Adam Maier-Clayton: Assisted Suicide and Mental Illness

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The life and death of Adam Maier-Clayton, the 27-year-old Canadian who recently used Nembutal to take his own life, should form a core discussion of every future debate on assisted suicide. His intense physical pain could not be diagnosed by the medical profession, so after many tests and procedures, they called it mental illness. Adam Maier-Clayton went along with all the tests and diagnoses and treatments, both medical and psychological; he tried psychiatric therapies and medications from Ativan to medical marijuana. He worked out and got exercise. He wanted to live very much. He just didn’t want to live a life of unremitting pain.

So the question arises: if we accept assisted suicide for a person with chronic unmanageable and unbearable pain, where does someone like Adam fit? Undoubtedly he had chronic unmanageable and unbearable physical pain, which professionals diagnosed as being caused by mental illness. Adam accepted this diagnosis. He followed every treatment recommendation and nothing worked. How should his case be treated?

Adam was not eligible for assisted suicide under existing Canadian law because he did not have a terminal illness. Although the Canadian Supreme Court decided in Carter v. Canada, 2015 SCC 5, that a constitutional right to assisted suicide exists for any competent adult with a “grievous and irremediable medical condition (including an illness, disease, or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition,” the Court suspended its judgment for a year (since extended) to permit Parliament to pass legislation implementing it. Instead, the Canadian Parliament passed legislation limiting assisted suicide to cases in which natural death was “reasonably foreseeable.”

So Adam purchased Nembutal with the advice of Philip Nitschke, the founder of Final Exit Network. Nitschke spent hours skyping with Adam, trying to coax him to stay alive, to give life one more chance. Adam skyped back for over a year, but even human connection cannot heal some kinds of pain.

I oppose assisted suicide because I am uneasy about any third parties assisting a person to die. I am certain that I oppose assistance from doctors who do not have a longtime treatment relationship with the individual requesting the lethal dose. Just imagine your answer to this question: what qualifications would you require for one person to be able to help a complete stranger to die the first time they met? Do you think a medical license actually guarantees everything you would want to require in a person given that much power and discretion?

I am not sure that any third party should be able to assist a person to die, but certainly not a stranger with a bunch of letters after his or her name. Most doctors who do this are well-meaning, but they are also advocates for a cause. You have to know a person very well to understand what is driving his or her decision to die. It’s not even particularly a medical issue. Thus, the fact that Adam’s father, with whom he lived, supported his decision strikes me as quite important.

On the other hand, if we are going to have assisted suicide, with doctors able to prescribe lethal medications pretty much at will to anyone that they determine meets the qualifications for assisted suicide, and if we describe “death with dignity” as a benefit, a good thing, a release and relief and a mercy for people with chronic unbearable and unmanageable pain, why do we also describe exclusions from assisted suicide for people with mental illness as a protection rather than discrimination?

Only because we think they are not fit to make up their own minds. The mythology that mental illness surely equals incompetence is just that—mythology. People should not kill themselves impulsively, but Adam Meier-Clayton was far from impulsive. He was certainly just as competent and thoughtful as other Canadians who have utilized assisted suicide.

Maybe he had a condition that was amenable to treatment, if only someone had tried harder, but no one did. How long should he have been required to wait and suffer? Longer than someone with a medical condition we recognize? Our modern society—particularly in the United States—offers inadequate, sporadic, and difficult-to-access mental health (and even medical) treatment and then demands that people stay alive because there is a possibility that they might be cured. Or maybe we think his pain was less agonizing because its source did not show up on a test or film or scan. But none of us can know how much another person suffers: it is with good reason that we honor people’s subjective experience of their own pain.

I am not at all sure that assisted suicide is a good idea. But if you, the reader, think it is, for people who are in unbearable pain and have tried in good faith all the treatments suggested, then you must support Adam Maier-Clayton’s choice of death as well. It actually doesn’t matter whether he had a medical condition that could not be diagnosed and the medical profession’s default to psychiatric disability was a tragic error, or whether he had a psychiatric disability resulting in unbearable physical pain that could not be deflected by therapy or medication or treatment. It’s impossible to know, and his life felt the same to him either way. He was competent; he tried hard for many years. It was his decision to make. It’s painful and it hurts, but he looked around the world, and we didn’t have what he needed to live.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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34 COMMENTS

  4. I’ve read about a man fleeing to Switzerland to have a doctor assist him at suicide over the suffering caused by a “bipolar disorder” diagnosis. As suicide, in that instance, would be DIY, doctor assistance is actually homicide. “Bipolar”, the “mental disorder”, is neither terminal nor ‘unbearably’ painful in any physical sense.

    Paternalism, people claiming to know what is best for a person better than that person him or herself, the rationale for protecting people from their own devices, is a big part of the issue here. I’ve always felt that a person sincerely could make a rational decision that one’s life was not worth living, and that it should, therefore, be ended. In the overall scheme of things, in this event, one death, like one life, is going to be of little consequence.

    You say Adam was in physical pain which would seem to me to make his “mental disorder” diagnosis somewhat questionable. Fortunately, the right to end one’s life is one right the government can’t entirely succeed in taking away from a person, try as hard as it might to do so.

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    • We have no idea why the Dr’s concluded that it was mental illness, whatever that is? All I can assume is that they could find no physical cause and therefore assumed it was psychological in origin. I think that is an easy way out for the Dr. Much better that they say they have found no cause.

      I hear people with mental health diagnosis sometimes have physical symptoms dismissed as being psychological in origin with no or little evidence.

      I also know someone with long term chronic pain caused by real physical disease who learnt to deal with it largely by psychological and behavioural methods. So these things are often complex.

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  5. I would love to have some Nembutol on hand–with the way the world is going *I* want to make the choice about how/when I want to die. When the shit hits the fan, just knowing that I have the option would give me a great deal of peace.

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      • As I said~

        Of course it’s a slippery slope when it comes to a decision like that in regard to those who are labelled ‘mentally ill’…I didn’t mean to ignore the point of the article. It’s just that I’ve thought about it long enough, and many of my older friends have as well–I think we should all have the right to decide when to leave the planet, and not give Modern Medicine ™ another nickel on the backs of suffering elders. Modern Medicine ™ acts almost like it’s a personal affront to ‘lose’ a patient, even if they’ve already been coded 4 times…Death is part of life, and pretending it’s not part of the great circle of life is part of our problem as a society. IMNSHO.

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  6. It’s hard to believe that I’m seeing arguments here that people with psychiatric diagnoses should be eligible for so-called assisted suicide. No, it’s not discrimination when they aren’t. Mental and emotional problems are not terminal illnesses. Some of y’all are arguing to reopen the door to eugenics with psychiatrists at the helm, and I’m left wondering if I’ve inadvertently gone to the wrong website.

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    • “Mental and emotional problems are not terminal illnesses.” Very true. Being forced to take the psychiatric drugs forever, however, does inevitably create terminal illnesses.

      I do not personally agree with medical assisted suicide, or forced drugging. I’m quite certain legalizing medical assisted suicide will lead to a slippery slope of medical murders. But I did deal with psychopathic doctors who were regularly mutilating and murdering patients against their will for profit. One of those doctors was finally arrested.

      http://www.chicagotribune.com/news/local/breaking/ct-sacred-heart-hospital-verdict-met-20160304-story.html

      I know these doctors were thrilled, at the time I dealt with them, that I was an “organ donor.” I’m now off that list. Organ harvesting is a lucrative business, I understand. And I have no doubt that had their “snowing” succeeded in killing me, they would never have confessed to murdering me for my parts.

      As a matter of fact, I have a letter from the ELCA Lutheran Advocate Good Samaritan hospital’s lawyer, where I had the misfortune of dealing with Kuchipudi, which states Kuchipudi’s medically unnecessary shipments of patients long distances to himself, “snowing” of patients, and hopeful unneeded tracheotomies for profit is considered by that hospital to be “appropriate medical care.”

      “Power corrupts and absolute power corrupts absolutely.” The doctors already have too much power, and some have already corrupted themselves, absolutely.

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      • “I do not personally agree with medical assisted suicide, or forced drugging.”

        It is your right. However if you vote against it, that might result in being part of paternalism which makes people suffer who really don’t want to.

        I think every single person should have the ability to own that magic potion in case they decide and many doctors agree with this.
        Whether we allow MAID or not, it all smacks of paternalism…in one case it’s the doc who gets to decide whether the beggar ‘deserves’ to be released and the other, whether he must suffer.

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  8. First of all, thanks very much for your article. I appreciate how it succinctly and clearly lays out some of the issues involved, and that it retains a humane sense of fallibility about one’s own decisions about what is right and what is wrong. It’s refreshing to see.

    Second, I doubt very much that this was a case of “mental illness.” I believe it was a case where the physical source(s) of his physical pain were simply unknown, which is a medical and scientific problem, not a psychological one. It is a reflexive habit of medical doctors these days to refer physical problems that they don’t understand to a psychiatrist. I believe this should be addressed, and that it should stop.

    And third, I have had plenty of time to consider whether mental difficulties are themselves a sufficient reason to kill oneself. There are two answers to this: 1) I believe that suffering is suffering, and that’s all there is to it, and you can die if you want to, and 2) that even more important is your right to die, for any reason, and at any time, and there shouldn’t even BE a debate about “mental illness” at all. The whole debate is a false dichotomy, or so I believe, and I think it should be stated clearly in those terms so we can all get over it and allow people to exercise free choice about their own fates.

    If God (I happen to believe in God, but have no problem with anyone who doesn’t: I was an atheist for a very long time myself) wants to keep you alive for some reason of His own, He will. Otherwise we should all get out of the way and permit people to exercise their own God-given will to make decisions about their own lives.

    Thanks again for the article. I hope I see more of your commentary in the future.

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    • Suicide and assisted suicide are not the same thing. There should absolutely be a debate about “mental illness” and assisted suicide because people with psychiatric diagnoses are usually drugged to the gills, which means not only that the drugs could be causing their suffering (or part of it) in the first place, but also that their decision-making faculties could be impaired to some degree by the drugs.

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  10. In 2002 when I was having unbelievable 24/7 pain all over my body like I was on fire. The doctors I saw were in the same hospital system so they had access to my psychiatric diagnosis. Every one of them told me to go back to my psychiatrist because there is nothing wrong with me. I was using crutches because my right foot was turned sideways and was dragging. The last doctor I saw was a neurologist and it turned out I had a progressive neurological disease that was known for its ferocious nerve pain. This neurologist did not know I had been on psychiatric drugs (I tapered off all the psych drugs by then) or my psychiatric diagnosis.

    Physicians are quick to think everything is psychosomatic and when there is no hope given you have none. I feel for anyone who cannot get the help they need for a physical illness.

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  12. Anyone have a right to commite suicide, also *mentally* ill people! Those who are against assisted suicide for
    *mentally* ill people, are in general all MH *experts*. Same people who dig grave for Adam! Same by profession. RIP Adam and 800 000 people who commite suicide, because of so called *mental* illness, each year. And RIP 8 000 000 of people, who died each year in cursed MH System. Wake-up *crazies* and crushed down NWO MH System!!!

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  13. “. . . we didn’t have what he needed to live?” BULLSHIT! We didn’t GIVE him what he needed to live. When I “looked around” at his life, I saw a father who said he “couldn’t live as a ‘diminished’ person”, a YouTube channel full of voyeuristic sycophants, and a pile of toxic psychiatric narcotics. There was NO reason why we had to turn that into his life. Apparently, his distress began during childhood. His abusive parents got him labeled as OCD, and that started him down the path to psychiatric Armageddon. More psychiatry made his life worse, not better. Suicide was NOT his “choice” and it was NOT inevitable. His executioners were the only people who got what they wanted from this.

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  14. “why do we also describe exclusions from assisted suicide for people with mental illness as a protection rather than discrimination?” Twisted thinking if you ask me, to say we have a ‘right’ to suicide and protecting the mentally ill from suicide is a form of discrimination. People from horrendous backgrounds or on mind altering drugs are in no position to have ‘rights’ with regards to suicide. I wanted to die when I was being given a steroid and tranquilizers by medical doctors and I can tell you that was certainly not the right option. No, I did not have full capacity for decisions. Yes, some agency should protect me from myself.

    As for the young man who had unbearable physical pain, I truly feel sorry for him. I have physical pain also which several psychologists have called psychosomatic which was ridiculous , it’s sciatica. To use this young man’s extreme case which could be the exception to the rule, to say that people with mental illness should be allowed to decide on suicide, is not sound thinking.

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  15. I apologize for the length of this comment. It’s a letter to the Canadian Medical Association Journal that I think adds something important to the discussion. Bottom line – we must trust people to make their own decisions, right or wrong. Anything else is disrespectful and opens the door to tyranny. Psychiatric survivors, more than anyone, know this to be true.

    Letter: Availability of medical assistance in dying can be therapeutic

    by Ian M. Ball, MD and Scott Anderson, MD

    The legalization of medical assistance in dying (MAiD) in Canada has created many logistical challenges for institutions and health care providers. In a country where diversity is not merely supported, but encouraged, it is not surprising that there are many outspoken critics of MAiD. One of us (I.M.B.) is the medical chair of our hospital MAiD committee; the other (S.A.) acts as a MAiD provider. Having been involved in over 30 referrals since June 2016, we have several important observations to make.

    The gratitude expressed to us by families and patients is staggering. A recurring theme is that patients’ moods are tremendously improved with the knowledge that MAiD gives them control over their disease. In some completed cases, symptoms were not controlled to an acceptable degree by aggressive palliative care. In some other cases, despite excellent symptom control with palliative care, patients desired control over the circumstances and timing of their deaths, and so chose MAiD. As per the law, all MAiD patients’ natural deaths were reasonably forseeable. For patients who received MAiD, being able to prepare for their deaths, assemble their families, and die in a comfortable, dignified manner, were the universally espoused virtues of MAiD.

    We have found that MAiD deaths provide a greater level of patient comfort than even the deaths from the withdrawal of life support in intensive care units. MAiD allows the use of intravenous medications in anesthetic doses, combined with neuromuscular blockade. At our institution, the procedure lasts only a few minutes, and avoids the dyspnea and increased work of breathing, which is so often associated with even the best palliative care or withdrawal of life support.

    Although we support palliative care and believe it to be the right experience for most individuals, we have witnessed cases where palliative care was insufficient to manage the degree of suffering, or where patients simply wanted to avoid perceived indignities and loss of control associated with their progressive diseases. It has impressed us tremendously that the availability of MAiD has improved the outlook of many patients who have not chosen the procedure. The knowledge that MAiD is an option, should symptoms become unbearable, is very reassuring for patients and their families.

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  16. Iner Gas
    Nitrogen asphyxiation is the most humane method to achieve painless and humane death. This should be euthanasia method No. 1, if anyone wants to call euthanasia humane, at first. And you don’t required medical staff to administrated it. I will run House Without Pain, any day.

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  17. Does it matter whether his suffering was physical or psychological? Either way, he couldn’t bear it. Mental torment is just as bad, if not worse, than physical pain. At least when your body is in pain, you still have control over your mind and you can distance yourself mentally from your body. But if your mind is in torment – the center of your thoughts, emotions, perceptions, etc., your whole universe is out of control and unbearable. Proverbs 18:14 comes to mind – “The human spirit will endure sickness; but a broken spirit—who can bear?” I’m not trying to trivialize physical pain in any way. I just don’t think anyone should trivialize mental suffering, which can be even worse. I’m a Christian and I’m not in favor of assisted suicide, which I feel is murder, but I wouldn’t dare tell anyone who is suffering profoundly, whether physically or mentally, that they should not be allowed to escape their pain and that they should be forced to bear it indefinitely. I don’t think the issue here is whether Adam’s pain was physical or psychological. I think it is really about having agency over one’s own life – and that should apply to everyone, whether physically ill or “mentally ill”. Mental distress is no less real or legitimate than physical pain. Every person must decide for himself/herself what level of suffering can be tolerated. Ultimately, it is between the individual and God. No one should take that basic human right away from anyone for any reason.

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