The Canadian Medical Health Association released its position paper on Medical Assistance in Dying (MAiD) and it endorsed euthanasia and assisted-suicide as a legitimate medical service while coming out against expanding criteria for the procedure to include those suffering from mental illness.

Noting that it released its paper days before World Suicide Prevention Day on Sept. 10, the CMHA said that “people with a mental health problem or illness should be assisted to live and thrive” and that mental illness should not be a reason to access medically assisted suicide. The CMHA said because “there is always hope of recovery,” mental illness does not qualify under the current MAiD regime that requires patients have a serious and incurable illness, and that natural death be reasonably foreseeable.

The CMHA, which represents psychiatrists, acknowledged mental illness “may be grievous or unbearable” but as a “recovery-oriented organization” it “does not believe that medical illnesses are irremediable.” The CHMA insists that assisted suicide for mental health reasons remain illegal, and called for investments in community mental health and addiction services and the development of a national suicide prevention strategy.

The paper said that because it opposes discrimination, the CHMA affirms support for assisted suicide in cases where death is foreseeable for physical health reasons, and that individuals who also suffer from mental health issues should have access to medical services to hasten their deaths in such cases.

As one physician told The Interim, the association’s position is inconsistent because the paper acknowledges “the potentially negative impact of a psychiatrist’s or medical practitioner’s approval of MAiD for their patient,” which may “reinforce loss of hope and demoralization” for the patient. The doctor told The Interim these concerns are as true for physical health reasons as mental health.

The doctor is also concerned that it is difficult to discern whether a patient with a mental health issue is requesting assisted suicide because of the physical or psychiatric pain. He pointed to a 2016 Reuters report that found more than half of Dutch euthanasia requests came from patients suffering from depression and many others were made by people who had various neurocognitive issues.

The CMHA also studied euthanasia and assisted suicide in Belgium and the Netherlands, where it found insufficient “standards and compliance mechanisms” to protect individuals with mental health issues and thus a growing tendency to kill patients suffering from psychiatric disorders rather than physical illnesses. Considering the evidence from those two countries, the CMHA insisted psychiatric euthanasia “does not have a place in the current Canadian context.”