Decision-Making Capacity to Consent to Medical Assistance in Dying for Persons with Mental Disorders
(2016) (open volume) Journal of Ethics in Mental Health 1-14
14 Pages Posted: 26 May 2016 Last revised: 9 Jun 2016
Date Written: May 25, 2016
Following a Canadian Supreme Court ruling invalidating an absolute prohibition on physician assisted dying, two reports and several commentators have recommended that the Canadian criminal law allow medical assistance in dying (MAID) for persons with a diagnosis of mental disorder. A key element in this process is that the person requesting MAID be deemed to have the ‘mental capacity’ or ‘mental competence’ to consent to that option. In this context, mental capacity and mental competence refer to ‘decision-making capacity’, which is a distinct area of clinical study and research in the theory of informed consent. The purpose of this discussion is to bring several controversial but insufficiently acknowledged problems associated with decision-making capacity to the forefront of the proposed extension of MAID to persons diagnosed with mental disorders. Open-ended access to MAID by persons who suffer from mental health conditions already exists in Belgium and the Netherlands, where the issues raised here are equally relevant. In this paper, we highlight the serious limitations of relying on capacity assessments to allow access to MAID/Euthanasia.
Keywords: Euthanasia; Decisionmaking Capacity; Competency; Physician Assisted Dying; Physician Assisted Suicide; End of LIfe; Mental Health; Informed Consent; Canadian Charter of fundamental rights and freedoms
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