Medical assistance in dying (MAiD) was introduced into Canadian federal legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is currently excluded from eligibility; such exclusion is scheduled to expire on March 17, 2024. Irremediability, capacity, quality of life, autonomy, family involvement, and healthcare system constraints have been debated intensively. Recent studies have not explored the views of family members of persons with mental illness on MAiD MI-SUMC. This study aimed to fill this knowledge gap. Twenty-five Ontario residents who had a loved one with mental illness participated. A persona-scenario exercise was designed to explore participants' views on MAiD MI-SUMC in hypothetical situations. Reflexive thematic analysis was used to analyze the data. A lived experience-advisory panel was engaged throughout the study. Seven themes were developed: Witnessing suffering; A road with barriers and limitations; Societal barriers; The unknowns of mental illness; Individual choices: the life or death that a person wants; MAiD MI-SUMC as an acceptable choice when suffering cannot be relieved with available treatments and supports; and The emotional outcome. Participants constructed their views based on their experience of supporting a loved one with mental illness. MAiD MI-SUMC was perceived as a multifaceted issue, whose acceptability and potential introduction required a concurrent exploration and discussion of the challenges arising due to limitations of the healthcare system, the opportunities and limits to family involvement, and the value of patient autonomy.
Competing Interests: Declaration of Conflicts InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Hamer Bastidas-Bilbao, Vicky Stergiopoulos, Vivien Cappe, Mary Rose van Kesteren, Alexander I. F. Simpson, Michael Dawthorne, and Lisa D. Hawke declare that there is no conflict of interest. Donna Eileen Stewart declares that she has served in the Expert Panel on MAiD and Mental Illness, the Canadian Psychiatric Association Working Group on MAiD, and as a reviewer of the Canadian Association of MAiD Assessors and Providers (CAMAP) curriculum on MAiD. Mona Gupta declares that she has received funding related to this subject from CIHR; she was Chair of Health Canada’s Task Group on MAiD Practice Standards, the Chair of the Federal Expert Panel on MAiD and Mental Illness, and the Chair of the AMPQ ad hoc committee on MAiD. Tarek K. Rajji has received research support from Brain Canada, Brain and Behavior Research Foundation, BrightFocus Foundation, Canada Foundation for Innovation, Canada Research Chair, Canadian Institutes of Health Research, Centre for Aging and Brain Health Innovation, National Institutes of Health, Ontario Ministry of Health and Long-Term Care, Ontario Ministry of Research and Innovation, and the Weston Brain Institute; he has also received for an investigator-initiated study in-kind equipment support from Newronika, and in-kind research online accounts from Scientific Brain Training Pro, and participated in 2021 and 2022 in an advisory activity for Biogen Canada Inc; he is also an inventor on the United States Provisional Patent No. 17/396,030 that describes cell-based assays and kits for assessing serum cholinergic receptor activity; he served on the MAiD Practice Standards Task Group as CAMH representative. David Castle has received grant monies for research from NHMRC (Australia), Barbara Dicker Research Fund, Milken Institute, Canadian Institutes of Health Research, and Psyche Foundation; consulting fees from Seqirus; honoraria for talks from Seqirus, Servier, and Mindcafe Forum; and honoraria as advisory board member from Seqirus and Lundbeck; he is a founder of the Optimal Health Program (OHP) and holds 50% of the IP for OHP; is part owner and board member of Clarity Healthcare; and is unpaid board chair of the Psyche Institute; he does not knowingly have stocks or shares in any pharmaceutical company.