Medical assistance in dying (MAiD) for Canadians whose sole underlying condition is a mental disorder: an examination of the validity of their autonomy

Tamale, Andrew (2023) Medical assistance in dying (MAiD) for Canadians whose sole underlying condition is a mental disorder: an examination of the validity of their autonomy. Masters thesis, Memorial University of Newfoundland.

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Abstract

Canadians with a mental disorder as their sole underlying condition (MDSUMC) are still unable to access medical assistance in dying (MAiD). This is due to the sunset clause in bill C-7 that temporarily prohibits MAiD MDSUMC until March 17th, 2024. Proponents of MAiD MDSUMC argue that prohibiting all Canadians with a mental illness from accessing MAiD violates their autonomy. This thesis challenges this argument, asserting that the autonomy of a significant portion of Canadians with mental illness is not valid due to the significant barriers to mental health care that reduce the voluntariness of their requests for MAiD. It also argues for the paternalistic prohibition of MAiD MDSUMC to ensure proper evaluation of the voluntariness of MAiD decisions. The argument is laid out in four chapters. The first chapter traces the legislative evolution of MAiD in Canada. It also describes the burden of mental illness and the state of mental health care in the country. It explores two barriers to mental health care: long waiting times and stigma. Chapter two establishes a link between the two barriers of interest and intolerable suffering, a core aspect in evaluating MAiD requests. Chapter three demonstrates how, by worsening the experience of mental illness to intolerable proportions, the two barriers diminish the autonomy of Canadians with MDSUMC regarding their MAiD decisions. It employs the socio-relational notion of autonomy to present this argument. The final chapter defends the paternalistic prohibition of access to MAiD MDSUMC. It argues that paternalism is justified when there are sufficient reasons to suspect autonomy failure, which occurs when an individual is stopped from pursuing their authentic goals or is forced to alter them. It asserts that the barriers to mental health care a strong enough factor to alter the goals of Canadians with mental illnesses.

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