Medical Assistance In Dying and Eating Disorders with Dr. Anita Federici
Let’s get controversial.
Can the concept of medical assistance in dying be used for individuals who are suffering from “severe” and persistent eating disorders, as it is for patients who have terminal cancer?
Now, before we go anything further, please know that I acknowledge the sensitivity of this topic and if it feels too heavy and overwhelming, please skip it.
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But the question is, why is this a controversial topic? MAID is not a new construct. It has been utilized around the world with different controversies for many years as a way of ethically, compassionately, and humanely allowing people to have a dignified way of dying.
The wrench to throw into this concept is, does it equally apply to those with mental health disorders, or is it only appropriate for those who are “physically” terminally ill? In modern-day science or modern psychology, we don’t have a way to alleviate the suffering of someone who is battling a severe mental health condition. While I acknowledge that different medications serve their purposes, the question remains: why is there a difference between “mental illnesses” and “physical illnesses”? Is there even a difference?
In this episode, I am joined by Dr. Anita Federici. Dr Federici is a Clinical Psychologist and the Owner of The Centre for Psychology and Emotion Regulation. She serves an Adjunct Faculty position at York University and is a distinguished Fellow of the Academy for Eating Disorders. Anita has provided more than 375 lectures, workshops, and invited talks on eating disorders, MED-DBT, compassionate care for complex needs, and developing differential care pathways that integrate temperament-based approaches, experts by experience, and ethical care. Her work has been presented at international conferences and published in peer-reviewed journals and invited book chapters.
These questions have become quite the topic of discussion in Anita’s world as we enter 2024 because, in Canada, you can be considered eligible for MAID if your only medical condition is a mental illness, as of March 17, 2024. Eligibility will be assessed on an individual basis, and a person must meet all criteria to be eligible. But in general, this will be an option as of this year.
While this is happening this year, there is a lack of training around the criteria and what it all means. So, let’s discuss.
In this episode, we're diving into:
What is MAID (Medical Assistance In Dying)?
Challenges and concerns of MAID.
A brief history of MAID and its application to mental health conditions in different countries.
The lack of preparation and training for mental health professionals regarding MAID
The controversy around the proposed criteria for MAID in “severe and enduring” eating disorders.
The terms “severe and enduring” as they apply to eating disorders.
The difference between palliative care, MAID, and hospice care.
The challenge of predicting outcomes in mental health conditions compared to terminal physical illnesses.
The challenges and emotional impact of collecting data on proposed criteria related to predicting death.
The absence of evidence-based treatment for severe eating disorders.
The ethical dilemma of determining how long someone with a severe condition should live.
The fear of giving up on individuals labeled as "complex" or "severe."
Critiques of higher levels of care and the, at times, limited function they serve in the overall treatment process.
What is MedDBT (Medical Model Dialectical Behavior Therapy)?
The importance of avoiding a one-size-fits-all approach.
The difficulty of changing institutional practices.
Resources for a deeper understanding of the concept of terminality.
Tweetable Quotes
“Even when there are hard conversations to have or complicated emotional conversations or even technically difficult conversations, these are not black or white topics. In any way that you look at this, if you look about the ethics, if you look about even the definitions of the words that we're using, none of it is black and white.” - Rachelle Heinemann
"Higher levels of care serve a very specific and limited function. They are not going to solve all of your problems." - Dr. Anita Federici
"We have to be really clear about what you're going for and what you're not going for." - Dr. Anita Federici
"Why is this controversial? I mean, medical assistance in dying is not a new construct." - Dr. Anita Federici
"You can't separate that from the history of how eating disorder treatment has evolved and what it is and what it isn't." - Dr. Anita Federici
"The limitations of the current system can leave individuals feeling hopeless, invalidated, and blamed." - Dr. Anita Federici
Resources
Annita's Email: Anita@MidlandDBT.com
Anita's Website:
www.psychology-emotionregulation.ca
Canada MAID Policy Update: https://www.canada.ca/en/health-canada/services/health-services-benefits/medical-assistance-dying.html
Related Episodes
Episode 103. What To Do When You Feel Stuck with Sondra Kronberg
Episode 97. How to Handle the Hardest Situations (Clinician Series)
Episode 96. What ED People Got Wrong About Science with Dr. A'nna Roby
Episode 93. Eating Disorders as a Way to Communicate with Dr. Elizabeth Hamlin
Episode 82. Secrets and Eating Disorders with Dr. Kathryn Zerbe
Episode 57. The Connection Between Trauma and Eating Disorders with Heather Ferguson, LCSW
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Hey there! I’m Rachelle, the host of the Understanding Disordered Eating Podcast. As a Licensed Mental Health Counselor, I work with clients to make sense of life’s messy emotional experiences.
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