Medically-Assisted Suicide Is Not a Win for Mental Health

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In recent years, medically assisted suicide programs have become popular in countries all over the world, with European countries seeming to lead the way. Euthanasia, assisted suicide, and non-resuscitation upon request are all slightly different procedures for the general idea of the medical system assisting people who qualify to end their lives in allegedly painless ways when they decide it’s time.

One of the main arguments I’ve heard for medically assisted suicide is “death with dignity.” If you have a terminal illness that will render you unable to care for yourself and need 24-hour care, you might want to choose not to burden your family or loved ones with that task and say goodbye while you still have your faculties. Of course, you wouldn’t have to do so; it would simply be an option for those who are facing unrelievable suffering at some point. This sounds fine, like it preserves choice and honors the autonomy of the individual to choose what to do with their own life, though I will say that spending time with those having experiences the medical system would call “dementia” has trained me not to make assumptions about what people would or would not choose.

There is one particular woman—we’ll call her Grace—I have had the pleasure of getting to spend time with on a few occasions these past couple of years. Grace is my longtime friend’s elderly mother, diagnosed with a rare form of dementia a few years ago. Her cognitive decline has been uneven but decidedly downward; she’s unsteady on her feet, struggles to find words and finish thoughts, and is disoriented enough that she shouldn’t be left alone for longer than it takes to go to the bathroom. But her spirit remains bright as ever. I didn’t know Grace when she was young, but my friend says there are even new parts of her personality coming out around me that he doesn’t remember seeing when he was young. I realize that the plural of anecdote is not proof, but Grace is an absolute delight; it is one of the great honors of my life that my friend and his dad trust me enough to give me one-on-one time with her.

During my most recent visit with Grace, she and I developed a secret code that we could use even in the presence of my friend and his dad without them understanding us. Without using words, we created a game involving trail mix and who could find the chocolate chips faster. She didn’t miss a beat when making a joke or gently teasing one of us. She has, in fact, gained spunk even in her terminal illness, and her ability to ask for what she needs has only gotten stronger since her younger years. The only other person whose eyes I’ve seen gleam like hers after she’s made an extremely witty comeback are her son’s. I’ve helped her stand up and find the kitchen in the house she’s lived in for over half a century, remember words, and drink water without spilling. She’s helped me laugh much more freely than I ever have, find the rest in every single moment and take my hopes for my life seriously, given how fast life is going by. I don’t know what her answer would have been in years past but, if you ask her now, I bet she’d say that’s a dignified life.

Of course, Grace is just one person; others may have different values, and that’s okay. The issue I have with the proliferation and “development” of medically assisted suicide programs isn’t that they don’t dignify life. It’s the potential for medically assisted suicide to become compulsory rather than a true choice. Canada’s MAID (medical assistance in dying) program demonstrates the slippery slope I see the increase in medically assisted suicide programs currently on. The programs in Europe that allowed doctors to either administer or prescribe lethal injections started out, from my understanding, having stringent qualification requirements. The diagnoses that qualified were specific, the thresholds for prognosis were high, and applicants for medically assisted suicide programs had to undergo a certain number of hours of counseling.

Disability rights advocates argue that difficulty in accessing medical assistance in dying services is unjust and oppressive, that forcing someone to stay alive against their will is abusive and devalues human life since it doesn’t respect the power of choice. Whether you agree or disagree with that, the problem is the precedent it has set: this is no longer about physical illnesses known to be degenerative and fatal; it is expanding well beyond that into the areas of mental health and even socioeconomics. Canada’s MAID program, which has been in the spotlight lately, has drastically lowered the requirements for who can qualify for their services. The kinds of diagnoses have expanded from physical illnesses known to be terminal to “mental illnesses”—and some applicants are being accepted for MAID simply because they’re poor. The worst part is that the process has been streamlined so that the time from application to death is getting alarmingly short.

Medically assisting someone in suiciding because they’re poor or experiencing mental or emotional distress does not value life; it, in fact, shows a blatant disregard for it. I’ve heard the argument that it’s not “dignified” to live in poverty, but I don’t see how it dignifies a society to funnel poor people into the medical system to end their lives simply because they’re poor. That many would rather advocate for access to painless suicide than build a world that works for everyone speaks volumes about the value (or lack thereof) of life. I’m under no delusions that creating a world where grinding poverty doesn’t drive people to suicidal ideation would be easy; I’m simply taking the main argument for MAID programs that I’ve heard on its face: MAID is allegedly about valuing life by giving people “dignified” ways to end it before they lose their ability to make free choices with their mind and body. Opening this option up to people who are poor or experiencing what is often temporary, albeit intense, emotional and mental distress does not dignify life. It cheapens life, reducing it to material or emotional comfort and sets a dangerous precedent.

This is not at all to deny the suffering that comes with financial lack or mental distress. I have experienced both, on occasion severely, but that’s how I know how insulting it would be if someone were to point me to a place I could just go to die rather than support me in working out my crises. As a disability rights advocate, I would think the way to preserve the dignity of all is to fight to preserve life’s quality and length as long as possible, not cheapen it by providing an out that would be easier for society. Offering MAID to people in mental/emotional distress and who are struggling financially is basically like saying, “You don’t have anything productive to offer society? Go die already.” I’m missing the part where that’s dignifying.

I have an even deeper concern, though. I can see the potential, in a world that increasingly devalues life and, in that, in a medical system that increasingly devalues life, for this to become compulsory. Especially in a socialistic medical system such as Canada’s, the choice to stay alive might start to be evaluated by those in power in terms of dollars and cents. The more widespread and widely accepted MAID programs become, the more that people who would like to live out their natural lives even with a terminal illness, mental/emotional distress or poverty might start to feel the pressure of the financial burden they’re placing on the systems keeping them alive. If there’s a cheaper way, I can imagine the medical establishment thinking (if not outright saying), why not give us the cost savings and take that route? Over time, that could become less and less a suggestion and more and more a part of healthcare culture.

The readily available access to medically assisted suicide to more and more people could dilute healthcare: if there is a cheaper option that saves money, time, beds, and resources for others who are “easier” to treat quickly, it might be that medically assisted suicide will start to be offered as a first option… and then perhaps as an only option to “difficult cases,” or people who society has labeled as undesirable—poor people, people with certain DSM diagnoses, people who don’t show themselves to be cooperative with the systems of power. As undignifying as it will feel to the person being “offered” medically assisted suicide, it will be that much more undignifying if these programs continue to infect the healthcare system so much that we get to the point of computer-generated treatment programs suggesting medically assisted suicide as the only option.

Of course, you can use the “slippery slope” argument for anything. But this is literally a matter of life and death; it deserves our utmost care. Some disability rights activists are starting to warn that MAID programs lowering their standards for acceptance is already lowering the quality of healthcare being offered, especially in places like Canada, where it’s alarmingly easy to get accepted into their MAID program. In our current for-profit healthcare system in the United States, it’s difficult to see how such a program wouldn’t become a common crutch for saving money: yes, medicine and psychiatry depend on people remaining sick in order for their business models to work. But in “hopeless” (as decided by them) cases—ones that won’t live long enough to be sufficiently profitable for them—MAID is becoming an all-too-easy option to reach for.

Neither medicine nor psychiatry need any further incentive to lower the quality of their “care.” While the argument that preserving free choice dignifies life makes sense, I’m not sure it’s sufficient to protect those who would choose to continue their lives even in the face of situations that would qualify for medically assisted suicide programs.

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11 COMMENTS

  1. Eugenics was a main component of the ‘enlightened’ and scientific world view until the end of the WWII. It was mostly accepted in the educated circles that there were those who didn’t really deserve to live but for the lack of corrective action are somehow alive. After the defeat of fascism, these types of ideas lost their respectability and became less easily recognized, their proponents having become maybe a little embarrassed of their clear application. It seems eugenics is having a strong comeback.

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  2. I agree with everything in here – too easy assisted suicide is not a win for mental health.

    At the same time, anyone familiar with the material on this website knows that often a systemic response to a mental health crisis makes things worse and essentially punishes someone for showing extreme pain and signs of trauma. We don’t put the suicidal in a safe space surrounded by good people who want to listen and include them in community. Instead we take away rights and often force medicate them. I’m a very real way, someone committing suicide before being recaptured in a POW camp, suicide is a better short term option than other systemic options.

    All the calls about more funding for mental health often fund outreaches that can cause more harm than help. The talk about suicide needs to include this reality, otherwise it’s just serving the needs of the powerful: distracting from the abuse of the system by virtue signals that “we care” without real care or help.

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    • Matthew, a person can recover after being incarcerated on a psychiatric ward and forcibly medicated. I am saying it as someone who spent more than a month locked on a psychiatric ward and forcibly medicated.

      But if one takes his/her own life, it is irreversible. A few years ago my brother spent 2 weeks locked on a psychiatric ward because of suicidal thoughts. His mental health has improved since that time. I am very happy that one of his friends decided to call the emergency services when my brother told her about his suicidal thoughts. My brother’s death would have been a tragedy for him and for our whole family.

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  3. There are two kinds of people in today society. The real and the compatible with the system. The problem is that people can’t recognize their evil and corruption. So your sins are – corruption, homicides (in accordance with the procedures), that’s okay. We will forgive you, because you are a sinner and you have your weakness. But when your ego won’t obey to our fake and deadly material reality – you will be killed. Because we believe in fake money made by FED and intellectualism sponsored by fake money. Psyche is too difficult for us, we are healthy imbeciles and we love it. FED money is our true religion.

    Normal is as evil as their fake money. Fake identity without psychological roots and without awarness of own pathology ( we are theology you are evil), fake language based on nominalism, fake money based on nothing. Antichrist is as good as normal people. Everything they done is good, or everything is just a sin. But “THEY” (psychological man, mythic reality of psychological politeism) they are the real evil. Monotheistic materialism based on fake money creates the fake worthless identity, without psychological roots. And now, they want REAL people to die for Wall Street.

    Don’t die for Wall Street, if you must, die for yourself and forget about this ugly corrupted world. I also can’ see the point in living when normal people are what they are. And they are EMPTY MATERIALISTST owned by two daddy’s – Rotschild and Rockefeller. Economy is as empty as Rotshilds eyes, and medicine is as greedy and ugly like Rockefeller face. Psychiatry is made by their “love” for psychological reality, for inherent reality. Psychiatry is a soul of biological machines created by anglo – saxons humanoids like Kraepelin. Normal people are to blame.

    Psychiatry of monotheistic materialistst are a antichrist for the psyche (politheism of mythic imagination, banned in monism/marxism). Antichrist is technocracy for monotheistic materialism. Just do not forget who start this depopulation.

    YOU. Normal people, sacred cow of materialism. As empty as trash bin for fake money. Normal people are people without identity, and their soul is owned by the devil. They don’t know about this, they think that depression, death or psychosis are evil. No. Marxists are. Empty materialistst are evil. And where are a plastics capsules for them? Normal people = traitors. In capitalism they are capitalism, in communism they are communism. And where is your identity?
    —————————————————————————–
    James Hillman “Re-visioning psychology”

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  4. I write this sitting at my dear dads bedside in a Hospice as cancer slowly and distressingly engulfs him.

    We are in a lovely setting with lovely staff and yet it feels to me like they are all pleasantly and warmly engaged in some sort of horrific medieval torture.

    Dad is a dying man and the cancer has spread from his prostrate to pretty much everywhere. Dad is fully aware of this and whenever the consultants or nursing staff ask him how he is or what he wants he has the same answer. He patiently (at least he managed this until today) explains to them that he would be considered cruel if he kept his beloved pet dog in such a state and he wants to die.

    Prior to coming to the Hospice he had to go through the indignity of using a commode and having me his son, his wife and granddaughter clean him up. We were also left to try and manage his unimaginable agonising pain with liquid morphine, tramadol and then Oxycontin/norm.

    We did not manage this and for three weeks I watched helplessly day and night and he writhed in agony begging to be put out of his misery.

    Over the last few weeks the cancer has broken bones in his spine and the damage to his spinal cord means that he’s fully conscious of the fact that he’s now paralysed and doubly incontinent and cannot even sit up.

    The new torture this week is his dwindling ability to even speak, barely managing a whisper.

    I wonder what hideous torture the cancer will bring for dad and us his distraught family tomorrow? because of course we have to wait until it’s done its absolute worst before his torture is ended.

    Any yet the staff here have the skills and the means to give him dignity in dying. Dad could decide and we could all be here with him but no he must suffer.

    Its made we wonder which life stage is the most profitable for drug companies and it must certainly be elders and end of life. So as well as the backward religious fanatics that are against treating people better than dogs big money interests must also be against such changes being made. I’m writing from the the disunited Kingdom.

    I also worry about what would happen in this capitalist, greedy, self focussed economy and politics if it was fully legalised without constraints.

    No doubt something like Soylent Green would ensue in between adverts for poisons like breakfast cereal, gambling, loans and living beyond your means.

    But in CLEAR cases likes dads sanity and humanity are long overdue.

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    • In Europe long term mental health patients have asked for and got assisted suicide. I find this extremely worrying as the quality of help offered is so bad and yet in your father’s case it seems a sensible option.

      Perhaps there is no sensible option, “in this capitalist, greedy, self focussed economy and politics.”

      I hope your father’s suffering ends soon.

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  5. Topher, heartfelt and soulfelt thanks to you, your dad, and all your family for all this, as well as a piece of incredibly powerful, heartrending, heartwritten writing.

    I spent a while as a hospice volunteer. I loved it more than any other work or “work” I have ever done.

    https://www.youtube.com/watch?v=g2aWjH7iNg8

    An Irishwoman was interviewed on radio and asked what got her through the agonizing first few months of their first baby’s life, as the child struggled through seemingly endless procedures in a Dublin children’s hospital

    Her answer surprised me then. It wouldn’t now:

    “The staff in the hospital cafeteria!”

    My belief is that we every last one of us go through hells to reach, perhaps to create heavens, and that Love can be found, and Grace, like Fear, find us anywhere, at any time, under any circumstances, and be made out of nothing, at all.

    “The man on the cross is an archetypal image: He is every man and every woman.”

    I believe – I have to believe – that human suffering is finite, but life, and joy and love and truth and beauty are not.

    In “One Flew Over the Cuckoo’s Nest,” I think the Native American/Indigenous/Aboriginal character did what his people did out of loving mercy, but I think any euthanasia legislation, at least until we all become more enlightened, is fraught with peril, obviously…

    I believe there may be no limits to the comfort one human being can bring to another under any circumstances, but that we must learn not to allow ourselves to be dragged to the bottom when trying our best to save others from drownings, either: easier said than done, very often.

    Your dad’s and your own agonies have brought you into contact and will continue to bring you into contact with people who needed to meet you – so I believe -as well as gifting us all here with such a tremendously powerful piece of writing.

    I am sure you must k now the Allegory of the Long Spoons, for it is surely written on the heart of every human being who has ever signed up for this, all, and the only thing that makes any sense of it.

    Viktor Frankl showed how we humans can (all) not only inflict extraordinary cruelty on one another….but also be the means of, well, I have no words for what Viktor demonstrated, except that he found it possible to find meaning by helping others find meaning, somehow.

    That his book is devoid of bitterness still leaves me in awe. Would that I could only think and write so!

    Thank you, and your dad, and all your family, again, for all you have done, and may you very soon if not already be done.

    Thank you.

    And heartfelt thanks, MIA, for bringing you to us all, here, now.

    Tom.

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  6. Megan, if you’re there, I just have to thank you a wonderful essay and for introducing us – me – to amazing “Grace.”

    I see her as some kind of Zen master/mistress.

    I mean, I think we are all well on our way to being such – just that “Grace” seems to be a lot, lot farther along the path than I am.

    Those Vietnamese monks who self-immolated in protest at the war, whether or not they or anyone else claimed they were Zen masters, I doubt they screamed in agony as they passed – anymore than I expect Jesus of Nazareth did, assuming they crucified him (and perhaps his agonizing, alone, and unassisted (by humans) preparation the night before ensured this stoic silence?): I guess they had practiced presence enough to be able to ignore any fearful stories their minds were trying to tell them?

    It’s said that some folks become so advanced in mind control that they can or could drink enough to pass out from intoxication still without becoming inebriated, if you understand. and I can believe this

    For all his brilliance and genius, sadly, Robin Williams seems to have been quote unable to tolerate witnessing his own brains’ deterioration,

    “Be healed!” He joked, as a comedian, and I think he helped heal many through humor and more as an actor, and not only as Dr Hunter “Patch” Adams, of course, but then, when his own time came…

    I believe it’s perfectly possible for some people to transcend their own severe loss of cognitive abilities, and that this may be because such women and men have so evolved, have “practiced presence” or “grace” during less challenging times, or, as as Max Ehrmann suggests in one verse of his Desiderata:

    “Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with dark imaginings. Many fears are born of fatigue and loneliness.

    The phenomenon of terminal lucidity is utterly fascinating – isn’t it?

    https://psi-encyclopedia.spr.ac.uk/articles/terminal-lucidity

    Do some folks manage to bypass brains which have become profoundly damaged by acts of will – in order to take care of stuff they know they most definitely need to do before passing?

    Christopher Kerr

    https://www.youtube.com/watch?v=rbnBe-vXGQM

    https://www.youtube.com/watch?v=g2aWjH7iNg8

    speaks of it.

    And perhaps what Jill Bolte-Taylor describes of narrates is SOMETHING like terminal lucidity, too, as certainly her speech/language center/s went offline, whatever about other centers of cognition, but allowing another intelligence to operate unfettered?

    https://www.ted.com/talks/jill_bolte_taylor_my_stroke_of_insight?language=en

    https://shrinkrapradio.com/147-nirvana-and-the-brain/

    When I experience any brain fog for any reason (AND realize it!), I try to accept it, but I don’t think I have ever managed to, yet…although I accept that this here contribution of mine is foggy, and apologize.

    It’s been said that if you’re poor, you’re “crazy;” if you’re rich, you’re “eccentric.”

    Me, I thought I’d met a few characters who were not “crazy,” “eccentric” or “neurodiverse.” Then I discovered whom they had married. Now I accept that the only perfect person I can ever hope to meet is a perfect stranger, and that we must all be so much more than infinitely perfect and beyond my present comprehension that, no matter how much terminal lucidity I may pray for and attain, I may never quite get it.

    Even if we can believe we are immortal beings, together equally struggling through incredibly difficult human lifetimes, while this belief may support the notion that neither we nor anyone caring for us we can suffer too much, whatever about one’s views on any form of suicide, at least such a belief may help us generate more compassion that we ever dared dream possible?

    “If this world was perfect, it wouldn’t be.” – Yogi Berra.

    Megan (Pearl: beauty formed through prolonged trials), and MIA, thank you very much indeed a most wonderful essay.

    Tom.

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  7. We already have this in the US and it is called “hospice” where you don’t necessarily need to have a terminal illness to get in the door. If you are the right age and get the wrong label then if you refuse to east and drink then Medicare will pay for your controlled suicide!

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