Sir, – We are grateful to colleagues who highlighted the "slippery slope" in Canada (Letters, June 12th). Although those with mental illness alone were initially excluded from accessing physician assisted suicide and euthanasia in 2016, it was subsequently argued that this was discriminatory. Canadian legislators must now determine criteria for those with mental illness, and which suicides are to be assisted and which are to be prevented.
We acknowledge that this is not what the current Dying with Dignity Bill is proposing. However, it does demonstrate how quickly safeguards can be removed and whether legislation can truly protect the most vulnerable. As psychiatrists, we find this deeply concerning.
Mental illness, primarily depression, is common in those with chronic illness and cancer. Certain mental disorders, such as psychotic illnesses and health anxiety, can lead to abnormal beliefs about one’s health or longevity. Feeling suicidal forms part of the diagnostic criteria for borderline personality disorder. If those with such disorders develop a terminal illness as set out in the Bill, they may be especially vulnerable to dying from assisted suicide or euthanasia as a consequence of their mental state.
There is a clear need to invest now in our health service and mental health services to provide timely access to excellent multidisciplinary palliative care, pain services and mental healthcare, so that all patients facing a terminal illness can live and die in dignity. – Yours, etc,
Dr ERIC KELLEHER,
Prof ANNE DOHERTY,
Faculty of Liaison
College of Psychiatrists
of Ireland, Dublin 2.