Dr Shirley van der Merwe, MBChB

Thank you to the others who have so eloquently expressed their concerns regarding the expansion of MAiD to include mental ill health. In particular, thank you to Drs Lisa Burback, Hamza Riaz, Shelia Wang, Darryl Rolfson and David Lounsbury for your excellent points. I have 2 further concerns to add to those already raised: 1. By allowing MAiD for mental conditions, how will we be able to convince suicidal patients not to kill themselves and that it is just their disease process "speaking" when on the other hand others with a similar condition are being offered and are accessing MAiD? I am afraid that we will see a rise in attempted and completed suicide outside MAiD as death becomes seen as the "solution" to mental distress. Don't we already have enough of a problem with suicide without aiding and abetting? 2. I fear that the ongoing normalization of MAiD for any condition will add to the rapid attrition of Physicians from the health care system that promotes death as part of "health care". Each time I am asked by a patient to cross my conscience and have to gently but firmly remind them that I am obligated to "first do no harm", I suffer moral injury (even if I am free to decline involvement respectfully). Moral injury adds to work place stressors that have left many of us burnt out and caused some of us to close practices or reduce hours. By opening MAiD to those whose only condition is mental ill health will greatly increase the number of patients requesting MAiD and add to the burdens we already shoulder as physicians. Once the door is open to MAiD for mental ill health, there will be not shutting it later!

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