The suicide of Adam Maier-Clayton, a 27-year-old man who was an advocate for extending the right to a medically assisted death to those suffering from severe psychological distress, is likely to intensify one of the most difficult parts of the debate about assisted death in Canada.
Mr. Maier-Clayton suffered from obsessive compulsive disorder, generalized anxiety and somatic symptom disorder and pain from which he could find no relief, he said in a Globe and Mail piece published a year ago. On his Facebook page and YouTube, he frequently wrote and posted videos about trying medication, counselling and behaviour-modification therapy without success for years. His mother confirmed his death on Facebook on the weekend.
"My son … was in such pain and yet, continued to battle with dignity until the very end," Margaret Maier wrote. "Rest in peace my beautiful son. I am devastated."
"What Adam did over the last year and a half is he asked a lot of medically difficult questions related to medical assistance in dying and people who have severe psychological and psychiatric illness," said Shanaaz Gokool, the CEO of Dying with Dignity Canada. "He was young and articulate and incredibly bright, but had a lot of conviction around his condition and around this issue," she said.
Canada's Bill C-14 legislation, passed in June, 2016, allows for a doctor-assisted death only for consenting adults facing an incurable illness for whom death is "reasonably foreseeable." The federal government has asked the Council of Canadian Academies to report on how the law may be extended to mentally ill patients, mature minors and those facing dementia. That report is due out in late 2018.
"We can't arbitrarily discriminate against people because we are uncomfortable," Ms. Gokool said. "We have to find a way to understand what are the parameters [through which] people with severe mental illness may be included in medical assistance in dying."
Previous governmental and independent expert panels recommended that the federal government assess a patient's competence rather than age. Such panels also found that if the government is to comply with the Supreme Court's landmark ruling on the issue, it will have to consider guidelines that would allow those suffering from mental illness to access a physician-assisted death.
But some mental-health advocates have argued that treatment of mental health is not yet extensive enough to show that a patient has exhausted all options. In addition, the tensions within the medical profession around assisted dying are likely to sharpen if the legislation is extended to those who are mentally ill. That could make every such request on mental-health grounds a battle.
In Ontario, doctors can refer patients seeking an assisted death to another physician if they do not want to help. But that requirement is being challenged in court by the Christian Medical and Dental Society.
"It's hard for psychiatrists to accept that you are never going to get better, that it's reasonable for you to want to take your own life," said Maureen Taylor, the co-chair of a 2015 provincial-territorial panel on assisted dying. That panel recommended that legislation not discriminate on the basis of age or psychiatric condition.
Ms. Taylor, a physician's assistant, is the widow of assisted-dying advocate and microbiologist Donald Low, who died of a brain tumour in 2013.
"I hope that the government doesn't just punt this for five, 10, 15 years and hope the next government deals with it," she said.
Mr. Maier-Clayton wrote advocacy and personal messages about his struggles to Facebook on a regular basis. It took him multiple sessions and breaks to complete the posts, he had said.
The option of physician-assisted suicide is crucial for the mentally ill "if we wish to truthfully be able to consider ourselves a civilized society," he wrote in a recent post.
In spite of his increasingly severe mental illness, Mr. Maier-Clayton had once been a dynamic student and athlete and studied at the University of Windsor and Algonquin College.
"He was extremely outgoing, I never knew that he had mental illness," said Filippo Principato, who took classes with him several years ago. "He was always a positive thinker, he was well-spoken, professional and kind, whether in class or sitting at the bar at the Algonquin Observatory," he said.
Mr. Principato had kept in touch with his friend on social media since they finished their courses and saw Mr. Maier-Clayton's mental health decline.
"I'm sure he was going through these problems when I knew him, but it just goes to show you that mental illness is invisible to the people around you unless you tell them what you are going through," he said.