BC hospital accused of suggesting assisted death to woman with suicidal thoughts
Editor’s note: This article mentions and discusses suicide and depression.
A Vancouver woman who checked herself into a BC hospital because she was having suicidal thoughts said she left feeling “disturbed” and distraught after a clinician allegedly asked her if she’s ever considered medical assistance in dying (MAID).
Kathrin Mentler told Daily Hive that last June she admitted herself into the Access and Assessment Centre at the Vancouver General Hospital (VGH) in hopes of receiving life-saving and affirming care on the advice of hospital staff who helped her earlier this year. She was told this space would be “calmer and quieter than the emergency room.”
Once Mentler met a clinician at the centre, she felt she had a “good connection” with them. While it was not easy to open up, she said she explained she was living with chronic depression, chronic illness, chronic pain, and suicidality. Additionally, she experienced a traumatic event that she is still processing and was reminded of that day.
She continued to tell the clinician, “I’m in this dark hole right now. I don’t know how to get out of it. I have these suicidal thoughts. I don’t want to give in to them. I’m here because I want to live.”
In response to hearing Mentler’s mental state, she claims the clinician said the healthcare system was “extremely overwhelmed,” there is a shortage of beds, and the waitlist is long.
And without any prompting, the clinician allegedly asked, “Have you ever considered MAID?”
“I was just in shock,” the 37-year-old said.
“I didn’t come there to get advice on how to die, I came there because I was in a crisis because I wanted to live and to get help and support to live.”
In Canada, MAID is illegal for Canadians suffering solely from mental illness.
A Vancouverite is speaking out after a clinician at VGH suggested MAiD to her after she came in for a mental health crisis.
While #Vancouver Coastal Health has apologized, many are disturbed by this incident. pic.twitter.com/z2bTz0Zor9
— Daily Hive Vancouver (@DailyHiveVan) August 14, 2023
Mentler added the clinician went on to tell her a “disturbing and upsetting” story about a previous patient who had several mental illnesses, was taking psych medications, and ended up drowning in the river and dying.
“She told me the story about this person, and I was like, ‘Do you think… I would be better off dead?'” Mentler questioned.
“I felt at the moment that [the clinician] was making a judgment about my life because I just shared… I have so many ongoing struggles that I don’t know what to do.”
The clinician allegedly went so far as to explain the technicalities of MAID, including the administration of benzodiazepines so that patients are sedated before receiving a lethal dose, according to Mentler.
“I’m scared to go back to VGH or the Access and Assessment Centre,” the Vancouver woman said, adding she’s had nightmares about going under anesthesia and this encounter at VCH exacerbated her fear.
Mentler added he was also disturbed to hear the clinician who allegedly said she’s spoken to “a lot of clients about MAID.”
Because she was in a mental health crisis, Mentler said she felt she was not as outspoken as usual and just wanted the conversation to end so she could leave.
When she went home, she said she did her best not to think about the day and went to bed. However, she woke up the next morning crying and screaming.
Mentler filed a complaint with the Patient Care Quality Office.
“Questions about MAID don’t have any place in a suicide risk assessment”
In a written statement to Daily Hive, VCH shared its “deepest apologies with [Mentler] for any distress caused by this incident” and confirmed that MAID is currently not an option for those suffering solely from mental illness.
It did add, “For patients who present with suicidal ideation, staff are to complete a full clinical assessment of the patient which would include a full risk assessment and subsequently explore treatment options.”
However, Mentler emphasizes “the goal of suicide prevention is life preservation” and said there are more ethical moral questions clinicians can ask people in crisis instead of suggesting MAID.
Mentler added she was surprised by VCH’s response and questions the legitimacy that a clinician can ask patients if they’ve considered MAID because it is part of the clinical assessment.
Jonathan Morris, CEO of the Canadian Mental Health Association’s BC division (CMHA BC), said there is a sense of unpredictability for someone in crisis to fully understand what’s being asked of them.
He said if a clinician asks a patient about MAID as part of the clinical assessment, there is a risk the question can be misinterpreted.
“When you’re inquiring about suicide risk, be very clear about the intent of your questions,” he suggested.
“In my view, questions about MAID don’t have any place in a suicide risk assessment.”
In speaking to Daily Hive, Mentler pointed out there are many misconceptions people have about those living with chronic depression or chronic suicidality.
“It’s not that it’s a constant state,” she said. “It’s just that it’s a recurring episode.”
“I also have joy in my life. I have things in my life. I have things that I work towards,” she expressed.
Arash Randjbar/Daily Hive
In regards to the clinician expressing that the healthcare system is overwhelmed, Mentler said she can recognize and sympathize with the clinician she spoke to, who may be feeling burned out in a system that is overwhelmed.
Over the past year, doctors in BC have been sounding the alarm over acute care beds and hospitalist physicians shortage and have been pleading to governments for help amid “unsafe” conditions.
However, while he acknowledges there are constraints in the system, Morris said, “We can’t compare physical illness and mental illness completely.”
“In a world where someone was presenting with an arrhythmia or heart attack… all efforts would be made… to get them to the care [they need],” he said. “We wouldn’t be saying, ‘Well… The system’s falling apart. We can’t treat you.’ All efforts will be made.”
“I think we need to make sure that care around mental health, mental ill health, distress, suicide, is on the same playing field,” he added.
Work underway to support doctors
Morris went on to tell Daily Hive that while significant work is underway, there is still a long way to go to create guidelines, standards, principles, and safeguards to expand MAID in the context of mental illness.
“It’s quite separate from someone who is experiencing such a level of distress that suicide is presenting itself as an option… In my clinical practice, I’ve not seen or heard the kind of the framing of MAID in the context of a suicide risk assessment… and I think it’s tricky to muddle those pieces up,” he explained.
MAID is illegal for Canadians suffering solely from mental illness but is set to change next March after the Liberal Government’s MAID eligibility expansions come into effect, a move that has sparked ethical debates and concern from Canadians and even the UN Human Rights Council.
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In the meantime, CMHA has been working with regional health authorities to improve the care of people when it comes to suicide.
He mentioned one health authority is working to improve practices in the emergency room regarding suicide risk assessment, and other health authorities are looking at suicide prevention within Indigenous contexts.
CMHA is also working with health authorities’ leaders to create a suicide risk reduction framework for relevant clinicians. This is expected to be released in the coming weeks.
If you or someone you know is in crisis, you can speak to:
- Crisis Services Canada 1-833-456-4566 or text 45645
- Crisis Line Association of BC 310-6789 (no area code)
- 1-800-SUICIDE (in BC)
- For more resources, visit the CMHA site.