Medical assistance in dying: special issues for patients with mental illness

Medical Assistance in Dying (MAID) is now legal in many jurisdictions for competent adults who have intolerable suffering and/or have a terminal illness with a short prognosis. Mental illness can be a source of suffering for these individuals, but it can also affect their capacity to make medical decisions. Clinicians, and psychiatrists in particular, need to understand how to assess patients with mental illness who are requesting MAID, to determine the impact of their mental illness on the MAID request.

Psychiatric disorders can be a primary indication for MAID in parts of Europe, and recent published case series from Belgium and the Netherlands have generated strong responses from the psychiatric community. Patients dying of terminal illnesses who request MAID often have symptoms of depression or anxiety, but psychiatrists are rarely involved in their care. Psychiatrists may be helpful in assessing decision capacity, but documentation of capacity assessment could be improved. There is a broad need to develop educational resources to train current and future physicians about MAID.

MAID represents an ethical and clinical challenge for psychiatrists in a variety of ways. As more jurisdictions legalize MAID, the psychiatric community will need to be prepared to meet these challenges with robust clinical standards and educational programs to ensure the highest standards of care for patients.