Thank you for touching on and raising an interesting question – I like the way you have articulated your understanding , coming alongside with respect, and humbly acknowledging our limitations to keep a person safe when they are ultimately taking safety into their own hands, and may say and show us all the “right” things so that health professionals assessing them believe they’re capable of decision making. We are one piece in a large care system, and some people, particularly after a relapse or setback, hold a lot of ambivalence about continuing to live.
I agree also that an assessment of their ability to make decisions based on their own values and preferences is important. Psychosis can eclipse the person’s wishes when it’s very acute, particularly for those whose thoughts are influenced by psychotic impulses, manic assessments of their abilities or command hallucinations, and the person, when clear to reflect on how they feel, what they want, might strongly disagree with these mood-state or psychosis-driven actions.
Of course, with years working with young people experiencing psychosis, we are likely to encounter a youth or young adult where something goes horribly wrong when they did not have access their own authentic desires or intentions, and instead acted without the benefit of all their faculties. It’s helpful, if/when this occurs, to make space for ourselves and our team members to feel the sadness and other feelings that are likely to surface. This is a vulnerable population, and sometimes our work asks us to be quite courageous when we know their vulnerability and the possibility that, like the MAID policy makers are considering, the person may sincerely contemplate whether they will ask for medical assistance to die.