A new policy allows for Medical Assistance in Dying (MAID) for patients whose sole underlying condition is a severe, treatment-resistant mental illness. What are the potential ethical benefits and risks of this expansion?

Where answers to this question lose points

Our scorer marks every answer on three parts. For each of the 58 applicants who finished this question on Confetto, we took their first scored answer and counted the part that scored lowest.

• Structure: a clear order and a clear point23 of 58

Confetto data as of November 8, 2026. A part is shown only when 20 or more applicants share it. Answers where two parts tied are not counted toward either. We never show anyone's answers or details.

What this question tests

• Critical thinking
• Health policy
• Medical ethics

How to structure your answer

1. Ask questions (25 seconds). The answer opens with concern and recognition of genuine suffering, rather than asking what needs clarification. To fill this part, ask patients and treating psychiatrists about treatment history, decision-making capacity, and access to care, and clarify the policy's safeguards.
2. Who is affected (20 seconds). The answer puts patients with severe, treatment-resistant mental illness first, recognizing their suffering, autonomy, and vulnerability to pressure. It then considers families affected by that suffering, physicians responsible for assessment and care, and society's responsibility to provide adequate mental health resources.
3. The conflict (20 seconds). The conflict is between respecting an informed choice to end unbearable suffering and protecting people whose judgment or prospects for recovery remain uncertain. The answer also contrasts equal recognition of mental suffering with concern that inadequate care or feeling like a burden could influence a request.
4. Options (40 seconds). The answer suggests allowing access to recognize autonomy and equality, while emphasizing the irreversible risks of impaired judgment, pressure, or later recovery. Its preferred direction is access only with extensive safeguards, which adds assessment and treatment requirements, but it does not explicitly compare this with maintaining exclusion.
5. Choose (30 seconds). The answer chooses to prioritize robust safeguards and access to the best possible care before considering MAID, chiefly to protect vulnerable patients from an irreversible decision. It calls for multiple independent psychiatric assessments over time and treatment trials, although its overall endorsement of the expansion remains qualified.
6. What next (20 seconds). The answer proposes extended independent psychiatric assessment, ensuring access to care, and ongoing dialogue among medical professionals, ethicists, and society. It does not specify who would coordinate follow-up or document findings, so those practical responsibilities would need clarification.

Example answer from Confetto

Example answer from Confetto. Not a real applicant's answer.

This expansion raises profound ethical questions that I find myself grappling with from multiple perspectives. My immediate reaction is one of deep concern mixed with recognition that this represents society's attempt to address genuine suffering that traditional treatments haven't been able to alleviate.

I see potential benefits in respecting patient autonomy - if someone has endured years of severe depression or other mental illness despite exhaustive treatment attempts, there's an argument that we should honor their informed decision about their own life. Mental suffering can be just as debilitating as physical pain, and I've witnessed how treatment-resistant conditions can devastate not just patients but entire families. There's also the principle of equality - if we allow MAID for terminal physical conditions, some argue we're being discriminatory by excluding mental illness.

However, the risks deeply concern me. Mental illness can impair judgment and decision-making capacity in ways that might not be immediately apparent. Unlike many terminal physical conditions, mental health outcomes can sometimes improve unexpectedly, even after years of struggle. I worry about societal pressure on vulnerable individuals who might feel they're burdens, and whether we're adequately investing in mental health resources before considering this option.

What matters most to me is ensuring robust safeguards are in place. I believe multiple independent psychiatric assessments over extended periods would be essential, along with mandatory trials of all available treatments. We need to be absolutely certain that suffering individuals have access to the best possible care before considering irreversible options.

As a future physician, I feel the weight of this responsibility. I want to alleviate suffering while preserving hope and protecting vulnerable patients. This policy demands the highest standards of ethical practice and ongoing dialogue between medical professionals, ethicists, and society.

Use it for its structure. Interviewers can tell a memorized script, so tell your own story.

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