That's a very difficult and probing question. I think doctors are aware of the social determinants of health, of such things as access to quality health care and access to clean water, good food, and so on. Maybe we're not as sensitive as we should be to some of the inequalities we see in our society, particularly with first nations communities and other disadvantaged individuals. I live in Vancouver, and the streets of downtown Vancouver are inhabited by people who have chronic mental illness and substance abuse problems.
I don't pretend to give you an easy answer on that one, because I don't think there is one. I certainly believe, however, that people whose primary suffering comes from mental illness should not necessarily be denied access to physician-assisted dying, although the numbers in Oregon and the European countries are very small for people who simply have a mental illness that makes their life intolerable.
Having known many patients with severe mental illness, though, I can tell you that many of them end up with a life that is intolerable. Could it be made better by the provision of better services? Probably the answer is yes.