Dr. Ben McCutchen: leading an important discussion on medical assistance in dying

GRH’s upcoming Day in Psychiatry mental health education conference (opens in a new tab) will feature an important workshop on medical assistance in dying (MAID) and its impacts for mental health.

And participants at the November 7th event will hear from a locally-educated psychiatrist on some of the implications.

Psychiatrist Dr. Ben McCutchen completed his residency and undergraduate medical education in Waterloo Region. Through his studies, he took part in several opportunities to learn at Grand River Hospital.

The Day in Psychiatry is marking its fifth anniversary of connecting GRH providers with primary care physicians in the community. Dr. McCutchen looks forward to helping his fellow physicians understand the wide-ranging implications of medical assistance in dying and some of the questions mental health providers might be asked.

How did you become involved in mental health care and education in the region?

I recently completed my general psychiatry residency at the Waterloo Regional Campus of McMaster University, where I also completed my undergraduate medical school education. This past summer, I began working as a general inpatient psychiatrist at Homewood Health Centre on the Trillium Acute Care Program for Crisis Support.

Grand River Hospital is an education leader for postgraduate psychiatry training, and I had the privilege of completing several of my psychiatry rotations at GRH throughout my residency education, including rotations in child and adolescent psychiatry and severe and persistent mental illness inpatient rotations. 

Why did you choose to be part of the workshop on medical assistance in dying (MAID) and its relationship to mental health care?

The landscape of healthcare in Canada changed dramatically with the 2015 Carter vs. Canada ruling, and since that time this topic has rapidly evolved. I became interested in this topic as a psychiatry resident, in particular how it relates to patients with mental illness. 

I had the opportunity to research this topic for a presentation that I gave at the International Congress on Mental Health and the Law in 2017. Since that time, I presented this topic to several local healthcare organizations. I find that many clinicians are very curious to learn more about MAID, and how to manage requests from patients with mental illness. 

How has the topic evolved since MAID was introduced?

The Supreme Court ruling of Carter v. Canada, which lifted the blanket prohibition on physician-assisted dying, and the eventual passing of Bill C-14 legislation in June 2016, meant that many Canadian physicians would be faced with requests for medical assistance in dying from their patients.

Though most health care organizations and stakeholders have interpreted Bill C-14 as an informal exclusion of patients who are requesting MAID solely for mental illness, there is no explicit exclusion.

The Canadian government has tasked the Council of Canadian Academies to examine three particularly complex types of requests… those being mental illness as the sole underlying condition, requests from mature minors, and advance requests. Their eventual report is expected to guide future legislation.

However, in the meantime Canadian physicians will have to navigate these complex requests which can often be ambiguous and difficult to evaluate. For this reason, I think there is great value in discussing this topic through avenues such as Day in Psychiatry. 

What areas of information are family physicians and community providers interested in with respect to MAID and mental health?

I think many clinicians want to know more about how to handle requests for MAID, especially when these requests are unexpected or involve other complex issues. Deciding whether a patient meets criteria for MAID is rarely straightforward, and requires a physician to examine the nature of a patients suffering, whether it be physical or psychological. 

Physicians are also confronted with criteria that are ambiguous and inherently subjective, such as evaluating the foreseeability of one’s death. These requests become even more complicated when patients have co-morbid mental illness, or other conditions which may impair their capacity to make decisions about MAID.

There are few decisions in healthcare that are as significant as having MAID, and naturally this would leave many physicians concerned about the wellbeing of their patients. I hope to lead a discussion about navigating these complexities, and share local and provincial resources that will be useful to clinicians managing requests for MAID. 

What do you hope people will take away from the workshop?

I hope that people will develop a more confident approach to managing MAID requests in patients with co-morbid mental illness or in patients who are requesting MAID solely for mental illness, and feel more equipped with resources to aid their decision making.

I will also focus on complex issues related to consent in capacity, using MAID as an example, and I expect that this will be transferable to consent and capacity issues that arise in other areas of healthcare.