Introduction
In the modern world, medical science is actively working to develop new treatments and rehabilitation methods for patients with various diseases. New effective techniques appear every year, giving hope to many patients. However, some conditions are still incurable and cause great suffering to patients.
The Medical Assistance in Dying (MAID) program guarantees the right to voluntary death for such patients and is considered an ethical good by society (Collier & Haliburton, 2021). However, the ethical debate about some controversial patient categories is still ongoing. Thus, from March 17, 2023, the MAID program will be eligible for patients with isolated mental illnesses (Bahji & Delva, 2021). In this essay, I will use utilitarian reasoning to argue that extending the program to this category of patients is necessary because it will secure such people’s right to achieve the best outcomes in their negative situations.
Explaining the Ethical Theory
Firstly, it is essential to briefly explore the basic elements of the selected theory. Thus, according to utilitarianism, “we are to do the thing that will provide the greatest amount of pleasure and the least amount of pain to the greatest number of people” (Collier & Haliburton, 2021, p. 7). Therefore, if one considers the proposed change from the point of view of utility, which is the cornerstone of utilitarianism, we can see its positive significance. Since the highest value in this ethical theory is the pleasure of many people, it is essential to review whether extending the MAID program will bring more happiness than pain to the community.
Arguments Against the Change
Since the utilitarianism theory is the most applicable to the ethical analysis of including patients with isolated mental illnesses in the program, one might argue that the expected outcomes are unlikely to bring more happiness. In other words, a question arises about certain pragmatic aspects, and hence creative benefits, that might be provided to a significant number of people (Singh, 2018). The validity of euthanasia lies in giving a person solace and pleasure as a consequence of the cessation of torment (Council of Canadian Academies, 2022). However, the focus of utilitarianism on the expected outcomes of action makes us question whether these patients can actually achieve this solace and pleasure.
One reason is that they might decide to end their lives under pressure from relatives, the public, or medical professionals. In this case, patients experience more pain, while utilitarianism aims to reduce pain for most people involved in the action. Numerous opponents of the MAID extension argue that the final decision to die in such people can be influenced not so much by the disease but by additional circumstances (Government of Canada, 2021; Westermair et al., 2021).
The latter often includes difficult living conditions, low income, and social exclusion, which frequently accompany severe mental illness (Simpson, 2018). All these factors are manifestations of the social stigmatization of people with mental disorders and theoretically can serve as provocateurs of their desire to die. However, the overall experience of pain will not decrease if these patients take advantage of the program.
Further, it is essential to view how many persons can be affected by the expansion of the MAID program. For example, according to statistics, “an estimated 1 in 4 Canadians has a degree of depression serious enough to need treatment at some time in his or her life” (Ontario Ministry of Health, n.d., para. 1). Next, “in Canada, 2.2% of individuals will experience bipolar disorder at some point in their lifetime,” and statistics form some other psychological conditions is unpleasant as well (Canadian Psychological Association, 2019, para. 9).
Therefore, if all these people decide to take advantage of the MAID program, they might experience happiness and relief. However, it is likely that the total number of relatives, friends, and other people interested in these patients continuing to live far exceeds the number of persons included in the statistics. As a consequence, the expansion of the program brings more pain than pleasure to many individuals. Therefore, this is how principles of utilitarianism can be used to prove that the proposed change should not be allowed.
Arguments For the Change
Furthermore, the selected ethical theory can also help explain the need for the change to be accepted. Firstly, mere knowledge about mental disease being considered severe, morally painful, and challenging to manage to the extent that it becomes legally possible to end one’s life may be calming and pleasing. Therefore, if the change to the MAID program is accepted, it will automatically bring happiness and satisfaction to a great number of people suffering from mental conditions (Bahji & Delva, 2021). They will be certain that they will not have to commit suicide if their states deteriorate significantly, and this knowledge may become their motivation to feel better. Therefore, as the ethical theory proposes, many will experience more pleasure and less pain.
Furthermore, supporters of allowing euthanasia for people with pathological mental conditions base their arguments on equality and compassion. Although isolated psychiatric illnesses are not fatal and potentially treatable, this does not make the patient’s suffering less serious. It is impossible to correctly consider whether mental suffering is equated with physical one, so automatically evaluating the latter over the former would be wrong.
If there is evidence that a person is competent and aware of their decisions, the refusal to alleviate their suffering can be considered unfair and even cruel (Koocher et al., 2023). This division between pleasures and pain on the basis of their value is not supported by utilitarianism. On the contrary, this theory indicates the need to focus on the consequences of an act, and the proposed expansion of the program will bring joy and satisfaction to many patients.
Personal Position
As mentioned earlier, I lean toward the supporters’ arguments for allowing euthanasia for mentally ill patients. While it is impossible to exclude the influence of external and internal factors on making this difficult decision, allowing individuals with severe psychological conditions to have such an option brings happiness to many people. Since the MAID program reviews each specific case individually, with strict compliance with the necessary criteria, it will decrease the amount of pain and increase the amount of pleasure for every patient who considers ending their life. In addition, I cannot ignore that patients with mental illness, in most cases, are physically capable of committing suicide independently, and this act increases the overall unhappiness of their relatives and communities in general. Per the principles of utilitarianism, expanding the program can prevent mentally ill patients’ fear of being denied assisted death, making them more satisfied and less anxious or unhappy.
Conclusion
I agree with the need to include psychologically ill individuals in the MAID initiative. This intervention can be reviewed using some concepts of utilitarianism. This ethical theory can help prove the unnecessary and even harmful effects of the proposed change, primarily due to its unpredictable outcomes and the raised unhappiness of friends and relatives of patients with mental conditions. However, this theory is more applicable to proving the need for change as it will bring peace, confidence, and satisfaction to such patients as they will know that their conditions are considered real and severe.
References
Canadian Psychological Association. (2019). “Psychology works” fact sheet: Bipolar disorder. Web.
Collier, C., & Haliburton, R. (2021). Bioethics in Canada: A philosophical introduction. Canadian Scholars.
Council of Canadian Academies. (2022). The state of knowledge on advance requests for medical assistance in dying: The expert panel working group on advance requests for MAID – Centre for Suicide Prevention [PDF document]. Web.
Government of Canada. (2021). Expert panel on MAID and mental illness. Web.
Koocher, G. P., Benjamin, G. A., Bolton, J., & Plante, T. G. (2023). Medical assistance in dying (MAID): Ethical considerations for psychologists. Professional Psychology: Research and Practice, 54(1), 2–13. Web.
Ontario Ministry of Health. (n.d.). Mental health: Depression. Web.
Simpson, A. I. (2018). Medical assistance in dying and mental health: A legal, ethical, and clinical analysis. The Canadian Journal of Psychiatry, 63(2), 80–84. Web.
Singh, H. (2018). Medical assistance in dying (MAID) for minors in Canada: Considering children’s voices [PDF document]. Web.
Westermair, A. L., Irwin, S. A., Schweiger, U., & Trachsel, M. (2021). Editorial: Approaches for severe and persistent mental illness. Frontiers in Psychiatry, 12(1), 2. Web.