. The Canadian health service's Medical Assistance in Dying (MAID) programme has given rise to a national outcry. The report states:
Kathrin Mentler, 37, lives with chronic depression and suicidality, both of which she says were exacerbated by a traumatic event early this year. Feeling particularly vulnerable in June, she went to Vancouver General Hospital looking for psychiatric help in dealing with feelings of hopelessness she feared she couldn’t shake.
Instead, Ms. Mentler says a clinician told her there would be long waits to see a psychiatrist and that the health care system is “broken.” That was followed by a jarring question: “Have you considered MAID?”
“I very specifically went there that day because I didn’t want to get into a situation where I would think about taking an overdose of medication,” Ms. Mentler, a first-year counselling student, told The Globe and Mail in an interview.
“The more I think about it, I think it brings up more and more ethical and moral questions around it.”
Vancouver Coastal Health, which operates the hospital, confirmed that the discussion took place but said the topic of MAID was brought up to gauge Ms. Mentler’s risk of suicidality.
Criticism arises over growing list of neglect
MAID is not currently legal for mental illness alone. Canada legalized assisted dying in 2016 for patients with “reasonably forseeable” deaths and expanded eligibility in 2021 to those with incurable conditions who were suffering intolerably. The legislation was set to expand again in March to allow MAID for those with mental illness as a sole condition, but the federal government sought a one-year pause to allow for further study.
The issue has divided doctors, researchers and mental health advocates who have taken sides in a contentious debate that is ultimately about patient autonomy versus patient protection.
Publicized cases have fuelled criticisms that the life-ending procedure is being offered in lieu of sufficient mental health and social supports. In April, 2022, CTV News reported that a 51-year-old Ontario woman with severe sensitivities to chemicals chose MAID after failing to find affordable housing free of cigarette smoke and chemical cleaners. And last August, Global News reported that a Canadian Forces veteran seeking treatment for post-traumatic stress disorder and a traumatic brain injury was unexpectedly offered MAID by a Veterans Affairs Canada employee.
Clinician's comment added to the distress
When Ms. Mentler presented to Vancouver General Hospital’s Access and Assessment Centre in June, she wanted psychiatric help and was prepared to stay overnight if needed. The centre offers mental health and substance use services, including crisis intervention, according to a web page about its services.
After filling out an intake form, she was taken to a smaller room where she shared her feelings and mental health history with a clinician. Day-to-day life was feeling overwhelming and she worried about her persistent feelings of depression, she recalled telling the clinician.
“She was like, ‘I can call the on-call psychiatrist, but there are no beds; there’s no availability,’ ” Ms. Mentler said. “She said to me: ‘The system is broken.’ ”
But it was the clinician’s next comments Ms. Mentler found particularly distressing.
“She said, ‘Have you ever considered MAID?’ ” Ms. Mentler said, adding that she was so bewildered by the question that she didn’t initially understand what the clinician meant. “I thought, like a maid that cleans a room?”
Ms. Mentler had not considered MAID before, but told the clinician of her past attempts to end her life by overdosing on medication. She said the clinician replied that such a method could result in brain damage and other harms, and that MAID would be a more “comfortable” process during which she would be given sedating benzodiazepines among other drugs.
The counselling student says she left the centre soon after, not wanting to think about the encounter. The next day, she says she awoke wanting to scream and cry, and posted about the exchange on a private social media account to a group of friends who echoed how troubling they found it to be.
How can this be standard procedure?
As to the hospital service's reason given for the conversation about suicide:
Ms. Mentler is unconvinced.
“Gauging suicide [risk] should not include offering options to die, which is what it felt like,” she said. “I also think it’s worth considering that, as of right now, MAID for mental health is not legal yet, so giving someone the specifics of the process seems wrong. How can this be standard procedure for suicide crisis intervention?”
Jonny Morris, chief executive of the Canadian Mental Health Association’s B.C. division, said the province, like many other jurisdictions, lacks a “systematic, accepted response” for how people should approach those in suicidal crisis.
As in most countries where traditional social norms and ways of life have been disrrupted by an individualistic and nihilistic mindset, Canadians suffer from mental illness in increasing numbers. Some statistics:
💢More than 6.7 million Canadians, that is, one in two Canadians have—or have had—a mental illness by the time they reach 40 years of age.
💢Opioid overdoses now account for more deaths in Canada than automobile accidents.
💢Over 4,000 Canadians die by suicide every year—an average of 11 per day.
The increasing health expenditure as Canadians' lifestyles are degraded by the typical Western lifestyle is often cited as a reason why the Canadian Government supports the MAID programme.
The online news outlet The Tyee reports:
These expansions [to MAID] have been met with heavy criticism from disability and mental health advocates, social workers and experts on mental illness. In 2019 then UN Special Rapporteur for the Rights of Persons with Disabilities, Catalina Devandas-Aguilar, said she was “extremely concerned” people with disabilities may request MAID because they couldn’t access adequate care.
Since then several people have told The Tyee and other media that they’re accessing or considering accessing MAID not because of their disability but because they’re unable to access supports to live a good life.
What is happening to Canadian medicine?
But ideology is the main reason why MAID has become a central feature of the Canadian health system, according to Scott Kim, a psychiatrist and philosopher who studies medical assistance in dying. He served on the Council of Canadian Academies Expert Panel Working Group on MAID Where a Mental Disorder is the Sole Underlying Medical Condition. Dr Kim writes:
The debate in Canada has not focused enough on why well-meaning doctors are continuing to approve and perform such outrageous cases of MAID. Aren’t doctors supposed to protect the vulnerable? Are they not guided by an ethic, a professional identity, that goes beyond the floor set by the law? What is happening to Canadian medicine?
The answer is that it has been captured by a uniquely Canadian MAID ideology. The current crisis cannot be averted without addressing this potent driver of Canadian MAID practice.
[I]t is striking that Canada’s main MAID-provider organization, the Canadian Association of MAiD Assessors and Providers (CAMAP), has been promoting the practice of bringing up the procedure unsolicited. The organization, which received $3.3 million from the government to develop a curriculum for MAID providers, has set this out as not merely something permissible, but as a “professional obligation.”
It is difficult to overemphasize how radical this position is.
Ideological capture in Canada is not hyperbole
Dr Kim goes deeper into the matter benefiting from his research vantage point:
Consider the controversy over doctors and staff initiating unprompted conversations with patients about MAID. Such incidents are understandably disturbing because no one should suggest to another person – especially someone living with a disability – that their life is not worth living.
Such unprompted initiations of MAID conversation are prohibited in the Australian state of Victoria, and in New Zealand (both jurisdictions in which the procedure is legal). One does not have to be a fan of gag rules – and, to be clear, I’m not – to see that such prohibitions are meant to draw attention to a clear boundary: Even when MAID is legal, it should be an exception to the practice of medicine, not something to be taken into its very bosom. There is a reason why all MAID laws regulate how to respond to requests, not how to promote it.
But in Canada, aided by a flawed law, a MAID ideology is transforming the way medicine views itself. To talk of ideological capture in Canada is not hyperbole.
Consider a patient who still has good (even curative) treatment options left, but who refuses them and requests MAID instead. In the Netherlands, a doctor who believes that the patient indeed has genuine options would be violating not only the law but also their professional ethic as a doctor if they sign off on MAID in such a case. Since MAID is a last-resort exception there, a Dutch doctor must exercise their professional medical judgment to determine that no medical intervention will alter the outcome for the patient.
In contrast, a Canadian doctor faced with a MAID request from a patient with a curable disease can put aside such an ethic (or, as one psychiatrist in such a situation put it in an interview with The Globe and Mail, go “against her better judgment”) and terminate the patient’s life. Why would well-meaning Canadian doctors discard their professional ethic? Why do they not feel the force of it to guide their practice?
To see why, we only need to return to the CAMAP document on bringing up MAID with patients. CAMAP repeatedly calls MAID a “treatment option” and a “care option” that is “medically effective.” This kind of Orwellian word game has chilling consequences. MAID is now a treatment option that a doctor may provide instead of even a curative option; after all, both are “medically effective” care options.
Through this ideological lens, it is easy to see why a doctor might approve MAID for even those who desperately want to live but cannot afford to.
Dr Kim's conclusion is this:
As we have seen, this MAID ideology – one shared by no other jurisdiction in the world – has made fact-based policy making nearly impossible in Canada. Unless its spell is broken, it is difficult to see how a further deepening of the crisis can be avoided, for no set of “safeguards” born from the ideology will be able to protect the society’s most vulnerable from the “helping hand” of medicine.
As with gender ideology's approach to distressed young people—cash flow first, patient second—so too with the unprincipled, and basically uncaring, response to the needs of sick, disabled and depressed seen in the Canadian practice of euthanasia. The official Canadian submission to an ideology that promotes low-cost solutions to an individual's life difficulties speaks volumes about the nature of that society now, and its direction for the future.
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