Warning: This story deals with disturbing subject matter, including suicide and medical assistance in dying, that may upset and trigger some readers. Discretion is advised.
A Vancouver woman says she’s deeply disturbed to have visited the Vancouver General Hospital in the midst of a mental health crisis, only to have a clinician suggest medical assistance in dying (MAID).
Kathrin Mentler, who has chronic depression and suicidality, visited the hospital’s Access and Assessment Centre on June 2, months after a “traumatic event” contributed to her distress. That day, she said she felt she couldn’t keep herself “safe at home” and didn’t have “the necessary supports.”
During her assessment, Mentler said the clinician was friendly, offered to call a psychiatrist, and confirmed there was a good chance Mentler would be allowed to stay overnight.
Then, Mentler said the staffer warned there weren’t enough beds because the system was “completely overwhelmed,” and “out of nowhere,” asked the question: “Have you considered MAID?”
“It really took me by surprise,” the 37-year-old told Global News. “It just didn’t sit right to me and I think it’s an important conversation to have.”
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The clinician reportedly explained how MAID works — the drugs administered, the lethal injection — details Mentler found “disturbing.”
Mentler said the staffer told her a story about another patient who had mental health challenges and drowned in a river, then relayed her “relief” that the patient had passed away, given their struggles.
“I was shocked that someone working in mental health or health care in general would make a judgment about a person and a person’s life without knowing what their wishes are,” Mentler said.
“No matter how much you struggle with mental illness or disability or chronic illness, no one should make a judgment about the value of your life or if it’s worth living.”
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Vancouver Coastal Health owns and operates the Vancouver General Hospital.
In an emailed statement, it said it abides by federal rules on MAID, and all staff must complete a clinical evaluation assessing patient’s risk when they present with suicidal ideation. It did not confirm or deny that MAID was raised with Mentler specifically.
“We share our deepest apologies with the individual for any distress caused by this incident,” it wrote, encouraging anyone with concerns to contact its Patient Care Quality Office.
However, in a Globe and Mail article published Wednesday, the health authority offered slightly different details: it said MAID was raised with Mentler not as a suggestion, but as a risk assessment tool.
“During patient assessments of this nature, difficult questions are often asked by clinicians to determine the appropriate care and risk to the patient,” its public affairs leader, Jeremy Deutsch, wrote in a statement to The Globe and Mail.
“Staff are to explore all available care options for the patient and a clinical evaluation with a client who presents with suicidality may include questions about whether they have considered MAID as part of their contemplations.”
MAID became legal in Canada in 2016 for those with “reasonably foreseeable” deaths. It was expanded in 2021 to those with a “grievous and irremediable medical condition” that causes “intolerable physical or psychological suffering.”
More than 13,000 reported medically-assisted deaths have taken place across the country. MAID solely for mental health reasons, however, will remain illegal in Canada until March 17, 2024, as the federal government implements additional resources for clinicians and other health-care system partners that will allow them to address these more complicated MAID requests.
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After hearing about Mentler’s experience, Johnny Morris, CEO of the Canadian Mental Health Association’s B.C. division, said he’s never heard of MAID being used as a risk assessment tool.
“Whether it’s appropriate or inappropriate, I leave that to the employer to figure out, but from my perspective, there are effective ways to meaningfully inquire about how someone is doing when it comes to suicide risk and the steps we can take to meaningfully support that person,” he told Global News.
“It does underscore the importance of the work we’re doing with the province here in B.C. to really drive the consistency and quality of suicide prevention care if you are in crisis in a hospital.”
The Canadian Mental Health Association, he added, is working with all B.C. health authorities to deploy a framework for staff on how to thoughtfully assess a patient’s suicide risk. Questions about MAID are not part of it.
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Mentler, meanwhile, said she’s concerned that the clinician drove the conversation about MAID — something she had never brought up. In her previous assessments after presenting with suicidal thoughts, she said no one has ever asked it about it.
Mentler said went home on June 2, feeling “hopeless because this was my attempt at reaching out for help and I feel it was actually more traumatizing.”
“It actually made me feel a lot worse to think I live in this place where the system is completely broken, there’s no help, and the only other option we talked about was assistance in dying,” Mentler said.
“I wanted help to live.”
Mentler, whose goal is to become a counsellor, said she hopes sharing her experience will start a conversation about mental health support, especially for those in crisis, before MAID is expanded to mental health patients. While clinicians may ask if a patient has a plan to die by suicide, she said it’s not their role to suggest one, particularly one that isn’t legal.
If you or someone you know is having thoughts of suicide, help is available 24-7 through the Crisis Intervention and Suicide Prevention Centre of BC at call 1-800-784-2433.
If you or someone you know is in immediate danger, call 9-1-1.
Mental health support and information on resources is available around the clock in B.C. at 310-6789 (no area code needed).
For online, real-time support, YouthinBC.com also operates a daily chat between 12 p.m. and 1 a.m. PST, and telephone support 24/7 at 604-872-3311.