Résumés
Abstract
Since Canada legalized medical assistance in dying (MAID) in 2016, it has become one of the most permissive regimes in the world for euthanasia and assisted suicide. The number of deaths has risen rapidly and the categories of eligibility continue to expand. The country is poised, as of March 2024, to allow MAID for those whose sole underlying condition is mental illness, generating considerable debate. Advocates of MAID for mental illness often frame it as a question of equal access, but this extension involves considerable complexities not present in other cases. This paper examines psychiatric MAID in the Canadian context, engaging directly with the most pertinent arguments of the practice’s advocates. The paper argues that independent of any prior commitments vis-à-vis the permissibility of MAID per se, there is a clear ethical and legal necessity to oppose extending MAID on the grounds of mental illness if we follow the parameters set up within the Canadian regime. The paper advances three arguments: first, that mental illnesses cannot be deemed irremediable, as required by the Canadian law; second, that we cannot establish with adequate certainty that a mentally ill patient has the decision-making capacity to choose MAID; and third, that allowing psychiatric MAID will have a devastatingimpact on care and support of the mentally ill.
Keywords:
- medical assistance in dying,
- MAID,
- ethics,
- euthanasia,
- assisted suicide,
- mental illness,
- Canada
Résumé
Depuis que le Canada a légalisé l’aide médicale à mourir (AMM) en 2016, il est devenu l’un des régimes les plus permissifs au monde en matière d’euthanasie et de suicide assisté. Le nombre de décès a augmenté rapidement et les catégories d’admissibilité continuent de s’élargir. Le pays est sur le point, à partir de mars 2024, d’autoriser l’AMM pour les personnes dont la seule condition sous-jacente est la maladie mentale, ce qui a suscité un débat considérable. Les défenseurs de l’AMM pour les maladies mentales considèrent souvent qu’il s’agit d’une question d’égalité d’accès, mais cette extension implique des complexités considérables que l’on ne retrouve pas dans d’autres cas. Cet article examine l’AMM psychiatrique dans le contexte canadien, en s’attaquant directement aux arguments les plus pertinents des défenseurs de cette pratique. Il affirme qu’indépendamment de tout engagement préalable vis-à-vis de l’admissibilité de l’AMM en soi, il existe une nécessité éthique et juridique évidente de s’opposer à l’extension de l’AMM pour des raisons de maladie mentale si l’on suit les paramètres établis dans le cadre du régime canadien. Le document avance trois arguments : premièrement, les maladies mentales ne peuvent pas être considérées comme irrémédiables, comme l’exige la loi canadienne; deuxièmement, nous ne pouvons pas établir avec suffisamment de certitude qu’un patient atteint d’une maladie mentale a la capacité de prendre des décisions pour choisir l’AMM; et troisièmement, l’autorisation de l’AMM psychiatrique aura un impact dévastateur sur les soins et l’assistance aux malades mentaux.
Mots-clés :
- aide médicale à mourir,
- AMM,
- éthique,
- euthanasie,
- suicide assisté,
- maladie mentale,
- Canada
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Parties annexes
Remerciements / Acknowledgements
Nous remercions Didier Caenepeel, OP, pour ses encouragements et ses commentaires sur le document, ainsi que les pairs évaluateurs et les éditeurs de ce journal pour leurs critiques et suggestions perspicaces.
Thanks to Didier Caenepeel, OP, for his encouragement and feedback on the paper, and the peer reviewers and editors of this journal for their insightful critiques and suggestions.
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