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Abstract
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Medical Assistance in Dying (MAiD) has rapidly advanced in Canada in recent years including its use within prison populations. In June 2016, the prohibition on physician-assisted suicide in Canada's criminal code was rescinded, and MAiD was enacted under Bill-C14. This allowed competent persons over the age of 18 with 'grievous and irremediable' medical conditions to be eligible for MAiD under the condition that death was 'reasonably foreseeable' and that the request is made voluntarily. A 'grievous and irremediable' medical condition was defined as a serious and incurable illness, disease or disability that causes enduring and intolerable physical or psychological suffering and cannot be relieved under conditions the person considers acceptable.
In March 2021, further legislative revisions in Bill-C7 removed the prerequisite of a foreseeable death. This change initially excluded 'mental disorders as the sole underlying medical condition' (MDSUMC); however, mental disorders will qualify for MAiD from March 2023. Given that Section 86(1) of the Corrections and Condition Release Act obliges inmates the right to access 'essential healthcare' and that existing policy deems MAiD a healthcare procedure, prisoners are entitled to MAiD services for non-terminal and terminal medical conditions that otherwise meet the legal thresholds. In 2021, 3.3% of all deaths in Canada were by MAiD, almost all by physician-delivered euthanasia which is the highest rate in the world.1 Corrections Services Canada published Guideline 800-9 to outline the procedure for MAiD requests specific to the intricacies of the incarcerated setting.2
Mental illness and suicide among prisoners
Prisoners have a high prevalence of psychiatric conditions with approximately 14% of inmates having major mood disorders or psychosis and high comorbidities of substance use disorder contributing to increased risk of suicidality.3 Suicide is the leading cause of unnatural deaths among federal prisoners in Canada accounting for 20% of all inmate deaths annually.4 When compared to the general population, this amounts to an elevated relative risk of suicide of 3-6 among male inmates and reaching as high as 56 among female inmates.5
Prison is recognized as an environment that can exacerbate the severity of mental illness and suicidality, which raises concerns that incarceration creates intolerable conditions for some that may contribute to a request for MAiD. The expansion to include MDSUMC intensifies ongoing concerns regarding the poor transparency and limited data of MAiD within the correctional system.1 It is imperative that the ramifications of this eligibility expansion in the prison setting are carefully considered...
Language: en |