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.)

Mentally ill are especially at risk when access to euthnasia is expanded

Should people with a mental illness be helped to die?

In 2019, 61-year-old Alan Nichols opted for an assisted death after he was admitted to a British Columbia hospital for suicide watch. On his application for MAiD, (Medical Assistance in Dying) the stated reason was "hearing loss".

More about the wrong minded and unethical movement to expand euthanasia puts the mentally ill at risk for preventable death.

"Dr. Madeline Li supports Canada's decision to pause the Maid expansion for mental health. She can recall the first patient she helped die, about one month after Canada first legalized euthanasia in 2016. 'I remember just how surreal it was', she said." BBCNews.

This echo essay is a response from Commonweal to the opinion published in The New York Times and blogged by Maine Writer at this link here.

Encouraged to Die? Canada’s euthanasia laws may be further liberalized. Echo report by Michael W. Higgins published in Commonweal Magazine.

When Ross Douthat wrote about Canada’s love affair with the “holiness of euthanasia” in a December New York Times column, he hit a nerve. His primary argument is reductionist, facile, and oracular but correct in its essentials: “What if a society remains liberal but ceases to be civilized?” Is Canada, in truth, Douthat’s moral dystopia, the inexorable endpoint of a corrupting liberal trajectory? A cautionary tale for an American society caught in an embattled landscape of irreconcilable philosophies?

Yes and no.

What provokes Douthat is the pending law before the Canadian Parliament that will expand its Medical Assistance in Dying (MAiD) legislation. In 2016, medical assistance in dying became legal in Canada as long as certain conditions were met, including the restriction that only patients with terminal illness were eligible. Indeed, the natural death of the patient must be deemed as reasonably foreseeable and the suffering irremediable. In 2019, a Quebec judge ruled that this legal restriction was unconstitutional and that Parliament needed to amend the MAiD legislation to include adults who didn’t have a reasonably foreseeable death. In 2021, the revised MAiD came into force and almost immediately there were cries for even further amendments, including the right for those suffering from mental illness to elect their time of death. Parliament imposed a two-year study period before any further alterations, with new legislation to be debated and most likely enacted in March.

But this appears to be a step too far for many Canadians—liberal creatures that we are—and pushback has been formidable. The Association of Chairs of Psychiatry in Canada—the lead psychiatrists of Canada’s seventeen medical schools—called on the federal government to delay the expansion of assisted dying to people with mental illness. These psychiatrists, and many others in private practice, are especially vexed over the law’s irremediable condition clause, arguing that it is very difficult, if not impossible, to predict accurately who will and who will not recover from a mental disorder. The Chairs Association makes the point that experts will need to find some common ground on “operational definitions of irremediability for different mental disorders” because no such consensus currently exists. In addition, many psychiatrists are disturbed by the simple clinical reality that physicians might find it challenging to distinguish between a client who is suffering from acute suicidal ideation, and one who is rationally seeking an assisted death as the final remedy for unendurable pain.

It is important to acknowledge that the primary concern of the psychiatrists is not the law per se, but its expansion to include mental-health candidates without any kind of training regimen established for evaluating these candidates. Medical school curricula need to be upgraded, safeguards put in place, and the full airing of contentious issues around prognosis assured before any expansion of the legislation is enacted.

Professional associations of psychiatrists aren’t alone in raising concerns. The executive director of the Canadian Association for Suicide Prevention, Sean Krausert, has cogently argued that “ending the life of someone with complex mental-health problems is simpler and likely much less expensive than offering outstanding ongoing care. This creates a perverse incentive for the health system to encourage the use of MAiD at the expense of providing adequate resources to patients, and that outcome is unacceptable.”

This use of MAiD as an option for those suffering grievously, and with little access to a timely and comprehensive health network, is more than unacceptable; it is outrageous. Nuala Kenny, a pediatric physician, bioethicist and Sister of Charity (Halifax)—and a vocal critic of MAiD from the outset—has watched with dread the persistent efforts to further liberalize the legislation:

Bill C-7 legislating medically assisted death is titled incorrectly Medical Assistance in Dying. Good medical and palliative care provide assistance in the process of dying. MAiD is assisted death. The legislation at the beginning provided safeguards for a ‘reasonably foreseeable natural death,’ professional medical assessments, a ten-day waiting period, and ongoing study of difficult issues. All this has now been overturned or liberalized. MAiD provides a quick, cheap, technological response to human, familial, social, and spiritual matters. It is the antithesis of compassion.

Although the number of known cases of unethical pressure on those burdened with great suffering to consider MAiD as a rational choice with an easily expedited protocol is low, such cases exist and are surfacing in the media. The most egregious have involved Canadian war veterans who were counseled to consider assisted dying. The public outcry forced both the veterans affairs minister, Lawrence MacAuley, and Prime Minister Justin Trudeau to assure Canadians that this was the recommendation of one misguided employee, now terminated—and that this is not government policy, nor will it ever be.

These official denials, however, are less than persuasive. The case of retired corporal Christina Gauthier, a former paralympian, highlights the insidious allure of the quick fix. Suffering from a deteriorating medical condition as a result of permanent knee and spine injuries incurred during military training, Gauthier testified to a House of Commons Veterans Affairs Committee that a caseworker from Veterans Affairs Canada offered her MAiD after her failure over five years to get a wheelchair ramp installed in her home. 

Although this may be a rare occurrence, as the authorities insist, it is a logical outcome in a society that finds itself with a stretched and cumbersome health-care system, that struggles to provide appropriate-level palliative and hospice care across a widely dispersed population, and that is, as a consequence of the Charter of Human Rights and Freedoms, willfully captive to the doctrine of personal autonomy.

There is liberal, and then there is liberal. The country that passed same-sex marriage legislation long before the United States, that has banned capital punishment for decades, that was one of the first nations to sanction South Africa over apartheid, and that welcomed more Syrian refugees than any other Western power is the same liberal nation that, under the rubric of compassion and free choice, is about to usher in an assisted-death law that knows no limits.

The Toronto Star recounted the story of a man suffering from a chronic but not terminal illness. His condition was exacerbated by social and emotional factors that included childhood sexual abuse, mental-health stresses, and poverty. His government allowance left him with only a couple of hundred dollars a month after he had covered his rent expenses, and he was unable to walk the two flights into and out of his residence. Under the current legislation he qualified for MAiD, was approved, and died last summer. Had the state seen to his needs, provided support for his various maladies, and given him a decent government income that allowed him to live with some dignity, he could have managed his chronic illness. MAiD was his escape, his solution, his free choice.

But was it really a free choice? William Sweet, professor of biomedical ethics and philosophy of law at St. Francis Xavier University, thinks it was anything but. “As for extending MAiD in cases of mental illness, reducing morality as a consequence to a matter of consent when that clear consent can be compromised by their condition shows minimum concern for the value of life and the dignity of the person. On this point many secular medical experts are in agreement with the majority of Catholic ethicists.”

Public outcry and protests from medical associations at the speed with which the government is moving has prompted it to delay indefinitely the March deadline until there is a greater consensus among parliamentarians and the experts.

It is clear that the government will not rescind the current legislation but will consider more carefully the extension of MAiD to those suffering from mental illness. Perhaps in the process they might listen to the advice of Theo Boer, a Dutch bioethics professor who cautioned the French government over its proposed assisted-suicide legislation by citing the experience of the Netherlands: its policy of legalized euthanasia was at the outset for mentally competent adults suffering from a terminal illness, but that has since been expanded to allow for young children to seek it as well. “If the most defined and controlled system in the world can’t guarantee assisted choice remains a last chance,” Boer wrote in Le Monde, “why will France do better?”

Or indeed, Canada.