Understanding Asymmetrical Opposition to Medical Assistance in Dying for Mental Illness

In Canada medical assistance in dying (MAiD) excludes individuals who have a mental health disorder as their sole underlying medical condition (MD-SUMC).This suggests mental illness is conceptually distinct from somatic illness, a position that requires further analysis.The Canadian government has postponed legislation on mental health conditions since it is highly controversial compared to physical illness, and this will allow them to collect more data on the issue (Government of Canada 2024a).Aside from the legislative reality in Canada, Jeffrey Kirby (2022) has described three positions that scholars have taken up regrading the ethical permissibility of MAiD for MD-SUMC: (a) accept that MAiD for MD-SUMC is ethically permissible; (b) presently oppose MAiD for MD-SUMC, but maintain that MAiD for MD-SUMC could become ethically permissible should the current eligibility criteria better align with the relevant empirical data; and (c) oppose MAiD for MD-SUMC on "philosophical grounds" and maintain that no alteration could make the practice ethically permissible.If we assume that each view described by Kirby also entails the claim that MAiD in general is ethically permissible, or at the very least is not ethically impermissible, it appears that opposition to MAiD for MD-SUMC reveals something important about the way in which mental illness is understood-namely, as something perhaps categorically different from somatic illness.This results from the asymmetry between holding that MAiD for somatic illness is ethically permissible, but MAiD for MD-SUMC is ethically impermissible.At present there are five conditions that must be met in order for one to be eligible for MAiD: (1) be eligible for government-funded health services; (2) be competent and at least 18 years of age; (3) voluntarily request MAiD; (4) provide informed consent; and (5) have a grievous and irremediable medical condition (Government of Canada 2024b).To determine whether one's medical condition is grievous and irremediable, there are further conditions that must be met: (i) "have a serious illness, disease, or disability;" (ii) "be in an advanced state of decline that cannot be reversed;" and (iii) "experience unbearable physical or mental suffering from your illness, disease, disability or state of decline that cannot be relieved under conditions that you consider acceptable" (Government of Canada 2024b; emphasis in original).Emphasis tends to be placed on the grievous and irremediable nature of one's medical condition in debates on MAiD for MD-SUMC (Birkness and Rudnick 2023).For example,