Collateral Damage: Medical Assistance in Dying and the Risk of ‘Suicide Contagion’

Editor’s Note: The following article is part of our continuing efforts to highlight the Medical Assistance in Dying (MAiD) issue and the potential harm that broadened access will do to vulnerable persons.

Canadian lawmakers now charged with revisiting the end-of-life requirement in Canada’s Medical Assistance in Dying (MAID) law would do well to review some of the important evidence that the Québec Superior Court appears to have sidestepped.

An expert witness who provided critical testimony in the Truchon & Gladu case was Dr. Mark Sinyor, a Canadian psychiatrist widely recognized for his clinical expertise and research on suicide prevention. In a comprehensive 50-page affidavit, Dr. Sinyor detailed for the court the “likely impact” of expanding MAiD for persons who are not at the end of life.

His affidavit begins by pointing out a clear distinction. Under the current law, physicians provide assistance with a dying process that is already occurring. Under an expanded law, physicians would bring about a death that is not otherwise foreseeable. According to Dr. Sinyor:

“The two circumstances are not the same, and in my professional opinion, should not be conflated as the considerations and societal impact are likely to differ substantially.”

The societal impact to which he refers, in part, arises from a well-established phenomenon referred to as “suicide contagion”. Dr.Sinyor explains that suicide contagion occurs “through a process called social learning in which vulnerable people identify with others who have had suicidal thoughts and/or behaviour.” After reviewing a range of relevant international research, he cautions:

“Expansion of MAID to include suffering, not at the end of life is likely to lead to suicide contagion and higher suicide rates, and to have a negative impact on suicide prevention….”

Dr. Sinyor’s affidavit, which is available upon request from the Québec Superior Court, also reflects upon the influence of “suicide messaging”, noting media guidelines, informed by public health policy, that advise against “portraying suicide as achieving results and solving problems”. He notes the extent to which many elderly people with chronic conditions, and younger people with severe disabilities, “feel like a burden to their loved ones and that their families would be better off if they were dead”. When others in similar circumstances are seen to ‘solve the problem’ of ‘being a burden’, the effect of such messaging is profound:

“If MAID becomes an option for a subset of Canadians with intractable medical and/or psychiatric conditions, the question is whether it might create a “duty to die” amongst people who feel like a burden but you would not otherwise have contemplated suicide.”

In the conclusion to Dr. Sinyor’s affidavit, Canadian lawmakers will find a clear signal of the weight and consequence that lies ahead for them in the wake of the Truchon & Gladu decision:

“…Normalizing suicide death via MAID as a remedy for suffering not at the end of life is likely to increase suicide rates in Canada at a time where there is a universal consensus among public and mental health experts of the imperative to decrease suicide rates.”

For further reading on this topic, read the following piece, written for CBC by Catherine Frazee.

Catherine Frazee is professor emerita in the School of Disability Studies at Ryerson University, a role she acquired after retiring from the school in May 2009, having served for a decade as a professor of distinction and as co-director of the Ryerson/RBC Institute for Disability Studies Research and Education. Frazee curated the program’s early offerings in disability arts and culture and is co-curator of the award-winning exhibit Out from Under: Disability, History and Things to Remember. She brought numerous honours to Ryerson, most notably when she received an Honorary Doctorate from the University of New Brunswick (2002), Dalhousie University (2009), and McMaster University (2015). Catherine was also the recipient of Community Living Ontario’s Lifetime Achievement Award in 2019.