Albertan with same mental illness as Adam Maier-Clayton had doctor-assisted death
When Adam Maier-Clayton died last week at the age of 27, he had been waging a controversial fight, arguing that those like him with untreatable mental illnesses should have the right to physician-assisted deaths.
He never received that medical assistance and died by suicide last Thursday. But he hoped to change Canada's laws which currently don't allow physicians to assist with deaths for those with mental illness.
Now, it has come to light that a case quietly made its way up to Alberta's Court of Appeal last year, in which a woman with the same illness as Maier-Clayton was able to access the kind of death he had long wanted.
The woman was identified in court documents only as "E.F." She too had somatic symptom disorder, or conversion disorder, a psychiatric condition that causes extreme physical pain with no clear cause.
Somatoform disorders are caused by the process in which a person's mental distress manifests as physical symptoms. The mildest forms include stress headaches, or neck and shoulder muscle tension that ease when the stress diminishes.
But in some patients, the patient's psychological problems may be much more complex and their physical symptoms become severe, disabling and long-lasting.
In the case of E.F., court documents show the 58-year-old woman told the court she was "suffering intolerable pain and physical discomfort," and "that her symptoms were irremediable."
She said she suffered from muscle spasms, digestive problems, immobility and periods of insomnia. She said she was exhausted from her suffering, as well as depressed and fully mentally competent yet unable over eight years to find any effective treatment.
Despite objections from the attorneys general of Alberta and B.C., who argued E.F.'s condition did not meet the criteria of being terminal, the Court of Appeal sided with E.F. and allowed a doctor to help her die by suicide.
Dr. Ellen Wiebe, a former family physician in B.C. who has become a vocal and prominent advocate of medically assisted death, says she met with E.F. and knows how she suffered.
"The case of E.F. is so important because she was the only case where someone received an assisted death for…mainly a purely psychiatric condition," Wiebe told CTV News.
"And she really deserved it because her suffering had been so terrible for so many years. She had been through every treatment that smart people could figure out and she didn't get better -- and she wasn't going to get better."
But Dr. Trevor Hurwitz isn't so sure.
He's a psychiatrist in B.C. who specializes in somatoform/conversion disorders and says the case of E.F. troubles him. He says, while court documents show that two doctors testified on E.F.'s behalf, a psychiatrist who offered a supporting opinion reviewed her medical records, but never physically examined her.
"You don't pass an opinion that has grave concerns, without visiting the patient," he says.
Hurwitz says neither he nor his colleagues were ever referred her case. He also said that electroconvulsive, or shock therapy, may have provided relief. A study from UBC shows ECT can help as many as 80 per cent of patients with severe somatic disorders.
"Hope is out there," said Dr. Hurwitz. "People need to know about it and avail themselves of those options."
Other ethicists, like Trudo Lemmens of the University of Toronto Faculty of Law, say the case shows the dangers of allowing medically assisted death for mental illness.
"The case highlights how courts often don't get full and accurate evidence, so we shouldn't too easily rely on these decisions to justify a practice and introduce new policy," Lemmens said.
"The case also confirms that the risk of error is much greater with mental illness, where clinical evaluation is more based on an impressionistic judgment, and less on straight forward, well-established clinical measurements," he added.
Still, Dr. Wiebe says she is getting calls from other patients with somatoform disorders who can't find relief from their pain and want to discuss assisted death.
"I have been a doctor for over 40 years and I have seen lots of somatoform disorder in my general practice but not the severity that I am seeing now from people asking me for an assisted death," she said.
"Now I am seeing these very severe cases who have been through multiple pain clinics and psychiatric treatment and so on. That is what I am seeing, these few people who are suffering so terribly and I wish that I could help," she says. Wiebe still hopes Canada will expand the current laws to allow more of those with severe, untreatable mental illness to be able to choose medically assisted death.
A memorial service was held Saturday for Maier-Clayton in his hometown of Windsor, Ont.
“The only good thing about this today is all this suffering, his agonizing pain, is over. And for that we’re all very, very happy. Though totally sad that he’s gone,” Adam’s father, Graham Clayton, told CTV Windsor.
Clayton described his son as a high-achiever who loved to play soccer and had a bright future ahead of him. His condition changed all that.
“Just imagine if you’re a person who excelled at everything all your life … and now you can’t even have a conversation with somebody for five minutes. He’d been unable to work for two years,” his father said.
“He had a great job and good prospects … he had to give that up because of his somatoform pain. And basically it just got worse and worse and worse until he could take it no more.”
With a report from CTV Medical Specialist Avis Favaro and producer Elizabeth St. Philip