Darryl Rolfson

Mental Illness, unlike other forms of illness, has the potential to impair the judgement and insight of the individual in a temporary or progressive way. It would be a grave error to remove mental illness as a reason not to provide MAID. Without question, allowing MAID in persons with active mental illness does place constraints on their autonomy However, there is often tension between competing ethical principles when there is borderline competency. Autonomy must be constrained by the principles of non-maleficence (do no harm) and beneficence (act in the best interests of another person). MAID has already placed greater emphasis on autonomy (ie. expressed wishes of the individual) at the expense of the other two ethical principles. The effect of this has been to shift the burden of moral distress to care providers who must suppress their impulses to act in the best interests of their patients in order to silently follow the expressed wishes of their patient (ie. to proceed with MAID). Removing mental illness makes this moral distress much sharper. Two examples are suicidal ideation in depression, and poor insight and judgement in dementia. Care providers are trained to recognize these illness presentations and formulate the underlying mental health issues that cause them. However, lifting prohibition of MAID in persons mental illness would disrupt clinical assessments, and create intense moral distress when caregivers cannot be confident that the choice for MAID is informed and exercised by a competent individual.

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