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Medical Assisted Dying and Mental Illness
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Medical Assisted Dying and Mentall Illness
Meagan Franchetto
Background
Background
Carter v. Canada
Carter v. Canada
- April 2011 - case filed by the British Columbia Civil Liberties Association
- Case made on behalf of Kay Carter & Gloria Taylor
- 2015 - Supreme Court ruling: Change must be made to the Canadian Criminal Code
Definitions
Medical Assisted Dying?
Physician Assisted Death?
- Involves the administration of a lethal substance.
Definitions
- Two main types:
- Euthanasia
- Medical-Assisted Suicide
- Defined by who administers the lethal substance
Euthanasia
- Adminstration by the physician
Euthanasia
Medical Assisted Suicide
- Lethal substance is prescribed by the physician
- Substance is self-administered by the patient
Medical Assisted Suicide
Regulation #1: The Condition
Regulation #1: The Condition
In order to be deemed eligible for medical-assisted dying, the individual must have a condition that is:
- Serious.
- Causing the individual to experience significant suffering, unrelieved by "acceptable" measures.
- And has resulted in a state of irreversible decline.
Regulation #2: The Individual
Regulation #2: The Individual
In order to be eligible for medical-assisted dying, the individual must be:
- Mentally competent
- Able to provide informed consent
- Making the request independently of external influences
Mental Illness
Mental Illness and Medical Assisted Dying
History
- E.F. - only individual with a mental illness in Canadian history to receive medical-assisted dying.
History
- April 13th, 2017 - Adam Maier-Clayton committed suicide after denied medical-assisted dying.
Critical Issues Paper
"Should Mental Illnesses Qualify as a Premise for Medical-Assisted Dying?"
Discussion #1: The Health Condition
Topic #1
Significance
- Mental illnesses are associated with significant suffering, reduced quality of life and greater occurence of physical health concerns
FOR
- WHO reports that mental illnesses account for several of the leading causes of disability
Treatment - Resistant
- Treatment-Resistance: unresponsive to treatment interventions
- 12% to 20% of individuals with depression are treatment-resistant
AGAINST
Subjectivity
Subjective measures for assessment of mental illnesses
Inconsistencies of Treatment Resistance
No operational definition of treatment-resistance
Discussion #2: Ability to Consent
Topic #2
Capacity for Consent
"you must also be mentally competent and capable of making decisions..."
Mental Competence
Decision Making
Against:
- Cognitive impairments leading to inability to understand information.
For:
- Cognitive impairments are not always present.
- Methods to enhance understanding.
Independence of Decision
Independence of Decision
Eligibility: Required to "make a voluntary request for medical assistance in dying that is not the result of outside pressure or influence"
- Suicidal ideations can be a symptom of mental illnesses.
- 4% to 47% of individuals requesting physician-assisted death were positive for the demonstration of depressive symptoms
Conclusion
Conclusion
- At this time, there is insufficient evidence to support mental illnesses as a basis for medical assisted dying.
Evidence Summarization
Summary
- Inconsistencies in defining "Treatment-Resistant".
- Difficulties assessing mental illnesses and symptoms.
- Cognitive impairment -> resulting in impaired ability to make informed decisions.
- Influence of mental illness on decision to request medical assisted dying.
Considerations for Care
- it is common for nurses to be the initial contact to be informed of the patients’ desire and request to receive physician-assisted death
Nursing Considerations
Legal Considerations
- incorrect understanding of the role of a nurse in medical-assisted dying.
References
References
Duffy, O. A. (2015, December 1).The supreme court of Canada ruling on physician-assisted death: Implications for psychiatry in Canada. The Canadian Journal of Psychiatry, 60(1), 591-596. Retrieved from http://journals.sagepub.com/doi/pdf/10.1177/070674371506001211
Government of Canada. (2017, October 27). Medical assistance in dying. Retrieved from https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html
Martin, S. (2017, April 19). Canada’s assisted-dying laws must be open to those with mental illness. The Globe and Mail. Retrieved from https://www.theglobeandmail.com/life/health-and-fitness/health/canadas-assisted-dying-laws-must-be-open-to-those-with-mental-illness/article34753182/
Steinbock, B. (2017, September-October). Physician-assisted death and severe, treatment-resistant depression. Hastings Center Report, 47(5), 30-42. doi: 10.1002/hast.768
Terkamo-Moisio, A., Kvist, T., Kangasniemi, M., Laitila, T., Ryynänen, O. P., & Pietilä, A. M. (2017). Nurses’ attitudes towards euthanasia in conflict with professional ethical guidelines. Nursing Ethics, 24(1), 70-86. doi: 10.1177/0969733016643861
World Health Organization 2000). Mental health and work: Impact, issues and good practices. Retrieved from http://www.who.int/mental_health/media/en/712.pdf