Medical Assistance in Living
Medical Assistance in Living (MAIL) should be healthcare’s first priority to reduce suffering and promote life, including respectful suicide prevention in the context of Medical Assistance in Dying (MAID).
A framework to protect and advance MAIL has never been more needed. As MAID is quickly being established as a health care service, concerns are emerging about:
Increasing prevalence of MAID in end of life decisions.
Potential legislation of MAID for mental disorder as the sole underlying condition.
Inability to reliably clinically distinguish suicidal thoughts and behaviours from the wish for hastened death in MAID.
Lack of integration of suicide prevention best-practices into MAID assessment. and lack of training in suicide prevention.
Social inequities that can increase a wish for hastened death.
Inadequate access to healthcare services that can reduce suffering, such as palliative care and mental health care.
Stigma associated with dis/abilities that can present MAID as a desirable alternative.
Medical Assistance in Living addresses the drivers of a wish for a hastened death by reducing suffering, problem solving to better meet needs for living, enhancing social connection, and drawing on strengths to prevent suicide. MAIL is important for each individual facing end of life decisions, and their families, and also at the levels of our health system and community.
This framework for Medical Assistance in Living (MAIL) is based on Thomas Joiner’s Interpersonal Theory of Suicide. The same factors that drive the desire for suicide (thwarted belongingness and perceived burdensomeness), coupled with the capability for suicide, are in many cases indistinguishable from the factors that lead to MAID. We believe that equitably addressing these drivers provides assistance in living, and can promote the desire for living. Future research should explore whether there are unique suicide prevention and life promotion factors that should be addressed in the context of MAID.
