Crushing symptoms day after day for years. Is it any wonder some of us want a permanent out? Assisted dying for patients with psychiatric disorders – psychiatric euthanasia. You okay with it?
’A few days ago, a 30-year-old patient with very treatable mental illness asked me to end her life. Her distraught parents came to the appointment with her…’
Some of you may find it troubling, even triggering. If you’re one of them, please feel free to close the piece.
We laid a solid informational foundation in part one of our two-part series on assisted dying for patients with psychiatric disorders – psychiatric euthanasia. If you haven’t already, be sure to give it a read.
By the way, I shared the inspiration for writing about the contentious subject in that piece – the heartbreaking Shanti De Corte story.
Well, part two – ethics and opinions. Let’s get after it…
Assisted dying: Ethics and opinions
First, a quick heads-up. The terminology associated with assisted dying can be confusing – euthanasia, medical aid in dying, legal suicide, physician-assisted dying, physician-assisted suicide, and more.
Don’t lose the forest for the trees over semantics.
Okay, let’s take a look at how several healthcare professional organizations feel about assisted suicide…
American Medical Association
The AMA has a Code of Medical Ethics Opinion for physicians who oppose assisted suicide and for those who are neutral or support it.
Opinion 5.7 states that allowing physicians to engage in assisted suicide would ultimately cause more harm than good. Among other negative consequences, it’s incompatible with a physician’s role as a healer.
Opinion 1.1.7 declarers physicians need to have the opportunity to act (or not) in accordance with the dictates of their beliefs and conscience.
British Medical Association
In September of 2021, the BMA changed their policy from opposition to assisted dying to a position of neutrality.
American Psychological Association
The APA takes a position of neither endorsing or opposing assisted dying.
Assisted dying for patients with psychiatric disorders: A psychiatrist’s opinion
Dr. Mark S. Komrad is a practicing and teaching psychiatrist, as well as a medical ethicist. His commentary, “Oh, Canada! Your New Law Will Provide, Not Prevent, Suicide for Some Psychiatric Patients,” appeared on Psychiatric Times in June of 2021.
Dr. Komrad put a lot of thought and feeling – and, yes, opinion – into his piece. I’d like to run with some highlights.
Context is crucial. Dr. Komrad’s comments were motivated by the development and passage of a Canadian law, and its expansion, that permit what they refer to as medical aid in dying (MAID). We reviewed it in part one.
The door’s wide open
As he begins, Komrad untangles some of that terminology confusion we just talked about. He defines euthanasia as allowing suicidal patients to receive death by lethal injection. It’s assisted suicide when the lethal medication is self-administered.
Komrad points out that Belgium, the Netherlands, and Luxembourg legalized both in 2002. As he puts it, laws in those countries permit voluntary death for patients whose physical or psychological suffering is unbearable and can’t be effectively treated by means that are acceptable to them.
A terminal condition is not a necessary criterion.
Komrad believes these developments opened the door for some patients with psychiatric illness having suicide provided for them, rather than prevented.
He observes that these laws are now being passed around the world, which could profoundly change the practice of psychiatry.
The Canadian spark
Now to what lit Dr. Komrad’s fuse. Canada is the latest nation to legalize voluntary death for psychiatric conditions.
In 2016, Canada passed a law permitting medical euthanasia and physician-assisted suicide, together labeled medical aid in dying (MAID).
A key eligibility criterion was a prediction that a patient’s natural death is “reasonably foreseeable.” Since death from mental disorders wasn’t seen as strongly predictable, mental illnesses were not considered eligible conditions.
Superior Court intervenes
In 2019, a Quebec Superior Court ruling led to the introduction of a new federal bill extending euthanasia eligibility, without limiting it to the end of life. It also removed the prior exclusion of those who have non-terminal chronic illnesses.
And because of accusations of discrimination against those with mental illnesses, the Canadian Psychiatric Association being one of the accusers, euthanasia was permitted for those whose psychological or physical suffering is deemed “intolerable and untreatable.”
A vote was forced and on March 17, 2021 the expansion of euthanasia became the law of the land in Canada.
It’s interesting that the mental illness piece was put on a two-year hold. The idea was to give an expert panel time to establish standards for evaluating patients and procedures.
Without a protocol, there would be no way to determine if suicide for someone with a psychiatric disorder should be prevented or allowed.
A psychiatrist’s bottom-line
Komrad provides this statement by Canadian psychiatrist, Dr. John Maher…
A few days ago, a 30-year-old patient with very treatable mental illness asked me to end her life. Her distraught parents came to the appointment with her because they were afraid that I might support her request and that they would be helpless to do anything about it. It’s horrific they have to worry that by going to a psychiatrist, their daughter might be killed by that very psychiatrist.
What are your feelings?
Objections to physician-assisted dying
According to Dr. Komrad, countries that have allowed physician-assisted dying have quickly found themselves descending a slippery slope.
He quotes attorney Wesley J. Smith, a prominent critic of such policies…
Once a society embraces doctor prescribed death as an acceptable answer to human suffering or as some kind of fundamental liberty right, there are no brakes.
Indeed, Komrad points out that in Belgium and the Netherlands, policy makers and legislators are debating extending euthanasia beyond medical conditions to include those who feel they have a completed life and are tired of living.
There’s even discussion of demedicalizing euthanasia by providing lethal pills over-the-counter.
And then there’s Pegasos Swiss Association, which will take an application for voluntary assisted death (VAD) at their clinic in Basel. You have to be a “Pegasos Supporter” to apply.
Using the Canadian law as reference, Dr. Komrad shared his primary objections to physician-assisted dying…
- There’s no requirement that additional, evidenced-based treatments be implemented, although patients are urged to give all treatments serious consideration.
- Physicians are allowed to end the life of people with disabilities or chronic illnesses at their request and will require the system to ensure it happens – even when physicians are convinced, based on their expert knowledge, that medicine offers options and even when the patient may have years or decades to live.
- Assisted dying laws would represent a terrible shift in the deep ethos of psychiatry. Psychiatrists would have to decide which suicides should be prevented and which should be abetted.
Do you think his objections are legit?
Assisted dying – psychiatric euthanasia: You okay with it?
If I’m going to ask, “You okay with it?” regarding assisted dying – psychiatric euthanasia, It’s only fair that I respond first.
As a former clinician and 50-year mood and anxiety disorder warrior, I’m not okay with it – as a matter of law for the masses.
My concern is the potentially lethal impact of a tired and hopeless mind, a lack of resources and alternatives, cognitive distortions, impulsivity – and rubber-stamped approvals.
What if I did it?
I know what it’s like to endure life-interrupting symptoms day after dreaded day. And I have no doubt my circumstances would qualify for assisted dying wherever it’s legal.
Thing is though, what if I did it? And don’t think checking out hasn’t crossed my mind a time or two over the decades.
What’s my family supposed to do with it? What about my readers? How do I account for it with my maker?
But you know what? Maybe most important of all is my belief there’s a living purpose for my suffering. And I sure can’t fulfill it if I’m dead.
So now it’s your turn. You okay with it?
If you or someone you care about are in immediate danger call 988 in the U.S. And here’s a list of international suicide hotlines.
Again, if you haven’t already, give part one a look-see. You’ll find lots of interesting details.
And dig into Dr. Komrad’s commentary. There’s a ton of information I couldn’t include, as well as an accompanying video: “Oh, Canada! Your New Law Will Provide, Not Prevent, Suicide for Some Psychiatric Patients“