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.

I do have personal experience. I was that suicidal child. I’m very glad that I didn’t live in a country where I would have been assisted to carry that out. I live a full and happy life now, and I am very grateful for my life.

Laws should be made on the basis of public protection. The law against taking someone else’s life away is there to protect all of us.

Capacity isn't a global issue and doesn't apply to every circumstance. Different medications, therapies, ECT, psychosurgery etc all have different rules.

It is not assumed that being under section means you don't have the capacity to make any decisions or that you have no rights. The mental health act and mental capacity act are complex legislation.

Sec 2 for example is a section for assessment so you can't administer medication without consent unless in an 'emergency'. A Sec 3 is for treatment but even then, if the patient is still not consenting to medication after 3 months, the psychiatrist has to state their intention to continue to enforce medication without consent and a second opinion is required from another psychiatrist who reviews the notes and meets with the patient and agrees or not.

You can't be forced to have medical (physical) health treatment under any section for example unless under specific legislation of the MHA where it is proven that the refusal for the medical treatment is directly related to the mental disorder that you are being treated for. NG feeding for anorexia nervosa patients starving themselves to death is the most common example where medical treatment is enforced without consent under that legislation.

So in the case of the person I mentioned earlier, they were being treated for a personality disorder. They were able to refuse treatment for cancer because their capacity to make that decision was assessed, they demonstrated full understanding of the proposed treatment and the potential consequences of not having it and their refusal to accept cancer treatment was not consdered to be related to the mental disorder they were being treated for.

A person can be required to remain on the unit under section but the fact is that if they did leave and returned home and refused to return to the hospital, they could be discharged. Because using the Police to force entry into someone's home to return them to hospital requires a warrant issued by a magistrates court where it has to be proven that not doing so would result in serious harm as the person would be unable to look after themselves. I can't count the number of times when I was working in inpatient, that someone under section went AWOL and we discharged them after 48 hrs and used their bed.

I am not proposing 'euthanising' anyone nor suggesting anyone be 'chosen to die'.

I'm talking about the individuals who would be able to say "I relive my CSA in flashbacks every single day, I've been in hospital for X years, I've tried X number of treatments, nothing has helped. I feel tortured and I want to die".

Because currently we say 'tough shit' to those people and force them to live miserable lives on specialist units, watch them bath and use the toilet, give them a TV in a perspex box to watch and give them plastic plates and plastic cutlery to eat with. Remove anything that they could use to harm themselves and then when they're banging their head on the wall trying to stop the horrible images in their head (we can't remove walls!) we have a bunch of staff pin them down on the floor which really reminds them of their CSA btw and wait till they've tired themselves out or pull their pants down a bit which again reminds them of CSA, to give an injection into their buttock and hopefully make them too sedated to try to harm themselves.

Then do it again the next day or a few days later. For years. That's why I felt abusive.

I am also very glad that you survived this time of your life. Which does not erase my experience and perspective.

I do not know of any political party, mainstream medical association or government that is suggesting assisted suicide for suicidal minors. Could you please point me in the right direction?

The law against taking someone else’s life away is there to protect all of us.

There is a difference between assisted suicide and taking somebody's life. This discussion requires nuance instead of black and white thinking.

There are patients who sound credible and even mislead doctor's into misdiagnosing their true capacity. That is the thing about interpreting a lot of mental health conditions. There is often nothing visibly diagnosable so it is reliant upon external observations and anecdotal evidence.
Perhaps the solution is to place those who have proven suicidal intent in non safety-proofed environments where the regular risk items are left in situ. I very much doubt that they will all end up taking their own lives. The threats are sometimes serious, at other times merely cries for help and it may swing frequently from one to another.

https://globalnews.ca/news/9491605/maid-minors-canada-medically-assisted-dying-committee-report/amp/

All assisted death legislation relies on you being of a sound mind when making the decision and not being pressurised to do it.
How does this fit with that. People can not make a rational and reasoned decision when suffering from a mental health issue so this legislation gives not protection. All this type of legislation is sold to us that it is compassionate and will never be used to dispose of people to save money or make judgement on someone's quality of life. But once you normalise it along comes this, and then the tests get weaker and weaker until we have an upright doctor, maybe called Shipman, making decisions for us.
This isn't progressive, it's just plain scarey.

Agree. There are various compromises being made to our human rights which get second billing by the tabloids or even lower in favour of trashy gossip stories. Once these changes go through unchallenged, it will be hard to ever reverse them. Within ten years, we have gone from disabled people's rights being recognized in the workplace and social settings to them being unfairly deprived of the basic tools which they require to function properly like benefits they are rightfully entitled to claim and now this.

Interesting. It is not what I asked but I do agree that this would be very concerning.

I still believe that assisted suicide (not allowing somebody to actively kill a patient!) is important and should be legislated for.

As you said, people will nearly always have the option to commit suicide (with enough determination). The one thing we can determine is the "how" and under which circumstances.

A certain country that had disabled, mentally ill and ND people and wiped them out between1939 -1941 in the guise of racial purity
Slippery slope, three of my adult dc would have been victims had they been around at the time. Doesn't bear thinking about.

Not the same thing at all though is it?

This is a thread talking about voluntary euthanasia or medically assisted dying for people who do not want to live anymore due to serious and treatment-resistant health conditions.

Having a mental health condition does not mean the person is incapable of making any rational or reasoned decisions.

There are a lot of posters here who seem to think it does. Which is worrying. But that view is also not supported by the mental capacity act. Which is law.

https://www.nhs.uk/conditions/social-care-and-support-guide/making-decisions-for-someone-else/mental-capacity-act/

@TrufflySnufgl6

There are doctors associations in Canada making representations to Parliament to legalise euthanising disabled children.

“Dr. Louis Roy, of Quebec's College of Physicians, said his group believes assisted death could be offered to babies up to one year old "with severe deformities and very serious syndromes for which the chances of survival are virtually nil, and which will cause so much pain that a decision must be made to not allow the child to suffer."

https://www.cbc.ca/news/politics/assisted-dying-carla-qualtrough-1.6625412

Not what I'm talking about. Or the subject of the thread.

Well, we’re talking about the extension of euthanasia in Canada to the mentally ill. And PP commented that this is a slippery slope to euthanising children who can’t possibly consent.

I think it’s pretty relevant to point out that this is a valid concern, given that doctors in Canada are already arguing for that very thing.

Just to make we didn't actually argue the same position:

Are you against assisted suicide in general?

Are you against assisted suicide for people with all MH conditions and illnesses?

Are you against assisted suicide services being provided on the basis of somebody being diagnosed with a MI?

Or are you simply worried about this being a slippery slope in regards to children?

I disagree. The thread is about the MAID programme in Canada which is for people seeking medically assisted dying due to a severe, treatment-resistant health condition, being extended to potentially include mental health conditions.

That proposal is not a slippery slope to forced euthanasia in any way, the article says that. But the thread was derailed by the suggestion and unhelpful and offensive comparisons to Nazi Germany.

"Canadians who weren't already nearing death became eligible for MAID in 2021, when the government changed the law in response to a lower court ruling. That change allows people with "grievous and irremediable" medical conditions who are experiencing "intolerable suffering" to seek a doctor's help to die — even if their natural deaths are decades away"

Above is what is being discussed. Whether or not someone experiencing "intolerable suffering" from a "grevious and irremdiable mental health condition and not just a physical one, should have the right to seek assisted dying.

Not babies. Not the medical/psychiatric profession choosing to kill people. Not people with a mental illness in the throes of an episode with no MH history or a proven history of recovering or partially recovering between episodes having a Dr back up their current possibly illness-driven desire to die when they don't really mean it.

It's about people who are experiencing intolerable suffering from a health condition who can evidence that they have attempted numerous treatments over a significant amount of time which have not helped them and who want to die and not do so in a way that will cause trauma to others.

As suicide always does traumatise whoever finds the body, is the train driver that hits them and so on.

Do you mean that someone who is on a section could be deemed to have capacity to make a decision to agree to euthanasia? IANAL but I find it hard to believe a court would go along with that, even if it is theoretically allowed. And tbh I would be very concerned that there could be coercion or influence involved.

Well the secure units I was in, you couldn’t just go AWOL. We were locked in the ward, and outside the ward (general areas, classrooms, shower rooms, toilets and our sleeping rooms there was a hallway with more locks on the other end to go into an entry/foyer area for visitors that itself had locking exterior doors. We had a small 3mx3m courtyard for “going outside” but it was enclosed with 5m high brick walls topped with an inward curving wire barrier like you see on bridges over the motorway. Inside there were lines taped on the floor that you had to be behind when they wheeled the food trolleys in. So no chance of a dash to the hallway, which was locked down at the other end anyway.

Are you sure you are talking about those who are detained like I was rather than those who have come in voluntarily? Again, this is what the NHS webpage says and it matches my experience. The asking “consent” was more asking if I was going to be quiet or make a fuss, it wasn’t actually giving me a choice, either way the treatment/medication/ assessment was happening. There has to be a limit to the power of doctors over patients and I think power of euthanasia is too much.

”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/

In certain circumstances yes. If appropriately assessed and weighed up with evidence.

Someone on a section already has the right to make decisions under the mental capacity act and mental health act to refuse medical (physical) treatment if you look at my previous posts.

So if someone on a section has the right and capacity to refuse treatment for cancer for example, why should they not have the capacity and right to choose to die by a less drawn-out and physically painful process?

There are an astonishing amount of people on this thread who don't understand the concept of mental capacity in law, either entirely or as it applies to people on a section of the MHA.

I've provided lots of information, examples and info on the mental capacity act. I don't know how else to explain it to someone with the unreasonable idea that someone with a mental illness is immediately judged to not have the capacity to make decisions about their own lives, including the decision to not want to be forced to live in intolerable suffering by society or the psychiatric system as it currently works.

There are some people living in unending torment due to their mental illness who are currently forced to live because there is no option for them to commit suicide or be medically assisted to die.

The constant assertion of people on this thread that they can't possibly make that decision because they have a mental illness is disablist.

No one has said that having a MH condition means a person cannot make any rational decisions. I have questioned you saying that you think euthanasia would be especially applicable to:

TrufflySnufgl6 · Today 08:54
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.

Inpatient and actively suicidal. As in likely to be detained under the Mental Health Act, in which they are in fact deemed to not even be able to consent to treatment and can be treated against their will.

Yet you are saying they could consent to euthanasia. A treatment with irreversible consequences, a treatment that is no treatment but rather disposing of the person in their entirety.

The constant assertion of people on this thread that they can't possibly make that decision because they have a mental illness is disablist.

No, we have expressed doubt that anyone whose mental illness is currently so bad that they are detained in a secure mental health unit under the MHA would have the true capacity to consent to euthanasia- the exact people you have said you think euthanasia would be the perfect solution for.

For many of us that doubt in your assertions is based on our lived experience of being in that state due to our mental illnesses. It’s not ableist for a wheelchair user to tell a HCP like you that no they can’t walk 100m, so why are you accusing us of ableism when we are telling you that when we are so unwell that we are sectioned, we cannot truly consent to be euthanised. That we know after coming out the other end of that particular kind of living hell that our brains were not working sufficiently well enough to be able to knowingly and fully consent to euthanasia. We know our illnesses better than you ever could. You may observe us and pity us when we are inpatient, but you don’t know what it is like to be us.

Literally every unit I worked in, could be 'escaped from'. They're not hermetically sealed, they're buildings with an enclosed garden with walls/fences that can be climbed or there's sec 17 leave where someone gets taken to the shops, or their Mums house or anywhere else or just for a walk around the grounds and they leg it.

People have 'escaped' from Broadmoor, Rampton and Ashworth the most high-security psychiatric hospitals in the country. People escape from prison FGS which have similar or higher levels of security.

I'm talking about working on units in the late 90s to a decade later. When I started we had patients that were there voluntarily. By the time I left there were zero patients that were there voluntarily. It just doesn't happen anymore in my MH trust area. If you'd be agreeing to be in hospital, you'd be agreeing that you're mentally ill and need treatment, and therefore you can be treated at home. You can't be sectioned if you know you're unwell and will accept treatment in the community.

You copying and pasting stuff about being sectioned is completely irrelevant. I've explained over and over again about the mental capacity and mental health act. You choosing not to read is not my problem.

This thread is NOT ABOUT YOU. You get unwell, you go into hospital and you go home. No-one is suggesting you be euthanized or that if you were suicidal during an admission, the staff would be lining up to support you wanting to die.

That's not what is being discussed here. No-ones trying to kill you. You don’t want to die and no-one is suggesting that you be killed.

@SwitchDriver has been sharing some very personal things on this thread, and it has certainly given me a lot of insight into what being a mental health inpatient involves, and I expect many others reading. And tbf you can't really criticise others for talking about their personal experiences when a lot of what you have posted suggests that it is you own experiences that have led you to think euthanasia of psychiatric inpatients should be allowed.

To give two examples that have stood out for me: you spent some, limited, time working on a secure unit-and I notice in your last post that this was about two decades ago, so far from recent, and you found this unpleasant and that you felt involved in abuse of patients because you were preventing them from harming themselves. You also commented that suicide is traumatic for the person who finds the body. With respect, neither of those are reasons to take someone's life. They are both basing the decision on the feelings of someone other than the person potentially being euthanised.

And I don't think it is fair to say that people don't understand the difference between the idea of capacity in the MHA and more generally. I am sure that there are legal differences and that you are correct in that, but you seem to look at the issue in a very black and white way. Something may be legally possible and yet ethically wrong.

Personally, I believe that all human lives are valuable and worthwhile, that every person has a right to life, and that no one else should be legally permitted to interfere with that.

I understand completely the compassionate motivations of those who argue for assisted suicide in the cases of terminally ill patients who genuinely request and consent. However, I think that improved palliative care and education would reduce this perceived need. I have also noted that suicide is legal and not always irrational. This is informed by personal experience of caring for a family member with a terminal illness. When you encourage, enable or assist a person to end their life, you take that power, that right to life, out of their hands, and in my view you are morally culpable, whether or not you actually administer the drug.

When you give up that legal protection, that moral principle, you open the door to cases where proper consent is impossible to obtain - dementia patients, depressed people, children. This is the pathway being demonstrated right now in Canada.

You give doctors the power and responsibility of judging which patients have lives that are not worth living. You leave doctors open to the charge of carrying out euthanasia when their intention is to relieve pain. You undermine trust in the medical profession who have sworn to “first do no harm” and make people afraid to seek medical treatment.

You encourage society to view certain lives as disposable. There is so much ableism already, and an overly negative portrayal of life with physical disability and MH conditions, and the possibility of recovery, or of living a meaningful, joyful and purposeful life, despite, or even because of enduring conditions. Again, I think the moral response is improved care, support and education.

Do you seriously think the patients you described would be allowed on leave to go to the shops? You know they would not.

“You copying and pasting stuff about being sectioned is completely irrelevant. I've explained over and over again about the mental capacity and mental health act. You choosing not to read is not my problem.”

We have both pasted from the NHS webpages. The NHS webpage says that I can be treated against my will because I am not deemed to have the mental capacity to consent to treatment.
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/

You also posted an NHS webpage regarding “making decisions for others” and it witters on about when making decisions for patients to take in to consideration their preferences in terms of what to wear and always deciding what you think is “in their best interests.” The first paragraph doesn’t even say what you think it does:
”The Mental Capacity Act (MCA) is designed to protect and empower people who may lack the mental capacity to make their own decisions about their care and treatment. It applies to people aged 16 and over. It covers decisions about day-to-day things like what to wear or what to buy for the weekly shop, or serious life-changing decisions like whether to move into a care home or have major surgery.” https://www.nhs.uk/conditions/social-care-and-support-guide/making-decisions-for-someone-else/mental-capacity-act/

It doesn’t say that I had the right to refuse treatment. It doesn’t say I can simply leave and go home like you are saying it does. Nor did I actually have these rights you are claiming I had when I was sectioned.

“This thread is NOT ABOUT YOU. You get unwell, you go into hospital and you go home. No-one is suggesting you be euthanized or that if you were suicidal during an admission, the staff would be lining up to support you wanting to die. That's not what is being discussed here. No-ones trying to kill you. You don’t want to die and no-one is suggesting that you be killed.”

How rude. I know this thread isn’t about me. But unlike you, safe in your position as potential euthaniser, I’m in the position of potential euthanisee.

I have been that inpatient person in a pit of despair and suffering, under an uncontrollable compulsion to kill myself caused by my illness. So yes, I think I can empathise better with the people you have said on this thread that you think are perfect candidates for euthanising.