Canada’s euthanasia for the mentally ill

[Noicant]

https://globalnews.ca/news/9454089/medically-assisted-dying-bill-mental-disorder/

Canada is in the process of introducing the option of Euthanasia for the mentally ill. It looks like this has been delayed for the time being but AIBU to find this concerning?

Just to be clear I fully support euthanasia as an option for people with terminal or chronic conditions. I think it’s human to offer people a peaceful death when there is no chance of things improving.

BUT this seems utterly mad to me. I’ve suffered from poor mental health in the past and only started feeling better after going through a few therapists and finding the right one. There were many times over 20years where I would have happily signed up for death. If someone is so ill that they are very impaired by their condition are they truly competent to make a decision like this and if it’s milder isn’t there a possibility of recovery?

It seems utterly dystopian. I guess I’m looking for someone to help me understand if I’ve missed something or not understood something that will help me understand why anyone would think this is a good idea.

It is slowly catching on in terms of acceptability and dull and dependable can often dupe more volatile countries.

For the supporters of this dystopian hell I'd ask - how will the killing be done?

At the start of Aktion T4 the Nazis instructed nurses to kill disabled babies by leaving them outdoors to freeze to death.
They then used injections to kill disabled children and adults as they systematically emptied asylums and hospitals. (This was performed by doctors).
Then they expanded to old peoples homes and prisons to include the elderly and criminally insane.

Individual injections took too long and they needed a more effective method of extermination and disposal so they constructed large crematoria and created mobile gas chambers.
And so it began.
This is where the Nazis learnt how to industrialise killing of people the state deemed "unworthy of life". They started with the disabled and the sick. And it was all performed by doctors to provide a veneer of scientific legitimacy.

Unworthy of life - several people on this thread have come very close to using that exact phrase.

I can only speak for Switzerland as I am very familiar with the Swiss process (due to personal experiences).
It is quite tightly regulated. What is legal and practiced by some of the prominent organisations is "active aid to suicide". The means (medication etc.) are provided but the person wanting to die has to do it to his/herself.

It also has to be done whilst still being mentally able and there is quite a lot of hoopla to jump through. There have been court cases and sentences for doctors when the mental state of the deceased was considerd inadequate...
Situations like in the link above in regards to the case of the Netherlands would be considered (extremely) illegal. Any kind of direct and actived in ending somebody's life isn't legal according to Swiss law.

=> Enthusiastic is a therefore a really incorrect description imo.

I would say that there is a massive difference between assisted suicide (direct but passive aid) and medical staff actively ending a life (direct and active aid - aka killing).

Providing the means to end one's own life under specific circumstances (I personally feel that certain MH conditions should preclude somebody from receiving assisted suicide services and definitely should not be a reason to provide said assistance) is imo simply part of living in a society that respects people's liberties and their right to make informed medical decisions.

People already have the freedom to make that decision for themselves. I’m not going to list ways of killing oneself but we all know that there are plenty of substances freely available without prescription that will do the job. It’s a personal decision, sad and regrettable. But suicide is not illegal and also not always irrational in my opinion, depending on the circumstances.

However, there is no reason or need to involve anyone else in that decision, actively or passively. The “helper” is then made responsible for judging who qualifies, ie which lives are valuable and worth living, and which are futile and pointless. This is dangerous and unethical, and it completely undermines the ideal of personal autonomy. The only person to weigh the value of a life should be the owner of that life.

True, but splitting the definition into ten variants is not going to detract from just how intrinsically horrifying it is on a fundamental level. It paints a dystopian picture of a future where many obedient workers will do as they are told to systemically implement legalized murder of the disabled as part of their humdrum day job with the approval of the state.

It is more credible in Switzerland with high GDP per capita and a robust healthcare system then it would be in Britain where the collapsed NHS system has failed the individuals. It is making the weakest pay with their lives for the failings of the powers that be.

I fail to see how you would consider this 10 different variants.

Assisted suicide (suicide. Not actively killing anyone else) should be legal but tightly regulated (imo).

Palliative care and pain management, which may decrease life expectancy, should definitely be legal as well. Anything else would be dystopian to me!

I'm thinking of 5 people all of whom were inpatients on 1:1 for several years when I knew them. One did make a phenomenal recovery which no-one would have predicted. Largely I heard, because she had a baby. That was wonderful to hear.

One last I heard was in an expensive out of area secure placement so 20 + years roughly of inpatient treatment. One died of cancer because they refused treatment for it. The other 2 eventually managed to take their own lives while still inpatients but trying to step down from 1:1. And I felt relief for them to be honest.

Of course loads more people I knew during inpatient admissions that made fantastic recoveries too! But a small number of people don't despite every treatment being tried and they get stuck living miserable lives in specialist units trying to end their lives.

I agree, suicide is (nearly) always possible for those determined. You also correctly point out that assistance therefore is not a requirement.

So why not provide options for assisted suicide?
These other methods you alluded to tend to put other people at risk, often traumatise bystanders, families and / or are incredibly painful.

Why do you prefer that to assisted suicide?

Agreed. Out of the 5 long-term (years) 1:1 chronically suicidal inpatients I'm thinking of, 4 of them had experienced unimaginable trauma, no treatment had helped and they didn't want to live with that trauma any more.

This. There are even substances that will provide a painless and peaceful end. Fighting to walk on past where I know I can get some, is a weekly battle as I go by on my way to my Dr appts. I do not need yet another voice whispering encouragement in my ear or enabling me.

How about when the individual is an inpatient and actively prevented from taking their life for years on end?

They're the people I'm thinking about that this may be relevant for.

The care we offer in this country isn't good enough. We have people waiting years for diagnosis, no mental health support until total crisis, no home care even when trying to manage terminal cancer. This will be supported by governments because it is cheaper and easier. I might feel differently if our care offer was consistently good but it's consistently poor so I can't support assisted suicide.

We already saw disabled people given do not resusitate orders in covid without their or their families knowledge - including a man who was merely deaf and just needed a translator and a 19 yr old with downs syndrome. I do not trust our society's view of disability to be able to support assisted suicide.

If they are inpatient, then how can they have the mental capacity to truly consent? If they had mental capacity, they would not be detained under the mental health act, right? Even the NHS webpage says:

”Consent to treatment
If you're held under the Mental Health Act, you can be treated against your will.
This is because it's felt you do not have sufficient capacity to make an informed decision about your treatment at the time.
This is also the case if you refuse treatment but the team treating you believe you should have it.”
https://www.nhs.uk/mental-health/social-care-and-your-rights/mental-health-and-the-law/mental-health-act/

So you’d be euthanising certain people without their true consent and in some cases without them even being aware what was happening.

What about the fact that as a patient you cannot leave? Apparently we could be chosen to die, but there is no right to leave the secure ward/unit?

Just to be clear I fully support euthanasia as an option for people with terminal or chronic conditions. I think it’s human to offer people a peaceful death when there is no chance of things improving.

But why do you see a difference with chonic MH conditions then OP?
I'm not sure about euthanasia personally. Yes good in some cases, but I worry about people feeling under pressure and a burden.

I do not trust our society's view of disability to be able to support assisted suicide.

Same. I don’t trust myself when I’m unwell and I would not be able to trust any doctors if they could legally choose the convenience of euthanising me. There would be nowhere safe to go when I’m suffering. No where. Unless charities set up “no kill” secure mental units. Sort of like the “no kill” animal rescues we have.

While I can see how this plan has come about, it is in no way a reasonable alternative to proper lasting mental health support and care.
My husband suffers with his mental health and has made several suicide attempts (classic 'cries for help' rather than really trying to end his life) when he's feeling absolutely desperate. When he's ok he can see that he doesn't want to die, just wants not to feel that way anymore, and would do whatever necessary to make it stop. I think at his lowest points he would opt for this if offered.
But...what about us, his family? And the family of those Canadians who take this option? Is their welfare and the subsequent impact on their mental health taken into account? Asking a person with severely impaired mental health to make a rational decision on something as huge as this is a big mistake. Yet how can anyone else make the choice for them?

We are rapidly arriving at a point where the balance will tip in favour of people keeping away from doctors and deliberately not seeking out help for mental health and related conditions along with avoidable casualties. It is also a chilling thought that the eugenicists mostly escaped the Nuremberg Trials and many countries in Europe retailed their concentration camps (often, the same countries which sell tours of their long depopulated Jewish ghettos). It is true that they are now open as museums but for many decades, they simply lay empty without explanation and it was very unclear why they were not destroyed.

I’d prefer no one ever felt so much suffering as to take their own life.

I’m not talking about methods that would put others at risk.

I don’t see that “assisted suicide” is obviously or necessarily less traumatic for family members than solo suicide. I can imagine the grief of parents being made to witness or be complicit with the suicide of their child. I can imagine parents seeing their child be “assisted” by the medical profession to kill themselves, and being powerless to intervene or protect that child.

Not to mention the vulnerability of people with MH or neurological issues to coercion by more sinister family members.

Ingestion (or injection) of lethal substances has the potential to be painful and distressing for the person whether they are assisted or unassisted in the process.

If they’re an inpatient then they wouldn’t have capacity to consent at that time, so they wouldn’t qualify for voluntary euthanasia unless you want to throw out the idea of consenting to be murdered and just go straight to murdering people instead.

Have you not heard about how so few people have medical power of attorney arrangements in place? Even those who do often have to fight to uphold the rights of the inpatient. In most cases though, medics have carte blanche.

And I wish we all lived long and happy lives and died peacefully in our sleep. I wish that nobody had to see a loved one die and that nobody had to experience a potentially painful or distressing death.

But that is clearly not realistic and cannot be used as a basis to determine law and health policies.

I don’t see that “assisted suicide” is obviously or necessarily less traumatic for family members than solo suicide. I can imagine the grief of parents being made to witness or be complicit with the suicide of their child. I can imagine parents seeing their child be “assisted” by the medical profession to kill themselves, and being powerless to intervene or protect that child.

I'm glad that you're such an empathetic person and willing to draw on our imagination.

I wish you also used some of that empathy and imagination for some of us who have personal experiences with this process and are extremely thankful their loved ones have/had that opportunity.Not to mention the vulnerability of people with MH or neurological issues to coercion by more sinister family members.

Good point. Which is why the Swiss organisations and Swiss criminal law do not let anybody - particularly family members - with a vested interest be involved in this. I would encourage you to look into how this is practiced in various countries.

This, perfectly said.

At the root of the matter it is trying to work out if it is what is best for the patient. If the patient believes it is what is best for them and the doctor also believes it is best then that would appear to be a good indication. Timelines should be indicative depending on the circumstances and earlier directives could be used to illustrate a level of consistency. Someone who is suicidal due to mental health may require a longer timeline and a more robust degree of evidence that this is best for them and what they want in order to take into account the highs and the lows as well as having tried other routes. However yes in an underfunded system with limited resources - there is dangers so the patient needs to remain at the very heart of it