¹University of Toronto, Psychiatry, Toronto, Canada

Background: Physician Assisted Death (PAD) or Medical Assistance in Dying (MAiD) has been legalized or decriminalized in over a dozen jurisdictions around the world. There is wide variation between policies, with most jurisdictions allowing for assisted dying only in terminal conditions, a minority allowing assisted dying outside end-of-life situations, and a smaller number allowing it for mental illness. Since being introduced in 2016, Canada has seen expansions in MAiD eligibility to those with disabilities who are not dying, and further expansion continues to be planned to mental illness conditions by 2027.
Two core assumptions implicitly embedded in most assisted dying policies is that PAD/MAiD is provided for a medical condition that will not improve (i.e. is "irremediable"), and that traditionally suicidal individuals who could otherwise benefit from suicide prevention interventions are not provided assisted death. This session will review evidence challenging those core assumptions, review the background to assisted death expansion and existing policies in Canada, explore ethics and emerging data trends including evidence showing potential risks to marginalized populations, and discuss related mental health issues from a suicide risk factor perspective.

Aims & Objectives: To understand the evidence related to predicting irremediability of mental illnesses, for the purposes of assisted dying assessments.
To understand factors associated with motivations for assisted dying, and compare those to factors motivating traditional suicidality.
To appreciate different issues motivating assisted dying requests in different patient populations, and consider the ethical implications.

Method: Review of processes that led to Canada's expanded assisted dying laws, including implications for other jurisdictions; review of evidence related to predicting irremediability in patients with mental illness; review of risk factors, including in different or marginalized populations, leading to wishes for death, and the ethical implications of this for assisted dying policies; and review of existing data of populations receiving non-terminal medically assisted death.

Results: Current evidence does not support that reliable predictions of irremediability in mental illness can be made in individual cases, and current assessments in assisted dying processes cannot reliably separate or filter traditional suicide risk factors from assessments especially in non-terminal cases.

Discussion & Conclusions: Discussion of the ethical implications of issues explored above, which suggest that marginalized populations in particular, and those with psychosocial stressors and vulnerabilities, may be at risk of premature death from assisted dying assessments in jurisdictions that provide assisted death for non-terminal conditions.