nursingforsocialjustice

Death is a difficult topic to talk about. Death in the context of health and healthcare is an equally difficult topic. Patient autonomy, and upholding a person’s wishes about the end of their life is something we need to get better at in the Canadian healthcare system, especially with people who are living with mental illness.

Equity of access and inclusion of the patients an autonomous decision-maker is a challenge within a system where most people who get to inpatient mental health treatment arrive there involuntarily. Is mental illness illness in the same way Huntington’s disease or cancer is? Decades of research tell us…maybe? Maybe that is why we need to ask different question when understanding access to MAiD for those who primarily have a psychiatric diagnosis; perhaps the questions must be asked with respect to why the recently approved changes to the Canadian Medical Assistance in Dying legislation are sparking such defensiveness, such anger, such polarization, such strange comparisons to the death penalty…which in some ways may be poignant because maybe now we can be feel more comfortable with comparing involuntary inpatient mental health admission to incarceration?

Statements that there is no evidence, means that there is no peer reviewed evidence that specifically explores questions about how similar or dissimilar someone living with a psychiatric diagnosis is to someone with non-psychiatric diagnosis. And, lack of evidence does not mean that there is no available data.

Is mental illness the result of a disease process or not? Is it this “brain disease” that all the eggs in the basket are in, or not? You cannot have it both ways, medicine. From a nursing perspective, it is the conversation that we have with patients about not just the immediate act of death, but but of the person’s understanding and wish of what they want. These decisions are not simple, they are complex. And, these decisions are not made in a split second, impulsively, it is a process.

If we rest an argument against MAiD on the idea that we just don’t know if someone could fully recover from a mental illness given the proper treatment and proper resources, then what has been going on this whole time that access to services, publicly funded non-pharmacological therapy, affordable housing strategies, anti-racist and anti-colonialist etc. etc. and so on and so forth has not been equitable or a priority? Is it a problematic argument that people with mental illness are inherently more vulnerable to misuse of MAiD?

Is the spark that ignites the fire of change the outrage physicians and people in healthcare feel about people with debilitating, chronic, refractory mental illnesses being able to access medical assistance in dying instead of engaging in their own isolated process of death? Something feels wrong about that. People suicide without the assistance of physicians everyday. People also live for decades suffering from disorders that are diagnosed to live in someone’s mind.

In short, there was a time when we did not have cures to anything and people just died. There was also a time when we did not have the complex ethical issues of being able to prolong life at the expense of the quality of it. Is some of the challenge to people with mental diagnoses being able to make a case for their suffering to end symptoms a result of this idea that the treatment team, and primarily the psychiatrist is the ultimate decision-maker? What does this mean for person and family centred care? What does this mean for autonomy in healthcare decision-making?

Thinking It Through

How do we reconcile this stance about vulnerability, lack of access and call for instilling hope over the reality of limitations of the science, with the call for action for safe supply, increase of overdose prevention, increase of access to a range of health interventions for people who use substances amidst the tens of thousands they have died who did not want to die, but, arguably, did because of inaction? These are different, yet similar issues in terms of values guiding what should and should not be. Sometimes, when I take a step back, I don’t know what I am looking at because health clinicians who, in theory, should be on the same side, are not.

Love,

Michelle D.