Medical Assistance in Dying for Multiple Chemical Sensitivities: A System Failure?

Medical Assistance in Dying for Multiple Chemical Sensitivities: A System Failure


Article abstract
We were astonished to read a recent media news item about a 51-year-old woman in Ontario who was offered and accepted medical assistance in dying (MAID) because she was experiencing multiple chemical sensitivities, also known by its preferred diagnostic term, idiopathic environmental intolerance (IEI).Reportedly, she could not access appropriate housing.We find this concerning, as providing MAID to individuals with refractory IEI symptoms on the basis of housing unavailability implies that there were no better management options available.This case should prompt ethical reflection on whether our supports for the most vulnerable enable them to maintain basic human dignity, and whether systemic societal action in other ways could better support people with IEI.We were astonished to read a recent media news item about a 51-year-old woman in Ontario who was offered and accepted medical assistance in dying (MAID) because she was experiencing multiple chemical sensitivities, also known by its preferred diagnostic term, idiopathic environmental intolerance (IEI).Reportedly, she could not access appropriate housing.We find this concerning, as providing MAID to individuals with refractory IEI symptoms on the basis of housing unavailability implies that there were no better management options available.This case should prompt ethical reflection on whether our supports for the most vulnerable enable them to maintain basic human dignity, and whether systemic societal action in other ways could better support people with IEI.
As specialists working in Occupational Medicine, Psychiatry, and Ethics, we have provided care for a number of individuals affected by multiple chemical sensitivities -otherwise known as idiopathic environmental intolerance (IEI), the preferred diagnostic term.This condition involves diverse chronic symptoms of unclear etiology manifesting in response to environmental stimuli.Without evidence of an underlying organic disease (1), this condition can undoubtedly be challenging to manage and to live with.However, we were astonished to read a recent media news item about a 51-year-old woman in Ontario who was offered and accepted medical assistance in dying (MAID) because she was experiencing multiple chemical sensitivities and reportedly could not access appropriate housing (2).
It is worth noting that IEI is a diagnosis of exclusion.Sometimes there are other, well established, medical conditions that can present with the same symptoms as IEI, such as olfactory-induced migraines (where migraine abortive treatment or prophylaxis may yield significant benefit) or asthma worsened by exposure to irritant cleaning chemicals (where, in addition to avoidance of triggers, optimization of asthma management may help considerably).For chemical sensitivities without identifiable organic cause, avoidance of the offending triggers to the extent possible, psychoeducation and psychotherapy should be considered as preferred management options.There may be underlying, undiagnosed mental health conditions that are amenable to treatment, while psychotherapy may enhance coping skills.Although symptoms may improve with care and treatment, in our experience they rarely remit altogether, and the degree of disability experienced by many with IEI remains high.
People affected by IEI who feel that conventional medical practice has little to offer them may seek alternative management options, which often involve costly, non-evidence-based investigations (such as experimental blood tests not used in routine clinical care) and treatments (such as extensive renovations of the home to remove supposedly causative chemicals).In our clinical experience, these alternative interventions do not leave individuals with IEI significantly better off and may in fact significantly burden them with out-of-pocket expenses.Providing MAID to individuals with refractory IEI symptoms seems like a further giant leap in the wrong direction, not least because this action implies that there were no better management options available.That the condition in the reported case was not irremediable is evident -if the woman with IEI had been able to access housing that met her reported needs, i.e., the ability to avoid the offending environmental exposures, it is likely that she would not have sought medical assistance to end her own life.
We do not question the quality of the care received by the individual whose case has been reported in the news, and there may well have been other co-morbid conditions or considerations justifying the decision to access MAID.However, the way the case has been portrayed in the media certainly raises the question of whether MAID is in fact a reasonable option available to someone with IEI.Whether or not she had a verifiable alternate medical diagnosis, her quality of life was undoubtedly poor.Her case should prompt ethical reflection on whether our supports for the most vulnerable enable them to maintain basic human dignity, and whether systemic societal action in other ways could better support people with IEI.The editors follow the recommendations and procedures outlined in the COPE Code of Conduct and Best Practice Guidelines for Journal Editors.Specifically, the editors will work to ensure the highest ethical standards of publication, including: the identification and management of conflicts of interest (for editors and for authors), the fair evaluation of manuscripts, and the publication of manuscripts that meet the journal's standards of excellence.