Photo ID: A Canadian flag at half mast against a sunset sky with text overlay

Medical Assistance in Death (MAiD) in Canada: Mental Illness and Assisted Suicide

Curt and Katie chat about assisted suicide related to an upcoming expansion of the MAiD laws in Canada to include mental illness. We discuss what these laws seems to say as well as how they might impact patients, medical providers, and therapists. We explore the moral and ethical questions as well as what other countries have done to put in further safeguards to protect patients and doctors.

Transcript

Click here to scroll to the podcast transcript.

In this podcast episode we talk about the expansion of Medical Assistance in Death laws in Canada

We have been watching the MAiD laws in Canada that are soon going to include assistance in death for folks with mental illness. We talk about the law and the concerns we have related to the safeguards (or lack of safeguards).

What are the updates coming to the Medical Assistance in Death laws in Canada?

  • With the approval of 2 medical professionals and a 24-month waiting period (for psychological illness), individuals can get medication or an injection from a medical provider to end their lives
  • Requirements for application include chronic, “grievous and irremediable” conditions
  • Information on requirements are here: Final Report of the Expert Panel on MAiD and Mental Illness
  • The differences in laws in other countries that seem to have more safeguards in place

What are the moral and ethical questions facing medical and mental health providers?

“Do we have the right – the moral right – as therapists, mental health professionals of any sort of background or license, to tell clients that they must live or that it is okay for them to end their life?” – Curt Widhalm, LMFT

  • What responsibilities do mental health providers have to their clients related to end of life?
  • Who will be negatively impacted versus who will be positively impacted?
  • Who would qualify and who would seek out assistance in dying?

“I’m not worried that someone that’s a little depressed is going to decide they want to die by suicide… I think it’s more that there are going to be folks [diagnosed with serious mental illness who are receiving insufficient mental health care] … who really don’t feel like they have options (and maybe they don’t) and they choose to die by suicide versus advocating for stronger treatment.” – Katie Vernoy, LMFT

  • What is mental illness? Is it only what is in the ICD or DSM?
  • What are the impacts of these laws on physicians?
  • Concerns raised by First Nations groups in Canada

Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:

Thrizer

Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client’s insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don’t need to give up your rate. They charge a standard 3% payment processing fee!

Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won’t be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code ‘moderntherapists’ for 1 month of no credit card fees or payment processing fees! That’s right – you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.

Simplified SEO Consulting

Simplified SEO Consulting

Have you spent countless hours trying to get your website just right and yet, it’s not showing up on Google and it doesn’t seem like anyone’s able to find it? Simplified SEO Consulting has a unique solution. They’ve been training therapists to optimize their websites, so they show up better on Google for the past 4 years. But let’s face it, with the busy schedules we all keep it can be hard to find the time to optimize your website even when you learn how. So, they are hosting a 16 day cruise in July 2023 going from LA to Hawaii and back. When you join them, you’ll get intensive SEO education and coaching during the 10 days at sea. Most importantly, you’ll have plenty of time to sit next to the pool and implement everything you’ve learned and then ask their team for feedback. Yes, it’s the perfect excuse for a Hawaii vacation. But it’s also a time to both learn about SEO and actually implement what you learn.

The upcoming cruise is a unique opportunity to learn to optimize your own website, have time to practice what you learn and the ability to get feedback from leading SEO professionals in our field.

To reserve your spot before it fills up, go to https://simplifiedseoconsulting.com/training-cruise-for-better-seo/ 

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Final Report of the Expert Panel on MAiD and Mental Illness

NY Times: Is Choosing Death Too Easy in Canada?

Medical Assistance in Dying in Canada: Too Much, Too Fast?

 Canadian and Dutch doctors’ roles in assistance in dying

Relevant Episodes of MTSG Podcast:

Part 1: Risk Factors for Suicide: What therapists should know when treating teens and adults

Part 2: What Therapists Should Actually Do for Suicidal Clients: Assessment, safety planning, and least intrusive intervention

What’s new in the DSM 5-T-R? An interview with Dr. Michael B. First

When Clients Die: An interview with Debi Frankle, LMFT

Therapists Struggling with Darkness

Suicidal Therapists: An interview with Norine Vander Hooven, LCSW

Therapist Suicide

Who we are:

Picture of Curt Widhalm, LMFT, co-host of the Modern Therapist's Survival Guide podcast; a nice young man with a glorious beard.Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

Picture of Katie Vernoy, LMFT, co-host of the Modern Therapist's Survival Guide podcastKatie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:

Patreon

Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage

Facebook

Twitter

Instagram

YouTube

Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann https://www.facebook.com/McCannDW/

Music by Crystal Grooms Mangano https://groomsymusic.com/

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Curt Widhalm 0:00
This episode of The Modern Therapist’s Survival Guide is brought to you by Thrizer.

Katie Vernoy 0:03
Thrizer is a modern billing platform for private pay therapists. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer you can potentially save them hundreds every month with no extra work on your end. The best part is you don’t have to give up your rates they charge a standard 3% processing fee.

Curt Widhalm 0:24
Listen at the end of the episode for more information on a special offer from Thrizer.

Katie Vernoy 0:29
This episode is also brought to you by Simplified SEO Consulting.

Curt Widhalm 0:33
Have you spent countless hours trying to get your website just right and get it’s not showing up on Google and it doesn’t seem like anyone’s able to find it? Simplified SEO Consulting has a unique solution. They’ve been training therapists to optimize their websites so they show up better on Google. But let’s face it, with the busy schedules we all keep it can be hard to find time to optimize your website even when you learn how. So they’re hosting a 16 day cruise in July 2023 going from LA to Hawaii and back. When you join them, you’ll get intensive SEO education and coaching during the 10 days at sea. Most importantly, you’ll have plenty of time to sit next to the pool and implement everything you’ve learned and then ask their team for feedback. Yes, it’s the perfect excuse for Hawaii vacation, but it’s also time to both learn about SEO and actually implement what you learn.

Katie Vernoy 1:24
Listen at the end of the episode for more information on Simplified SEO Consulting,

Announcer 1:29
You’re listening to The Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings to support you as a whole person and a therapist. Here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 1:44
Welcome back modern therapists This is The Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast for therapists where we discuss things going on in the world and therapy, mental health plans, the things in our office, and we’re bringing another week of discussion around suicide here, we’ve just had two weeks of our continuing education episodes on working with suicidal clients. This week, we’re focusing in on you, Canada, and…

Katie Vernoy 2:17
Oh, Canada.

Curt Widhalm 2:20
So Canada has a medical assistance in death law that has been out since 2016. And much like many other jurisdictions over the world, this allows for people who are facing terminal illnesses and things like that, to receive medical assistance in being able to die by suicide once certain conditions are met. Now, this Canadian legislation has an interesting twist that’s coming up in March of 2023. And what this does is makes Canada the third country in the world that will allow for mental illness to be one of the things that can be a qualifying factor for receiving medical assistance in death. The acronym for this is pronounced maid M A I D. That’s what we’ll probably be using a lot through this episode here. But this is kind of a shocking thing that leads to a lot of moral questions and ethical questions that Katie and I have seen, read about or come up with on our own, but really it boils down to Are you in support of people ending their lives because of mental illness?

Katie Vernoy 3:42
That’s such a complex question. I think there are folks who I’ve worked with who I’m aware were of who have had what has been called serious mental illness where there is a lot of suffering, a lot of time spent trying to figure out how to keep them safe. Also living in, you know, just huge amounts of paranoia and fear and doing dangerous things and causing a lot of concerns for their family members. And there’s a part of me that says they should be able to make a decision about how they end their lives. And there’s another part of me that says, I don’t know that they could make competently make that decision. And so I’m sitting at a strong I don’t know.

Curt Widhalm 4:38
My first thoughts was, okay, when I found out that this is going to expand to include mental illness, my thoughts went to some of the very, very severe mental illness that you’re referring to here.

Katie Vernoy 4:51
Yes.

Curt Widhalm 4:53
This legislation is actually any mental illness. Depression, adjustment disorders. I don’t know if it gets into like Z codes and that kind of stuff.

Katie Vernoy 5:07
So it opens, you’re saying it could theoretically open it up to everyone.

Curt Widhalm 5:11
It opens it up to everyone. And little background information on this Canada’s Cardus think tank, is finding that 80% of Canadians want help in making it simpler to have the ability for people to make their own end of life choices. 33% are enthusiastic supporters of MAiD but 48% are cautious supporters. And I think that that’s why initially if I was pulled in this, yeah, that’s probably where I would fall, because as we’ve discussed over the last couple of weeks is many people who are in the feelings of suicide, finds that they’re temporary, and that they are able to get through those feelings may not improve any of the situations that led to those feelings in the first place. But there seems to be an absence of the abundance of caution that goes to our very ethical codes and the very way that we approach being mental health professionals in this. And where we’re going to point is to the to other countries that have safeguards in place that as of the recording of this episode, are not in the Canadian legislation at this point. Now, the two countries that have these things in place are the Netherlands and Belgium, and will meander in and out of talking about their experiences with it. But the safeguards that those countries have in place boils down to the idea of all other treatment options have been exhausted.

Katie Vernoy 6:52
And or considered, I mean, the way that I read the article that you had found about this, I feel like there was an element of the doctor needs to present and, and try other mechanisms and determine with the patient, that there is no other reasonable option to make things better. So it doesn’t mean they have to try every palliative, you know, effect, they don’t have to try every thing, but the doctor needs to be satisfied before they would approve it. Whereas what it seems like is happening with Canada is that the patient can just say no, I don’t want to try anything else. And if they have what is considered appropriate for MAiD that their lives are foreseeably going to end which I guess that’s everybody and there, they have a situation that is unbearable, they can then they must the doctors actually must approve it. Whether the they can they can try to convince their patients. Hey, there’s other things to try. But if the patient says no, I don’t want to try it, then the doctor, at least in one of the articles that you that you shared with me, the doctor has to say okay, then I will help you with this.

Curt Widhalm 8:06
And we’ll include links to the articles that we’re referencing in our show notes, you can find those over at mtsgpodcast.com. Now the safeguards that are in place in the Canadian legislation is that people have to be evaluated by two medical professionals, and if the cause is psychological illness, then there has to be at least 24 months from application until the procedure can be carried through.

Katie Vernoy 8:35
Ah, okay.

Curt Widhalm 8:36
So this is not where it’s just somebody who’s in the midst of a first feelings of suicide ends up being able to initiate this maneuver the bare minimum of safety here. And Donna Wilson, a professor within the Faculty of Nursing in the University of Alberta in Edmonton describes the safeguards as sufficient quote: the person has to apply there has to be an assessment by two qualified medical professionals. And there has to be sort of a grace period. It isn’t like you apply today and it’s done tomorrow. However, Harvey Schipper, MD, aprofessor of medication and adjunct professor of legislation on the University of Toronto says those requirements are mainly procedural and don’t go far enough. They’re usually not clear or uniformly utilized. There’s nothing in any educational curriculum about it. So wild west second right here and because of this, charges are made on inhabitants, foundations fluctuate throughout Canada.

Katie Vernoy 9:40
So he’s describing it as the wild west that these aren’t that these safeguards are not enforced the same way or they wouldn’t necessarily be enforced the same way. I mean, I think, two different medical professionals and I guess one of the questions are, are we some of those professionals that would be making this assessment? And 24 months. I mean that that actually seems like in part that would give someone the opportunity to have symptoms abate or things to change. I think there’s this other piece though if someone’s trying to convince people for 24 months that they should die, that doesn’t necessarily improve their mental health as it stands. So, I don’t know. I mean, what do you do you think that that is a sufficient safeguard?

Curt Widhalm 10:32
You know, whenever we look at things like scope of practice, we look at what the educational standards are. And as an educator myself, I look at what are the things that we train students to do. And, you know, I’m a faculty member of a marriage and family therapy program, we generally teach people here’s how to intervene and keep people as safe as possible during suicidal feelings. And when we do talk about California’s Death with Dignity Act, we do it as a, that’s beyond the scope of this course. And you should get specialized training on that later.

Katie Vernoy 11:05
Ah, got it. Got it.

Curt Widhalm 11:08
So I very much agree with like, we can acknowledge that these things are there. But if it’s not a core part of the curriculum that this comes very much to where a lot of our ethics codes and the guidance within our profession says, what is an appropriate standard of training on something like this. But I think that when it comes to mental health and the way that we look at clients, part of what our ethics codes also say, is to respect the decision making of where our clients are coming from, and what their desires end up being. And some of that self autonomy sort of aspects and

Katie Vernoy 11:48
Self determination.

Curt Widhalm 11:50
This is where it really raises the question as far as like, do we have the right, the moral rights as therapists, mental health professionals, any sort of background or license to tell clients that they must live? Or that it’s okay for them to EMS their own life?

Katie Vernoy 12:09
Yeah, I mean, I think that’s, that’s really the crux of it. If I have a client who is actively suicidal, I, by training, I’m going to try to keep them alive. And yet, what say do we actually have and whether someone continues to live? I mean, there’s laws that prevent it. I think that there’s this criminal aspect of dying by suicide. I guess the question that follows for me on this is whether or not it’s worked for us to say, No, you must live and I’m going to, I’m going to keep you alive in whatever way I can. Because Canada’s going the other way, Canada’s saying it is up to individuals to decide if they live or not. And they can get medically medical assistance and death if they so choose, and, you know, go through this process that may or may not have enough, have sufficient safeguards. And so to me, I could argue either point.

Curt Widhalm 13:18
This doesn’t seem to be one where you can just kind of pick the middle.

Katie Vernoy 13:22
Yeah, just saying on that. And yet, I mean, there’s gonna be a huge, you know, a crapload of it depends, I think, client by client, there are situations where I would feel like it’s my responsibility to try to keep them alive. And there are clients that I’m certain that would have reasonable standing for, you know, what used to be called euthanasia or assisted suicide. I mean, I think that there, the broader array of experiences make it hard to say one thing or the other, thoug.

Curt Widhalm 13:56
You know, most of us who listen to this podcast are probably not going to be in a position, at least as of the time of recording or when the time of this goes into effect, are going to be the people who evaluate but it is something that directly affects a lot of the clients that we may end up serving. The expertise of the people who are the ones evaluating if a client is qualified for MAiD has to be a medical practitioner, or nurse practitioner who has expertise in the requesters condition. In cases where a thorough appraisal of past interventions is required to establish incurability and irreversibility and the requester must be given complete information about existing options. It is essential that at least one of the assessors have Royal College of Physicians and Surgeons of Canada certification in a specialty that covers the requestors condition. The other assessor may or may not be the person’s treating physician or nurse practitioner, but one of them should not be on the treatment team.

Katie Vernoy 15:08
So a person outside for a little bit of extra objectivity, but there’s more of a requirement about the condition, which for the mental health folks would be mental health. But if it’s somebody that is seriously depressed, or hopeless, or those types of things because of a medical condition, and they’re seeking MAiD for a medical condition, it may not even come up that they’re not, there’s not capacity to make the decision, because there’s not a medical, mental health professional on the team.

Curt Widhalm 15:43
And I think that that’s huge within this as well is the capacity to make the decision ends up also being something where, you know, a lot of this is portrayed incorrectly by things like, you know, the Hollywood view of like incurable insanity or, you know, not guilty by reason of insanity as far as the courts go. But the competency in those cases, to be able to stand trial ends up being one thing, the capacity to be able to make a decision of I, as a patient feel this way and want to get out of this feeling, I don’t see myself being able to make these decisions in the future, I don’t see things getting better. I can imagine some cases of severe mental illness where that feeling can permeate for quite a while. But I’m also just kind of looking at, you know, the, the number of different treatment options, where people, you know, therapists come up short sometimes, and it might just be a responsibility of the therapist of like, you know, we, you know, need to maybe find you a different provider that can offer something that I cannot, that seems to be like, there’s too many places, I guess, in my initial reaction of this, there’s too many places where too many little gaps might end up being something that ultimately leads to the loss of life here.

Katie Vernoy 17:22
Well, it’s what you’re saying it requires a quote unquote, incompetent therapists being able to identify they’re incompetent and refer on because if they don’t, their client may choose to die by suicide. I mean, I think some of this may be some hand wringing, I don’t know how many folks are just waiting for this to come into effect so that they can get medical assistance in death. I think the elements I think that are interesting, that you’re you’re speaking to with this, Is someone competent to make a decision? Is folks trying to do it ahead of time, like with an Alzheimer’s diagnosis or other cognitive decline, and, and really being able to do some end of life planning. And so I think that there’s this possibility that it opens up some really positive options for folks on ending their life the way they want to, and being able to have their family with being able to kind of create a some sort of a scenario. And then on the other end, I see it as what you’re describing is, is this wasteland of folks who are in incompetent or poor treatment? They’re, they’re in a space where, you know, they don’t have a lot of options, not because there’s not treatment options, but there’s not a lot of medical providers, who will who will treat them. I mean, I think about our field and how few people want to work with serious mental illness or how few people want to do things for folks who have some of the quote unquote, challenging mental health concerns. Like to me, I’m not worried that someone that’s a little depressed is going to decide they want to die by suicide. I think a lot of people we’ve talked about protective and risk factors and that kind of stuff. I think it’s more that there are going to be folks who are, are in this space of not being cared for, being outside of, you know, the, the typical treating, you know, kind of community, so to speak, who really don’t feel like they have options and maybe that they don’t, and they choose to die by suicide versus advocating for stronger treatment. And so to me, I just I worry about who will be negatively impacted by this versus the folks who I think could be greatly benefited by it because they are already navigating end of life decisions and that this gives them a little bit have more control over that, and potentially a, you know, kind of the Death with Dignity that I think is intended by it.

Curt Widhalm 20:08
The Netherlands has had MAiD since 2002. And it’s been regulated by law there. And it’s really part of their evaluation looks at is the condition grievous and irremediable. And there’s a very difficult struggle there, because how do you determine grievous and irremediable in psychiatry?

Katie Vernoy 20:36
Yeah.

Curt Widhalm 20:36
Outside of dementia, nothing else gets really shown on brain scans as far as there being something physically different in going on at the client. And Dutch psychiatrists, Dr. Cisco van Veen says, In psychiatry, really all you have is a patient’s story and what you see with your eyes and what you hear and what the family tells you. And that makes looking at a mental disorders, prognostic predictability really, really difficult. We don’t make predictions in our fields. As far as we don’t make promises to clients, we don’t say you get better in any of these, you know, number of sessions. And in the 15 years between when this procedure went into effect in the Netherlands, and a 2017 study said in 45%, of all requests in the Netherlands, the request did not lead to euthanasia. So about a little more than half actually did end up fully completing the procedure. The half that didn’t were either because the patient died before the request could be completed in about 60% of those cases. Or because the physician concluded that the new care criteria were not being met. And that’s the part that’s missing from the Canadian legislation here. And about 20% of requests were withdrawn after discussions with the doctors. So presumably, during the two years of intervening that clients decided that, Hey, maybe I can live with this.

Katie Vernoy 22:14
Yeah.

Curt Widhalm 22:15
That 20% number is the one that sticks out to me most.

Katie Vernoy 22:18
Yeah. I mean, it’s not a huge number, necessarily, because it’s 20% of the 45%, who didn’t go through. So it’s not gigantic, but it’s still significant in my mind. I don’t know if it’s statistically significant. But it’s as if it is significant in my mind, because it’s folks who are hopeless, have a have a conversation or maybe 20 conversations with a medical professional, and decide that life is actually worth living and life or it’s better enough.

Curt Widhalm 22:53
I think that’s a p value of like, 9%. That’s pretty significant.

Katie Vernoy 22:58
Sure, I mean, we’re not actually doing math here. We don’t have all of the data. We don’t know the numbers. I mean, we’ve got some numbers. But still, I think what we can say, though, is that even if it’s around 10%, or even 5%, I mean, that there are folks who, in a country that’s highly regulated for this, there’s there’s a mechanism that they’re saying, I don’t see a way out, this is how I want to die, that without those extra safeguards, that who would die in Canada? I think that is relevant. I think it is important that we look at it that way. I guess the question is, I mean, stepping further back on this, when we look at reasons why and I don’t know that we have this information, but why someone with a mental illness is seeking medically medical assistance in death? I mean, do we know what that is? Do we know why folks are actually doing it because to me, I can see potential things, you know, kind of the treatment resistant depression or serious mental illness that is so pervasive that it’s almost akin to a severe dementia as far as kind of cognitive problems. But I mean, there there are things that will never get better, that I don’t think require this as an option or or should even be suggested as an option. I mean, we talk we talk about the folks the disability movement, we talk about the neuro divergent movement, like these are folks, they would potentially qualify for this and I believe that they have the ability to to create lives, especially if as a society, we become more or I guess, less ablest and more inclusive. To me, it seems like this is saying, Well, you know, you can write yourself off. We have. I mean, it’s just it’s hard to really get my head around what is really acceptable here? What’s really worth happening here?

Curt Widhalm 25:07
Well, I mean, this also pushes big questions like, what is in fact mental illness? Because…

Katie Vernoy 25:16
Fair.

Curt Widhalm 25:17
…with you know, let’s go back to our DSM 5 interview where Dr. First was talking about, there’s some things that they just kind of leave in the DSM to help with insurance billing and for people to get services coverage that probably don’t fit within what we would call mental illness anymore.

Katie Vernoy 25:37
Yeah.

Curt Widhalm 25:39
And I think that, you know, this is where there’s so much that’s undefined within this Canadian legislation that really ends up making it to where physicians have to be obedient to the wishes of patients, if they can’t convince the patients that there’s other viable alternatives.

Katie Vernoy 26:02
Well, and that goes also too physicians could recommend it. And if the patients say, okay, the physicians don’t have to try any additional treatments. I mean, we’re talking about good physicians who are potentially going to be traumatized, because they’re going against what their morals and values are. But this is also a mechanism to get rid of folks. I mean, you’ve got a patient that feels like it’s hopeless, you can just say, Oh, you don’t feel like there’s any treatment that can work? Well, well, you have this new law. Here you go. I mean, I don’t, I don’t know that people will do that. I hope they wouldn’t. But there’s still that element of bias and poor treatment, and all of these things where I think if there’s not sufficient safeguards, this can be abused not only by not abuse, that’s the wrong word. But like it could be, unfortunately used by patients who can’t see the possibilities, or abused by physicians who are giving up on patients.

Curt Widhalm 27:05
Being forced to kind of acknowledge that you as a physician have to follow through on a procedure that you may not necessarily agree with. Now, it might not be that particular physician who’s the one providing the injection, but the here’s somebody who, you know, has done, the evaluation says, you know, you meet the three requirements that are here, whatever number it is, without necessarily being like, but there’s all of these things outside of the bare minimum of requirements that should be a safeguard that’s here.

Katie Vernoy 27:41
Yeah, I think, you know, we can we can wring our hands, we can make dramatic statements, but I think it really comes down to more safeguards should be in place, because we’ve got medical professionals who are either complying with potentially uninformed patients, or medical professionals who are co-signing on something that they may not feel comfortable with. And so to me, it seems like it needs to have some delicacy, it needs to have some nuance. And my hope is that the medical professionals would do that. I think what I’m hearing is that you’re concerned that it would be way too easy for this to be used in a way that would be very harmful for both patient and doctor.

Curt Widhalm 28:30
I’m thinking of, you know, the episodes that we’ve had in talking with people about losing a client. Like there’s the unexpected, you know, when you lose a client to death when you lose a client suicide. this seems to be, you know, taking care of the therapists here.

Katie Vernoy 28:50
Yeah.

Curt Widhalm 28:51
When patients are gonna go through with something that you don’t agree with, and it results in their death.

Katie Vernoy 28:57
Yes.

Curt Widhalm 28:57
I’m imagining the burden that’s gonna feel on therapists.

Katie Vernoy 29:02
Yeah. Therapists, doctors, all the folks that would be involved on that, that end of it, I think it’s, it’s a huge, a huge weight, emotional weight.

Curt Widhalm 29:12
One last group that I want to talk about with this is the first nations Inuit and Metis peoples of Canada. And the articles that we’re citing here say that the engagement with the indigenous people of Canada concerning MAID has yet to occu. Which is difficult. But there’s a 2020 study by Turpel and Lafond, that talks about the historical harmful policies and practices of colonization such as residential schools, legislation that the federal government has a history of causing harm to the aforementioned groups and compared to the non indigenous populations, a disproportionate number of indigenous people live in poverty, have inadequate housing, a lack of clean drinking water and have limited access to education and health care. Anti indigenous racism is also widespread in Canada’s Health Care System. And as a result of creations of laws that provide access to MAiD concerns have been raised by indigenous leaders and communities that it is far easier for people in their communities to access a way to die, than to access the resources they need to live well.

Katie Vernoy 30:31
Wow. Yeah, I mean, that speaks to a lot of the concerns I have about this, where it is wonderful to think that people can have some self determination and get what they need in these difficult times. But it puts out something that’s really interesting, we don’t have that self determination in medical care in a lot of ways. Not in accessing things and not accessing that them. We do, right? We can say, No, I don’t want that medical treatment. But we can’t say I want this medical treatment. And maybe it’s different in Canada, but it’s harder to say I want this medical treatment. And they’re like, Well, no, but it’s not medically necessary. And so this is, this is really I mean, it’s it’s a really complex thing. I don’t even think we got into all of the the complexity here on what this means. I mean, there’s I still sit with I think folks should be able to make decisions for themselves, but I want them to be competent decisions. I want them to have the best possible decision, which means that they’re not necessarily in that entrapment place of the model that we talked about, in the last two suicide episodes. We are such a cheerful little podcast here. But I think if someone’s in the entrapment phase, I just cringe at them being able to make this decision without any safeguards, without any, any requirement to at least give another chance to living. But I do want people to have some self determination. And I certainly don’t think that criminalizing suicide is necessarily the strongest way to keep people from taking their own lives.

Curt Widhalm 32:25
And I’m concerned that this puts treatment professionals, both the medical doctors, also the mental health professionals in situations where they’re going to have to legally support services that they’re morally against when it comes to situations of life or death.

Katie Vernoy 32:45
Yeah, no, I and I think, as we’ve seen, and we’ve talked about with, you know, a few episodes on clinician suicide, I think this could potentially lead to more clinician, medical provider, mental health provider suicide. Just because it is such a moral misalignment.

Curt Widhalm 33:09
We would love to hear your thoughts, especially if you’re part of our Canadian audience. And help us know whatever it is that we can do from here and join us on our Facebook group, the Modern Therapist Group, let us know have conversations there, follow us on our social media. And if you want to continue to support us consider becoming a Patreon member. Where we do some cool things with our audience from time to time and have goodies and stuff to give away. If you can’t become a patron, consider supporting us at Buy Me a Coffee. And until next time, I’m Curt Widhalm with Katie Vernoy.

Katie Vernoy 33:50
Thanks again to our sponsor, Thrizer.

Curt Widhalm 33:53
Thrizer is a new billing platform for therapists that was built on the belief that therapy should be accessible and clinician should earn what they are worth. Every time you bill a client through Thrizer an insurance claim is automatically generated and sent directly to the clients insurance. From there Thrizer provides concierge support to ensure clients get their reimbursement quickly and directly into their bank account. By eliminating reimbursement by cheque, confusion around benefits and obscurity with reimbursement status they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick and easy to get set up and it works great with EHR systems.

Katie Vernoy 34:34
Their team is super helpful and responsive and the founder is actually a longtime therapy client who grew frustrated with his reimbursement times. Thrizer let you become more accessible while remaining in complete control of your practice. Better experience for your clients during therapy means higher retention. Money won’t be the reason they quit on therapy. Sign up using bit.ly/moderntherapists and use the code ‘moderntherapists’ if you want to test Thrizer completely risk free. You will get one month of no payment processing fees meaning you earn 100% of your cash rate during that time.

Curt Widhalm 35:09
Once again, sign up at bit.ly/moderntherapists and use the code ‘moderntherapists’ if you want to test Thrizer completely risk free. This episode is also brought to you by simplified SEO consulting.

Katie Vernoy 35:23
These days most people go to Google when they’re looking for a therapist and when they start searching, you want to make sure they find you. Simplified SEO consulting offers a variety of training options to help meet you where you are in your website journey led by professionals with a background and education and mental health who truly understand our field. The upcoming Cruise is a unique opportunity to learn to optimize your website have time to practice what you learn, and the ability to get feedback from leading SEO professionals in our field.

Curt Widhalm 35:53
To reserve your spot before it fills up go to simplifiedseoconsulting.com.

Katie Vernoy 35:59
Once again go to simplifiedseoconsulting.com to check out all the information on the cruise.

Announcer 36:05
Thank you for listening to The Modern Therapist’s Survival Guide. Learn more about who we are and what we do and mtsgpodcast.com You can also join us on Facebook and Twitter. And please don’t forget to subscribe so you don’t miss any of our episodes.

 

0 replies
SPEAK YOUR MIND

Leave a Reply

Your email address will not be published. Required fields are marked *