Assessing suicidality assessments in physician assisted death applications: do they filter out traditional suicidality?
K.S. Gaind1
1University of Toronto, Psychiatry, Toronto, Canada
Background: Canada has quickly become the number one assisted death provider in the world1, with laws introduced in 2016 for terminal conditions (Track 1) being expanded in 2021 to any adult with a disability even if they are not dying (Track 2). Medical assistance in dying (MAiD) provisions grew 30% year over year to exceed 13,000 by 2022, representing over 4% of Canadian deaths. The government plans to expand MAiD further to mental illness and addictions (initially scheduled for 2023, then twice delayed and now planned for 2027).
Expansion advocates have reassured the public that “MAiD for mental illness is not suicide”, yet have not provided evidence showing that distinction can be made. The Canadian Psychiatric Association refused to provide evidence or mention suicide risks related to mental illness and marginalization during public consultations on MAiD for mental illness2. This study examines the claim that assessments of expanded MAiD requests filter out traditional suicide risk factors.
Expansion advocates have reassured the public that “MAiD for mental illness is not suicide”, yet have not provided evidence showing that distinction can be made. The Canadian Psychiatric Association refused to provide evidence or mention suicide risks related to mental illness and marginalization during public consultations on MAiD for mental illness2. This study examines the claim that assessments of expanded MAiD requests filter out traditional suicide risk factors.
Aims & Objectives: 1. To recognize the range of factors that may motivate assisted dying requests in different patient populations.
2. To understand how assisted dying assessments attempt to identify suicidality.
3. To appreciate the degree of certainty or uncertainty that assisted dying assessments filter out suicide risk factors in different patient populations.
2. To understand how assisted dying assessments attempt to identify suicidality.
3. To appreciate the degree of certainty or uncertainty that assisted dying assessments filter out suicide risk factors in different patient populations.
Method: Review of evidence related to motivations leading to physician assisted death (PAD) requests in different populations, and review of guidelines and specific factors PAD assessors use to attempt to identify suicidality and distinguish that from other motivations leading to PAD requests. Guidelines are compared to established evidence and factors related to known suicide risk, and suicide prevention strategies, to assess how well PAD assessments can differentiate traditional suicidality from other motivations leading to assisted dying requests.
Results: Those making PAD requests in terminal situations frequently seeking PAD in efforts to preserve dignity, while those seeking PAD outside terminal conditions or for mental illness cite feeling a burden, or an accumulation of life stressors, as fueling their requests.
Most factors presented in guidance on distinguishing suicidality from PAD requests equally apply to traditionally suicidal individuals and to those requesting PAD.
The few distinguishing factors used to attempt to separate suicidality from PAD requests, specifically impulsivity and acting on one's own, do not filter out suicidality.
Most factors presented in guidance on distinguishing suicidality from PAD requests equally apply to traditionally suicidal individuals and to those requesting PAD.
The few distinguishing factors used to attempt to separate suicidality from PAD requests, specifically impulsivity and acting on one's own, do not filter out suicidality.
Discussion & Conclusions: While a key goal of physician assisted death assessments is to identify and separate traditionally suicidal individuals from those seeking and receiving assisted death, current assessment techniques are unable to filter out suicidal individuals in an unknown number of cases.
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