To not get the controversy over Canada expanding assisted dying for mental illness?

[janef001]

I’ve been reading online and watching videos regarding Canada expanding MAID for those with incurable mental illnesses in March of this year. It’s been getting a lot of backlash.

I understand that a lot of mental illnesses can cloud someones judgement but does that really make them inherently irrational? In almost every other case, an adult with depression/bipolar/schizophrenia would be considered competent in other aspects of life when it comes to signing a contract, purchasing a home. If they were to get in trouble with the criminal justice system, they'd be seldom shown any leniency and considered as responsible as someone without mental illness.
In an ideal world, mental disorders would be properly treated so that people wouldn’t resort to dying but the public resources (therapists, psychiatrists) are not easily accessible. Many meds prescribed also take too long to work, don’t work much/at all, or have unpleasant side effects.

It seems fair to allow death in certain cases even if the mental illness might not be terminal itself.

Brrrrrrrrrr please know that there is help and support available. Please don't leave your children, you are worth saving and it will get better. Please believe that.

@Felix01 do you not think this woman had capacity in the moment that she was being asked? Dementia affects memory. So whilst she may not remember the question asked, she would be entirely capable of saying in the moment that she wanted to live. And mean it. My MiL has severe dementia but is still capable of being perfectly lucid in the moment and certainly capable of enjoying life in the moment. That story of the Dutch woman is horrendous.

No she wouldn't have had capacity because she had severe late stage dementia. So cannot weigh up the information and make an informed judgment that's why the high court allowed it and keeps allowing it in Holland. She signed the contract when she had capacity, I've looked after many people with dementia 100s if not 1000s and I don't want my death to be like that bed bound with dysphagia, wasting and pain so I should have freedom of choice to not go through with it. I don't want to have to make the decision to kill myself whilst I still have capacity and some quality of life which is what will happen if they don't allow it.

I've required rapid tranquillisation before surgery, I remember being very happy , calm and then I fell asleep if I died during the operation then oh well it was a good death I felt no fear. We have the ability to give good deaths.

Agreed that it’d be a living hell to be bed bound with dysphagia, wasting and pain. Surely at that stage, most people with dementia would also be unable to even be asked a question, let alone answer it pretty coherently. However the wasting bed bound stage didn’t sound like it was the stage of the Dutch woman when she was euthanised.

There’s a lot of fear about getting dementia. I’m terrified. At the same time my MiL can joke, laugh, enjoy a party even if she no longer recognises her family. She may lack cognitive capacity but doesn’t lack capacity to enjoy herself. Does she warrant being euthanised? It feels a bit more complex to me.

They give it late stage now in Holland if they have signed an advanced directive. I'm talking about personally for me. I've looked after many people with dementia as a nurse and I know this will likely be my fate as a female. It's a roll of the dice how you will be with it , your MIL is lucky to be content , many many people with dementia are not happy , I've known many to cry constantly, be fearful , I can only give so much diazepam to try and ease the anxiety for them. I don't want to be sad and unhappy and I hope a kind HCP will be able to end my suffering if I'm like that when the time comes.

TW - suicide and mental illness

In my personal opinion, I think it's a good idea.

I suffered severely with mental illnesses for many years and had to be cared for. I had weekly support workers, doctors visits, psychiatrists and psychologists.
I was on 24/7 suicide watch and was barely able to function as a person without help.
Thankfully I received significant help and was heavily sedated and medicated as my parents didn't want me sectioned.

I'm now mostly recovered and live a good life but it doesn't always work out that way for everyone. Had I not recovered, I 100% would've commit suic*de so humane euthanasia would've been a dream.
I could not have carried on that way for years.

Just because it's mental and not physical doesn't mean people should just have to suffer.

My grandma had late stage dementia. She spent years being severely unhappy, even if she didn't recognise it herself. The last time I saw her she couldn't even talk but she was crying. She was kept alive with countless interventions and pills.

I'm in Holland. When I turn 60 I will put everything in order so I can avoid this faith. Not sure if I would like direct euthanasia, but there were several opportunities that my grandma could have died a natural death, but she kept being patched up with antibiotics etc. I think I would want pain management only at that stage, no curative medicine.

I'm a mental health nurse. Something we aren't great at is acknowledging when treatment options have been exhausted. This can lead to people with complex trauma based diagnoses being essentially kept alive in hospital against their will for years, often in pretty horrendous and restricted circumstances, with no hope of change.

Some will definitely lack capacity to make a decision like this due to their illness, but some would do and I brlieve in very isolated cases the law should allow for this

Rumandspinach is this due to their condition or lack of options of treatment? I'm just curious as to whether it is NHS not being able to afford certain treatments or that some people are so far gone with mental health issues that they cannot ever be cured? That's desperately sad if so.

I've worked within MH settings , the reality is some people can spend years in hospital. We have tried DBT, trauma based therapy , medications , positive risk taking. We have to keep people on constant observations even the toilet. We monitor all of their post , rooms can be stripped bare and some can't even have clothes and will wear a rip proof strong suit. As soon as they are taken off observations they go on to attempt suicide or serious self harm so they are put back on. They headbang so much they fracture their own skulls, they interfere with wounds. We have to physically restrain them to stop them hurting themselves.

We try our best to keep these people alive, it's so sad they are so distressed and it upsets me they have such a poor quality of life

Well I live in a country where people with terrible mental illnesses and/or trauma can be left without access to appropriate treatment and support for years and years. The thought of my government bring able to offer euthanasia to such people is terrifying. Is it really so different in Canada? I remember reading about very real health inequalities bw different groups. Is that really different for mental health?

Is it really so different in Canada? I remember reading about very real health inequalities bw different groups. Is that really different for mental health?

At a time that Canada was ranked about 5th best country in the world (its dropped now), when the data was disaggregated, the First Nations peoples data (life expectancy, literacy, income etc) ranked about 112th… So, yes, very real health inequalities between groups. It’s naïve to think prejudices wouldn’t get played out in such decisions made by health professionals.

Indeed. I watched this documentary years ago and it stuck with me:

Sorry - this documentary. A young woman with severe MH issues preparing for MAID in the Netherlands.

The Netherlands have had PAD (physician aided death) for those with psychiatric suffering since the 1990s. There must be information and data. Is it similar to Canada?

This is incorrect. The first euthanasia law in the Netherlands was passed in 2001. Because of the way the law was worded, it could include psychiatric patients. Criteria are far more stringent than the ones proposed in Canada.

@pointythings not wanting to come across as pendantic but have you read the scientific paper I linked to?

Does there seems to be conflicting information on internet?

who is wrong or right? We both are.

I said that PAD had been available not that an act had been passed or any procedure had been carried out.

Wikipedia cites that in the Netherlands there was a act passed in 2001 concerning euthanasia whereas the scientific paper I linked to, in its introduction, states that the Supreme Court in the Netherlands rules that PAD could be undertaken for psychiatric suffering then goes on to state that there had been 320 requests in 1995 for PAD for psychiatric suffering and 1100 requests in 2010. None had been carried out till 2001.

so, my point is whether you want take the Netherlands starting point as the 1990s or the early 2000s PAD for psychiatric suffering, it’s been available for 20 to 25 years.

How is this working out in the Netherlands?

Perhaps a slow cautious approach would be prudent. In the Netherlands in the 1990s it was discussed and proclaimed it would be available, but was not enacted upon till 2001, even though 320 people had made requests in 1995.

I understand and am empathetic that this timescale for many people would not be best.

Me too.

We've already seen Canada (link given earlier) suggest to a disabled person they might take that "option".

Like at least one other poster, the more I hear of what's going on in Canada, the more uncomfortable they make me feel.

The Dutch have a thing called 'gedoogbeleid' which is basically monitoring something that is technically illegal during the period while the legislation catches up with events, which is what I suspect you are describing. It means that what was happening in the mid 90s was technically illegal but there were few prosecutions because the law was being developed which would make those instances of euthanasia legal. Personally I think it's a far more sensible approach than the British one, which seems to be to yell 'no, no, slippery slope' and bury one's head in the sand.

I would say the Dutch law works pretty well. There are instances where it goes wrong, for instance with the case around the lady with dementia who clearly withdrew her consent but was not heard - cases like that will hopefully lead to refinements in euthanasia law. Dementia is probably the most difficult area and personally I would want to see a withdrawal of consent after an advance direction taken at face value, with no further efforts at ending that person's life thereafter, even if the person asks, as no capacity for consent is present any more. It would be erring on the side of caution. My father was offered an advance directive when he was first diagnoses with Parkinson's dementia - he refused. Later on, when he was getting worse, he wanted to change his mind in his lucid periods but was deemed not to have consent any more. That to my mind was a tragic but fully correct application of the law,

In terms of euthanasia for mental health, I am in favour. Those people who have had euthanasia in Belium and the Netherlands have all suffered for many years before choosing to end their lives, and have had to jump through all the legal hoops. I feel it is incredibly patronising to think that someone with a mental illness is therefore not capable of making an informed choice about ending their life.

The Canada law seems to be drafted far more loosely than the Dutch one, which is why I feel it needs a lot more work before implementation.

I feel it is incredibly patronising to think that someone with a mental illness is therefore not capable of making an informed choice about ending their life.

I don't think people are saying that capacity is the problem; more that the mental health system offers a very limited range of help and that in some cases what's needed is not more of the same - more drugs, or more therapy - but something different.

@TheInebriati I do agree with that, but in the cases highlighted in Belgium and the Netherlands, the people involved had been engaging with mental health services for years. In the case of the alcohol addicted man who requested and received euthanasia, it had been 30 years. There comes a point where the carrot of hope of recovery becomes a stick we beat people with. How long do you think someone living miserably with mental ill health should carry on?

Yes. Hospital is by far the most expensive option (£3-600 a day), so it's not a question of having funds. Sometimes people are so profoundly traumatised they can't engage in psychological treatment and so the crux of their treatment is to offer medicine to reduce their distress with them on essentially suicide watch for years.

I wouldn't be happy to see legislation to allow this group of people to die, but I don't think that for many we are offering much in the way of hope or quality if life. It can feel like we are prolonging life because withdrawing the nursing care/supervision feels uncomfortable to us as clinicians as opposed to what is genuinely in the person's best interests.

It's really hard.

@RumandSpinach it's an enormously complex area. I had a cousin who had psychosis - this was before the advent of modern antipsychotics. Despite trying everything that was available at the time, nothing worked and he took his own life in a particularly violent way, causing enormous distress not only to his wife and young children but also to the wider family and to members of the public who witnessed it. We mustn't forget that suicide is incredibly distressing to both the person themselves and the people around them, and that sometimes there is no 'good' outcome - only a less awful one.

I found this article pretty fair and balanced - and it talks about the impact having to make these decisions has on doctors or the members of the approval boards, which I think is an often overlooked element. www.theguardian.com/news/2019/jan/18/death-on-demand-has-euthanasia-gone-too-far-netherlands-assisted-dying

As fas as I know it is possible for doctors to opt out, which it should be, I also agree it is important to assess competence,

The case of Marc in the article does not move me at all. My mother suffered mental trauma as a result of her experiences in a camp and never recovered - it is not for Marc to decide his mother should have carried on living and suffering to appease his feelings. My mother had a mostly good life, but after my dad died her mental health fell off a cliff. She did not choose euthanasia, she drank herself to death instead, at a cost to my sister and me. She would not and could not help herself or be helped. We did not suggest anything to her, we supported her as best we could and made no demands, Marc should have done the same,