Canada's euthanasia and assisted suicide regime has rapidly expanded since its legalisation in 2017. 

From March next year, it will be available for people suffering from only mental illness. 

In anticipation of this legal change, media attention has focused on 47 year old woman Lisa Pauli who has been battling with anorexia since she was a young girl.

Her illness has left her severely weakened and suffering, and has led her to plead with lawmakers to allow her to end her life through the country’s euthanasia regime.

The issue of approving euthanasia and assisted suicide for mental illness is a minefield and Ms Pauli’s case illustrates the complexities involved.

As Paul Kelly, editor-at-large at the Australian newspaper has argued:

“Imagine the complexity of authorising euthanasia for a person suffering from mental illness. That involves psychiatric, depression, personality issues where individuals are capable of changing their mind. Mental disorder lacks the biological basis that underpins physical illness”.

Last year, we reported on the push for euthanasia and assisted suicide to be available to those suffering from ‘terminal anorexia nervosa’. 

It is an issue that is fraught with risk and uncertainty.

A psychiatrist and senior researcher in Belgium has weighed in on the debate, arguing against expanding euthanasia for people with mental illness. Dr Marie Nicolini argues that one of the three criteria normally required for approval for euthanasia - that is that the condition is ‘irremediable’ or incurable (the other two being a voluntary request and that suffering must be unbearable) - is highly problematic when it comes to mental illness. 

Dr Nicolini highlights the difficulty of determining that a condition is irremediable, given that:

“...incurability is ambiguous. There are no objective signs, lab tests or scans to help clinicians identify whether a mental disorder has reached a point of ‘no return’. And there are no straightforward ways to distinguish a curable from an incurable mental disorder”.

Dr Nicolini argues:

“In an in-depth study we conducted of 74 Dutch cases of psychiatric euthanasia from between 2011 and 2017, all patients were considered ‘incurable’. Most patients were women with depression and personality difficulties, and all patients had experienced significant, chronic suffering for many years. Astonishingly however, more than a quarter of them had not tried psychotherapy, and a similar portion had never been hospitalised. It is hard to see how a condition can be considered incurable when a first line treatment like psychotherapy has not yet been deployed”.

Of particular concern are the conclusions from a study that found the issue of euthanasia for mental illness affects women in particular: 

“The consistent finding among people receiving euthanasia for mental disorders, 69 to 77 per cent are women. In my team’s study of Dutch psychiatric euthanasia cases, 36 per cent had a history of severe sexual or other kinds of abuse. Gender-based violence is a major public health issue that affects one in three women worldwide, and for which mental healthcare and prevention are lagging”.

Given that a majority of people with eating disorders in Australia are women, this will be another front that adversely affects women. We know that the research shows that women are especially susceptible to assisted suicide due to multiple factors, otherwise known as “gendered risks.”