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.

Funny how most of us feel that we shouldn't dictate if women keep a pregnancy or not but we feel that we do get to decide that strangers aren't allowed a peaceful death, they should just jump from a building or something.

I do think that people need to be offered help, but who am I to decide about life or death?

Something that stands out on this thread is that the people most against this idea are the people who have lived experience of mental illness and being a patient in a MH unit.

And the posters most in favour are people who:
a. Have worked in MH units, and
b. Have been very dismissive of the posters who have experienced mental illness.

Which leads me to believe it is the first group who should be listened to. I'm not sure what to say about the second group. At least two (unless it's one and they name-changed) seem to have little regard for the feelings and opinions of the people they are supposed to be caring for. Which is really quite disturbing.

I can't keep repeating myself about the mental capacity act and mental health act but will reiterate again, that being sectioned doesn't mean that not consenting to MH treatment at that time doesn't mean the person is unable to consent to any other treatment.

I'm talking about someone that has been in hospital for years. On a 1:1 because even 5 minutes observations result in them trying to end their life.

For years.

Because they are so tormented by their CSA or other trauma or the auditory hallucinations they hear every day.

And every medication has been tried. And every therapy has been tried.

And it hasn't helped.

I'm not talking about people who are acutely psychotic and not in touch with reality.

Or someone who is suicidal as they're currently extremely unwell and distressed and not able to see a way out but there are ways out that they've used before so can do the same now.

I'm talking about people who are 'intolerably suffering' who have been inpatients on a 1:1 or more for years for whom no treatment has helped them and they're living a really shitty life on a specialist unit and their care team would be able to provide evidence to support that.

It's not about Dr's or staff wanting to kill people or whatever else, it's about them providing objective evidence that yes, this person has been in hospital for X years, X treatments didn't help and every time we've tried to reduce from 1:1, they harm themselves so we go back to 1:1.

And it's where mental illness and having suffered unimaginable trauma for example often come into this discussion as they can be conflated and one can result from the other and contribute to any MH illness.

The assumption of many, is that severe trauma can be 'treated'. The right meds or the right therapy or even the right therapist can help.

For some people, it doesn't. For some people they relive their horrendous trauma every day with no relief. And they've tried all that can be offered by mental health services. Which hasn't helped and they're tormented.

Having been diagnosed with a mental health problem doesn't mean those people can't make a decision about how tortuous their lives are and want to end it. Currently, for those inpatients, they're prevented from doing so and living miserable, tortuous lives.

They're the people I'm talking about and think the MAID system could benefit.

Thank you to all those listening.

“I'm talking about people who are 'intolerably suffering' who have been inpatients on a 1:1 or more for years “

Yes and I asked you, what time limit would you put on things then? 2yrs? 5yrs? and if not recovered, euthanise away? You say they’d be perfect candidates, but haven’t said how you’d implement this. Implementing would involve a time limit of some sort. A get better or die deadline, unless doctors can make assessments and decide it’s hopeless after a few months for some patients but go longer for others (like that would be unbiased!)

Do you think doctors should have this power over patients? Or are you still asserting that such patients can all fully, knowingly and truly consent to euthanasia? Patients that can’t even stop harming themselves if left unsupervised.

”no treatment has helped them and they're living a really shitty life..”
Ah, a life so shitty it is not worth living?

“every time we've tried to reduce from 1:1, they harm themselves so we go back to 1:1.”
Have you thought that perhaps being alone and in pain is worse than having 1:1 care and being in pain?

@SwitchDiver well what time limit would you put on things? How much suffering before a person can decide they have had enough?

Nope. At no point have I ever said that 'euthanasia of psychiatric inpatients be allowed '.

I'm not suggesting psychiatric inpatients be eathanised', I'm suggesting there are certain circumstances where a person experiencing intolerabe suffering for years on end, should be given the right to end that suffering and not as currently happens, be forced to live shitty lives.

This would never apply to SwitchDriver given everything she's said on this thread
Since she doesn't want to die, and even if she wanted to when in hospital, there'd be a wealth of evidence to say she did not have a treatment-resistant mental illness since she gets treated and goes home repeatedly and during those times, is very clear that she does not want to die and says suicidality is just a symptom of her mental health crises.

And don't try to make assumptions about my experiences of working in the the mental health system. It was a decade ago, not 20 years that I stopped working inpatients ( you didn't read my posts ) but funnily enough, still work in the same NHS trust, still have friends and colleagues who do still work on wards who tell me how things are now since we're friends and talk about our lives/work.

I didn't work in inpatient for ' a short time'. , that's a major assumption on your part It was 4 years. Long enough to get a good idea of what was happening.

You suggest I found it 'unpleasant' as if I made a judgement and it was not nice or not what I expected. Not really. I was diagnosed with PTSD after the trauma I experienced on the wards.

Just a short list in 4 years would be someone setting fire to themselves, trying to cut someone down that had hanged themselves, slipping over a massive pool of blood as I entered someone's room after a night shift, trying to restrain someone as they were on a chair smashing their hands into the tube lights, showering everyone including me with blood.

Oh and being physically and sexually assaulted.

And 99% of the time when I was restraining someone and forcibly medicating them I did it because I really believed that it was in the person's best interests because they would get better.

But sometimes, I didn't believe that at all so questioned myself. Which is in regards to the small of group of inpatients that I've already referenced.

I didn't previously mention any of the traumatic things I endured because they are entirely irrelevant to the thread.

It's not about , .me or anyone else deciding if someone should die, but caring enough about the individual to think they should have that right.

But since you decided to claim things that aren't true about me, I've responded.

I will also add that in the 4 years I worked on wards/PICUS there were more days than not, where I wasn't exposed to trauma and many lovely days with patients who were getting better and we even had fun.

I don't have to come up with an answer. I'm not designing legislation..

YOU have to think about why your fear of being killed by the state, which is absolutely not what is being proposed here makes YOU think that other people with more severe mental health problems than yours, should not ever be able to choose to end their lives and suffer intolerably.

This literally is not about you.

You're still making it about yourself though. Your trauma. Some of the patients made you feel traumatized. But some of the other patients didn't make you feel traumatized, so you don't think they would be suitable to be offered euthanasia to. I'm sure it was a very difficult environment. But you are not able to be objective.

Oh, and I would say 10 years is a long time ago tbh. I work in a mental health/ homelessness/ addictions based charity and things have change massively in a decade.

I practiced in that field, briefly. I could not wait to leave. I have my hesitations. As I said before, the compromise solution would be to create some secure units which are not safety-proofed beyond what you would expect in a regular care home and allow those who have demonstrated a true desperation to end their lives the opportunity to live in a less controlled environment where their medications are still being administered, they are not a danger to others but little else beyond that. I maintain that it will result in a % of deaths well below one hundred unlike if the same cohort was euthanized.

Maybe that's because a lot of people see a fetus as not yet a 'person' in their own right? It's a different situation to dealing with a fully grown adult who very much does have a life, but one they don't enjoy and desperately want to get out of.

Oh, also the trust that I am involved with through work are currently trying very hard to bring as many of the people detained in out of area placements back to local units with a long term goal of them being safe enough to live in the community.

Because, these days it is accepted that this kind of unit very rarely produces good outcomes. The very restrictive environment ends up, as in the case of some of your patients, actually embedding very harmful coping strategies- for example, extreme self harm leading to restraint.

Admittedly, it can be quite difficult to work with people who are so institutionalized but so far there has been quite a few successes.
Surely a better answer than, you won't get better but the nice doctor will give you an injection so everything goes away.

I would never suggest that people living with MI do not deserve to live. And they (obviously) deserve medical care, compassionate treatment etc.
This is not about eugenics or health care costs (at least to me).

But if they decided during (a stable period) that they still wanted to die? And if (various) medical experts independently came to the conclusion that they were capable of making that choice?

I ultimately still believe that people should be allowed to make their own decisions. Mental illness therefore shouldn't automatically preclude somebody from assisted suicide, especially in the case of other comorbidities. (Assisted suicide, not euthanasia!).

I have however reread this thread and appreciate that many people shared their own experiences with severe mental illness and suicidality. And that they do not share my opinion.

and these voices obviously should be listened to.
I also believe that we need to ensure that people do not fear mental health providers etc. due to fearing offers of assisted suicide or euthanasia (should they experience suicidality after the beginning of treatment etc.). That might lead to horrible outcomes... Their needs should be prioritised if something like this were to be implemented.

Anyhow, this has been extremely interesting. I unfortunately don't have time to continue participating in the discussion. But I will definitely continue to think about this.
I wish everyone a nice evening.

@TrufflySnufgl6 also, I have been involved in many board level discussions around the problems that these units can end up with staff. With patients kept on units for years, often "out of sight, out of mind", very unhealthy working practices can develop, with staff burnt out and believing that patients are hopeless cases who have no chances of recovery. Which can result in neglect, poor treatment and even abuse. The way you have been speaking to posters who have been open about their illnesses, I think you are showing signs of this yourself.

Thank you to everyone who has shared their stories of mental distress. Your voices are really important in this debate

I think it's reasonable to think that for some people, with crippling long term mental health conditions, who have treatment with no avail, euthanasia is the right option for them. It's much more humane than taking an overdose or jumping off a bridge.

Obviously there needs to be carefully considered limits around it.

It is obscene, I work in mental health and see on a daily basis even the most severely ill people move into recovery and live brilliant lives. I have worked with the most desperately unwell and suicidal people, who get better. I recently went to a talk from a guy who spent almost twenty years in and out of hospitals (seventies and eighties when long stay patients were a thing) who has just finished a phd and is leading research into new treatments for severe mental illness.

What is needed is investment in care, in treatment, in education so people are able to recover and able to see that they can recover and have the space and time to do so and not patched up and kicked out on the street again.

If you are advocating for assisted dying for sectioned patients because of unrelievable distress caused by their mental health condition then you cannot say that such assistance is a treatment unrelated to their mental health condition.

This is nothing like sectioned patients being assessed as having mental capacity to refuse cancer treatment!

@TrufflySnufgl6
At no point have I ever said that 'euthanasia of psychiatric inpatients be allowed

You didn’t use that exact phrase, but you did say:
I 100% support this [euthanasia] as an experienced MH practitioner. I haven't worked on acute wards or PICUs for a decade but when I did, the majority of staff time was taken up trying to prevent people who wanted to die, from dying. People who had been receiving treatment for years or decades. Sometimes 1:1 care (or 2:1) for years which is degrading and humiliating for the the individual to have someone watch them bathe, urinate, defecate, and insert and remove tampons.

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.

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 [euthanasia] may be relevant for.

The above adds up to advocating a law change allowing the euthanasia of psychiatric inpatients. All you’d require is for them to say they want 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"

I posted that I have been a patient like that also saying that I wanted to die, because when I’m sectioned I’m at my lowest and most vulnerable. Yet you see fit to describe me when you don’t know me at all. What ‘wealth of evidence’ I don’t want to die? My records say otherwise. Thousands of pages of them. You’re going by this thread alone which is less than 24hrs of my life and saying things like you know me.

@pointythings I live in the NL now too and get how the system works.

It comes down to respecting the individual's will when made in their right mind.

The elderly woman who was held down had previously said she did not want to live beyond a certain point, and iirc defined that point. When it came the family and the doctor took action.

A woman I knew who lost her child to suicide had the courage to say at her funeral "I don't understand the choice you made, but I respect it". That really shook me, but also got me thinking; for a mother to say that about her only daughter while her heart is breaking, really -is- respect.

The huge difference between the NL and the UK is that there is a good health system here where care -is- available and people with MH illnesses are treated much better. I get the impression now that that just isn't the case in the UK. The vast majority of people who need help get limited, broken and inadequate help so things get worse.

One problem that no one has mentioned (admittedly I skipped a few pages) is that in the absence of medical euthanasia some people try to commit suicide, fail and are left with unbearable physical damage. To be trapped by unhelpable mental distress and by severe physical damage with no way out is cruel.

Honestly, if someone mentally ill or not decides to apply and go through the process, who is anyone to actually stop them? We are all equal here on this earth, all born the same. We should be entitled to make our own decisions. And if someone is feeling like it's too painful to be alive, then it's too painful for them to be alive and they should be allowed to make that decision.

You are aware that just because you and another poster have one type of similar experience, does not mean that other people have the same experiences yes?

Isn't it better for someone who has suffered from mental illness for a long time & may have tried every treatment available to be allowed to die in a controlled way with their family & loved ones there to support them? Or to die alone from suicide & their family have the horror of finding them dead? Some people sadly suffer from mental illness all their lives & nothing can help them, therapy or medication can only do so much.

@madbongolee all the most severely ill people, or just some of them? What happens to the others?

The mental health act allows the state to deprive you of your human right to liberty (Article 5) and deprive you of your right to refuse medical treatment (Article 8) as long as specific conditions are met.

For a section to be lawful one of the conditions is that you are a danger to yourself or others. So the state can remove your liberty if an AMHP and two doctors all agree that in the interests of your own health or safety there is no other option than to detain you in hospital. If you are very unwell then your 28 day section 2 will turn into a 6 month S.3 and maybe then another and if you're still not safe after that then it becomes a yearly tick box exercise.

However shoddily this process works in practice, at every stage, at every renewal, the state officially reasserts its right to deprive sectioned patients of their article 5 and 8 human rights on the legal basis of keeping them safe.

So how would the MHA work in conjunction with a law that said sectioned patients can be helped to die? Are we redefining 'safe' now, along with all the other words? What legal basis would the state have for depriving someone of their liberty in the first place? How on earth could it be lawful to detain someone for their own safety and then help them to die?

Whenever the state takes away people's liberty, whether in hospitals, prisons, detention centres, care homes or children's homes, they need to make very sure they have a legal basis for doing that and they need to make very sure they are protecting the rest of people's human rights because by detaining someone the state becomes wholely responsible for their welfare. People who have had their liberty removed are by definition extremely vulnerable because they cannot escape whatever conditions they find themselves in.

I have no doubt that there are a small number of people for whom assisted dying would be a blessed relief in the face of unrelievable, unrelenting mental distress. I wish there was a safe way of allowing this group of people the good death they seek without compromising other people's right to life (article 2) but there's just not. It's just not safe. Rights need to be balanced.