Physician Assisted Suicide is a horrible end of life policy to end the lives of mentally ill people

Physician Assisted Suicide (PAS) or Medical Assistance in Dying (MAID) is morally and ethically wrong. Full Stop. The ambiguity around this method of mis-treating end of life care by normalizing suicide is personally disgusting to me. In fact, suicide is among the most prevalent causes of death in the U.S. With tens of thousands of people perishing from suicide each year, it is the 10th leading cause of death overall.

Suicide prevention ribbon

Suicide is already a tragic act by people who are victims of substance use disorders or because of untreated depression.  Creating the policy to normalize suicide is just morally inconsistent with improving the human condition.   

Echo report published in MedScape Nurses:

One of the most controversial issues today is whether a physician should be permitted, or even obligated, to assist patients with a terminal or incurable illness to end their life — a process known as medical assistance in dying (MAID) or physician-assisted suicide (PAS.)

Until recently, this contentious issue applied only to patients with physical illnesses who want to end their suffering and who seek out a physician willing to assist with that objective. 

In the United States and other countries, this is the patient population who may be able to avail themselves of this option.

However, newly proposed legislation in Canada — which has the largest number of physician-assisted deaths worldwide — would expand the indication for MAID to include serious mental illness. Originally set to be passed in March 2023, the law has been deferred for final decision until March 2024. (This policy issue in Canada is a mystery to me because Canada already has a population deficit problem but killing their own is now accepted? Makes no sense.)

A recent Medscape commentary by psychiatrist Dinah Miller, MD, explored the ethics of this proposed legislation for mental health professionals. "To offer the option of death facilitated by the very person who is trying to get [patients with serious mental illness] better seems so counter to everything I have learned and contradicts our role as psychiatrists who work so hard to prevent suicide," Miller writes. "As psychiatrists, do we offer hope to our most vulnerable patients, or do we offer death? Do we rail against suicide, or do we facilitate it?"

Miller's piece garnered a huge amount of reader response that included many, laudatory comments: a "nuanced and open-ended inquiry here," "timely and honest," and "beautifully written." 

One reader thanked the author for "this thoughtful, questioning, and open reflection on what it means to be a psychiatrist facing a thorny and deeply personal practice and philosophical question."

Cognitive Distortion or Objective Reality?

Vincent van Gogh had a history of mental illness. He painted Starry Night in 1889 during his stay at the asylum of Saint-Paul-de-Mausole near Saint-Rémy-de-Provence.

Many readers were opposed to any type of physician involvement in hastening a patient's death, regardless of whether the condition is medical or psychiatric. "Let others who wish to die make their own arrangement without the aid of the medical profession," one reader writes.

But others felt that for those with terminal physical illnesses or intractable pain, it is justified for medical professionals to either facilitate death or, at the very least, withhold life-prolonging treatments.

A critical care physician described responding to families' accusations that withdrawal of life-sustaining measures means "playing God." On the contrary, the physician writes, "there is a limit to our abilities; and withdrawing those life-prolonging interventions allows nature or God or whatever to play a role and take its course."

Another US reader pointed out that "multiple polls in this country have shown that the majority of the general public, physicians in general and psychiatrists in particular, support the option of MAID for the terminally ill. They do not find it at variance with their calling as physicians." (So, what is the purpose of the physicians' Hippocratic oath to "first do no harm")

"I and many of my elderly friends don't fear death but fear prolonged dementia with its dependency and lack of quality of life," one reader writes. "We would be much more at peace if we could put in our advanced directive that we request MAID once some point of dependency has been reached."

(P.S. Maine Writer- a person experiencing dementia is not competent to make any decisions. Selecting suicide to end their lives is morally, ethically and legally wrong.)