In April 2017, 27-year-old Adam Maier-Clayton committed suicide. While his friends, family, and thousands of followers on social media and YouTube were devastated, not many were surprised.

Over the past year and a half or so of his life, Adam had been campaigning for the right of people with severe and untreatable mental illness like him to receive medical assistance in dying (MAID).

On June 17 2016, Canada passed Bill C-14 into law, formally allowing medically assisted suicide in dying (MAID). According to the law, patients are only eligible for MAID if they’re suffering from a “grievous and irremediable medical condition” and meet all of the following criteria:

  1. they have a serious and incurable illness, disease or disability;
  2. they are in an advanced state of irreversible decline in capability;
  3. that illness, disease or disability or that state of decline causes them enduring physical or psychological suffering that is intolerable to them and that cannot be relieved under conditions that they consider acceptable; and
  4. their natural death has become reasonably foreseeable, taking into account all of their medical circumstances, without a prognosis necessarily having been made as to the specific length of time that they have remaining.

It seems clear that the wording of the law was intended to allow only those with terminal illnesses for which living has become unbearable to seek MAID, but what about those who have an incurable medical condition that makes living unbearable but will never actually cause death?

Adam Maier-Clayton was one of those people. He suffered from a milieu of mental health afflictions including a debilitating case of somatic symptom disorder (a kind of catch-all term referring to any mental disorder that manifests as physical symptoms that cannot be attributed to any other medical disorder) that caused him unbearable pain. Over the years he’d tried every medication and therapy that doctors could recommend but nothing seemed to improve his condition. It still only seemed to be getting worse. Eventually it got to the point where he was unable to do any activity requiring even minimal cognitive effort. Reading a book would bring about a searing and all-consuming pain within a few minutes. He could find no effective therapy or relief.

In bygone decades, debates around MAID centred primarily around people who were facing uncontrollable pain while in the face immanent death (end-stage cancer, AIDS, etc.) and those who were being medically supported but had little-to-no chance of making any sort of recovery (those considered “brain dead”, in a coma, etc.). The debate used to be focused on the question of whether or not medically assisted dying should be allowed at all. Now, the question society faces seems to be, “Who amongst the ill has the right to seek medical help in dying?”

Whether or not people whose condition is solely mental health-related should be able to seek a medically assisted death is an even more contentious question still, particularly within psychiatric medicine. Many psychiatrists treat suicidal patients frequently and feel that offering MAID is antithetical to their profession. There is also serious concern around the ability of some people with mental health issues to make decisions effectively.

Others may argue that all patients who would seek MAID should also be subjected to psychiatric screening before being cleared to receive MAID. It is also true that not all mental illness affects rational thought and decision-making ability. In this way, patients with mental illness would not necessarily pose a qualitatively different challenge for clinicians in determining soundness of mind.

As was exemplified in Adam’s case, it’s widely accepted that there are mental illnesses that are essentially incurable with current medicine and cause extreme suffering.

Who should decide whether a person who is living in constant agony has a life worth living? Is it fair for anybody else to make their decisions for them just because we don’t understand their suffering and death makes us uncomfortable?

These are considerations that must be address in Canada’s medically assisted dying laws.