(Trigger warning) Assisted suicide - Caroline March

[Clumsywithwords]

Name changed for this but regular MN user.

I have read and cannot stop thinking about the event rider Caroline March who sadly had a bad riding accident in 22 which resulted to her breaking two vertebrae in her spine, losing the use of her legs and this week has died by assisted suicide, due to the effects of her injuries.

She left with a very moving letter/post (which is circulating round most newspapers forums and isn’t hard to find) which explains why mentally and emotionally she couldn’t go on.

I can’t really articulate what I feel about this, just that I haven’t stopped thinking about her and how she came to the choice she did and while I support assisted dying and can’t even imagine what a horrific injury this must have been to come to terms with, I was (possibly naively) shocked that someone who wasn’t terminally ill or with a degenerative condition could end their life this way.

I’ve read many say that it was such a frank and brave thing to admit and do and there is an element of braveness to it, certainly her letter definitely encapsulates her fierceness of character but I guess I’m on the fence to where the line is for assisted dying and I’m finding her end choice hard to process…

Has anyone else had mixed feelings on this?

To give assisted dying for mental illness opens up an ethical minefield that isn’t manageable or able to be boundaries in the same way that assisted dying for those with physical conditions can be.

I disagree completely. I think the Netherlands manages it pretty well. The fact that numbers are rising is neither here nor there; assisted dying for mental health is subject to the same rigorous scrutiny as other forms of assisted dying. In 2021 (the most recent data could find), 1.5% of the total number of reported cases was for mental ill health, a total of 115 people. Euthanasia accounted for 4.5% of all deaths with the majority being for cancer.

I ask you yet again: How long do you think someone with severe and enduring mental illness should have to suffer before they can decide that they do not want to live?

I'm fully aware that people can commit suicide if they want to and that most people do not want to. That doesn't help the small cohort of people who want to die but for whatever reason feel they cannot manage it for themselves. One of my cousins committed suicide by jumping off a tall building - imagine the trauma for the people who witnessed it. He had been severely mentally ill for a decade, but back then there were no atypical antipsychotics, nor was assisted dying an option.

I also grew up near a train line where the crossing near our house was a suicide hot spot. The trauma for train drivers was very real.

Not permitting assisted suicide for mental ill health means a continued impact on people who witness a suicide or whose family members commit suicide when at least some of those instances could be handled in a less traumatising way.

@pointythings you may want to read this article, the authors discuss the ethical issues far better than I ever could (edited to include link) https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-018-0257-6

This.

I find it very disrespectful to question her choice. She was an intelligent woman. Her life was fantastic and then it wasn't. She tried to live with it, she could not and she was faced with a life of pain and no real happiness . She made the right choice for her and that's really all that matters.

Yes CaptainSensiblesRedBeret I would certainly hope that is the case in most instances. I worry though that financial considerations come to play more of a part in the decision than they should in certain contexts eg NHS in certain postcodes.

The reason I worry about this is that a close family member had a disabling blood clot in the brain that caused a stroke. From that point they were severely disabled and needed help eating and drinking and with personal hygiene. Latterly, they were bed-bound. And yet, throughout all of this, they desperately wanted to stay alive!

They had many inner resources and very much enjoyed their life, to the extent that they could, and they wanted it to continue as long as possible.

The problem was that many of the nurses and doctors we met during that period, who made an assessment of my relative’s life, using purely objective, medical criteria, assumed that there was no merit in prolonging it and assumed this person would be miserable and they were terribly wrong! These assumptions made an already difficult situation much, much worse.

@123anotherday your article focuses on people with LD/autism - that is a very particular subgroup. However, even for that group the authors do not state that it would be ethically impossible to legislate for assisted suicide. They also do not mention anyone whose mental ill health is not related to autism and people with mental ill health who do not have any LD. I'm not sure what you are trying to achieve with this article - I welcome the suggestions that more research is needed, but this article does not in its arguments or conclusions oppose the idea that assisted suicide should not be available to people who are mentally ill.

@pointythings i included it because they described the ethical issues very well….those with LD and autism are equally vulnerable as those with chronic enduring mental illness, you do not expect to cure someone with schizophrenia or personality disorder so the ethical dilemmas are similar and so are the problems these groups face such as discrimination, difficulty with financial support, inadequate physical care and lack of nhs and social care funding to support and treat their conditions . That’s aside from the risk of their decision being compromised by physician bias and subjectivity, capacity issues, undue influence or coercion. Undoubtedly there is a need for ongoing research & debate but stats are already showing a gender imbalance (ie.more women)in those choosing to die due to mental health reasons in the Netherlands, as well as a significant proportion who for eg. have never needed hospitalisation for their condition or been never offered such first line treatments as psychotherapy.

@123anotherday It's a good article and there's no doubt that the ethical ramifications of assisted dying in people with mental ill health are more complex than in the case of 'straightofrward' physical illness - you'll have no argument from me there. Where we differ is that you take this to mean that we must never allow assisted dying for people with mental ill health in the UK. I disagree most vehemently and you will never convince me that it is always impossible to have full valid informed consent for assisted dying from a patient with long term and severe mental ill health. The question then remains: how long do we force people to live a life they do not want in order to satisfy our own conscience? Given that no medical decision is ever 100% guaranteed to be safe and correct, why are we allowed to demand 100% perfection from decision making in this particular situation?

A note on your mention of women being overrepresented in the statistics: I can see two clear potential reasons for that. Firstly, women's symptoms are still routinely not being taken seriously by the medical profession, whether physical or mental health related, and secondly women are far more likely to seek help than men, especially for their mental health and so are likely to be overrepresented in clinical populations to begin with. Other confounding factors may also be in play.

@pointythings and @123anotherday

A major issue - the major issue, perhaps - is that the Dutch culture and the UK culture are rather different.

Having had considerable experience of both systems due to enduring serious ill health ....

I trust the Dutch system, have had two friends who chose to contact the end-of-life clinic and having heard about the teams who actually visit and carry out the termination of life.

I don't trust the UK system. It isn't joined up, it's desperately hard to get the help at all, and I certainly wouldn't trust it to be carried out in a dignified way, as my two friends with late-stage cancer experienced it.

I believe profoundly that we should respect peoples' wishes - it's a dangerous thing to say "but you might feel differently in the future". Yes, you might. But you might not. And for people to remove the possibility of assisted suicide on 'maybe's' is quite arrogant.

I think people should respect others' choices.

But as with the Liverpool Care Pathway, in the UK there would be serious concerns because of the patchy care in the UK.

@DancesWithDucks that is a completely valid point and well made.