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.

Also you absolutely can be treated without consent on a section 2 and it doesn't need to be an emergency. The guidance just says they're supposed to ask you nicely first and if you refuse then they can make you.

Also what psychosurgery? I'm not aware of any advances in this field since lobotomies. Have I missed something?

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.

I can't believe you are condoning the way this woman died.

It is normal for terminally ill people to choose assisted dying and then change their minds. What you are saying is that people with mental capacity should be alowed to change their mind but people with dementia should not. She was shouting and kicking and screaming against death but they carried on and ended her life because of what she had written on a bit of paper, years earlier.

'Respecting the individual's will' my big fat arse.

I do not want to live in a country where that death would be considered lawful.

To repeat:

The potential safeguarding failure here is that you deliberately cause someone's death who did not want to die, who was coerced or persuaded against their best interests that they wanted to die, or who was not capable of consenting to being killed.

The stakes could not be higher.

How many of those kinds of deaths are acceptable so that you or your loved one can choose the time and manner of your death?

If there's the remotest doubt then the default must be that you do not take active and deliberate steps to end someone's life.

@LangClegsInSpace
“If there's the remotest doubt then the default must be that you do not take active and deliberate steps to end someone's life.”

I was thinking this morning regarding doubt and how it applies to other forms of death.

The existence of doubt was the primary reason we abolished the death penalty. Because even though the vast majority of people sent to the hangman were guilty of their crimes, there had been a tiny minority of innocent men and women executed. And we thought, if we cannot separate guilty and innocent with 100% certainty, then the death penalty is barbaric and should be abolished in a civilised society. So we did.

Doubt also applies in the question of true consent and mental capacity for the mentally ill, especially since a desire to die with or without suicidal behaviour is a key symptom of many mental disorders. To me, it is objectively much more difficult for doctors or family to know if a person is “all there” and truly wanting and consenting to euthanasia than it is to solve a murder. And we are encouraged to divulge our darkest and most destructive thoughts to these same doctors- thoughts that often are intrusive thoughts which are not of our own making but are imposed on us and distress us. It’s just a slight subjective shift in perspective for a doctor to decide certain thoughts are not intrusive, but true desires.

Since we give murderers and child rapists, the benefit of the doubt, then why can we not do so for the mentally ill?

I think some would answer it’s because we suffer? So with criminals it’s taking away a life they want, but for the mentally ill it’s saving us from suffering. Everyone with a disability suffers to a certain extent. The presence or amount of suffering isn’t a justification to decide someone else should die imho and it would be doctors and family deciding this when it comes to a person so mentally unwell they are suicidal.

And in an environment where a person who is perhaps on benefits due to disabling mental health conditions, or their mental disorder is violent/creates mess and distress it is all too tempting for government policy to be influenced by considerations of cost savings or for doctors/staff to be influenced by sympathy fatigue/numbness when setting the requirements for and signing off on what is a medical version of a death warrant.

This is a very difficult, very complex area and I am glad I don't have to make the decisions. I do, absolutely, want to take that route out if dementia comes and fortunately for me, I'd be able to.

But I do note that some of the people here are making blanket statements without nuance, and that they do not address the fact that some people have an enduring, long term and stable wish to not be alive, and that others try suicide and leave themselves in a permanently terrible condition.

By not answering that you are ignoring and condoning sometimes extreme suffering., and overriding an individual's stated and long - term will.

They are also speaking form their own experience and not acknowledging that their experience is not universal. Other people may have other experiences and condemning people who have stated that they want to take a dignified route out on the basis of their own experience is disrespectful.

But as said this is a very complex, difficult and nuanced area and in the UK I would be afraid of it being misused. The MH system is far too damaged to provide effective support.

It’s been discussed? All through the thread many of us have discussed the fact that if a person in full possession of their mental faculties wishes to die there are many many ways freely available for them to do so. Including ways that are objectively also a form of lethal injection as used in euthanasia.

It’s also been discussed that the assertion there are people with a long term will to die, how does anyone know that is their actual will and not part of mental illness? Because that is the most frequent cause of such self-destructive desires, expressions and actions.

And it’s been discussed numerous times that there is no certainty in telling the ones who want to die apart from the ones who seem to want to die. So any legalisation would result in unwanted death for some people.

It’s been discussed too that no one can predict who has no hope of recovery. In regards to MAiD, the Canadian Mental Health Association has warned it is "not possible" to determine whether any particular case of mental illness is incurable and strongly opposes the coming expansion. Some leading psychiatrists, like University of Toronto's Karandeep Sonu Gaind, have said the odds of predicting curability are worse than a coin flip. So even if a patient has lost hope, should their doctors cave into that and sign off on their death?

I think the comparison to dementia is fair, but we need to recognise it is an end of life disease that affects mental capacity. It isn’t a mental illness per se in that it has a physical cause of brain damage which cannot be repaired, it is progressive and ends in death- there can be no recovery. To lump in the chronically mentally ill with those who have end of life dementia doesn’t make sense to me. I think they should be considered separately.

In these debates the extreme cases are difficult to argue against. So extreme intorable suffering unresponsive to any treatment where a reasoned decision can bé made, we understand. But then we move into the margins as we normalise it. What actually is extreme or intorable, the scrutiny of family and society influence becomes more and change what is viewed as intorable, people join supervising committees with their own agendas, vocal sections hold undue influence on decision making. Other people start dominating the decisions. People will say that won't happen, but it always does with legislation for social change. There are some very clear examples going on now, which there is no need to mention on this thread.

I also think that euthanasia should be available for people who have gone through horrendous traumas.

My father abandoned me as a child. I had an abusive mother. I had no grandparents. I had no love. I grew up in poverty, lack of love. I'm 39. I don't want to be in this life.

I often wake up and think, only fifty more years to go.
Many people who went through extreme trauma are just existing not living.

I don't want to be in this life that I'm in. I want to do euthanasia. I'm going to look into this in Canada.

Is anyone thinking of going for euthanasia? I think it's important to talk about this.

I've very occasionally thought about it but as I have a family and 3 children, I couldn't ever put them through the loss of their mum.

Sorry you are feeling so low Mooshamoo.

The Canadian government website says you must be eligible for government funded health services and so generally, visitors to Canada are not eligible for medical assistance in dying.

https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html#a2

That makes zero sense.

If someone wants to utilise this for mental health reasons, they are, indeed, suicidal.

This makes me feel heartbroken @Mooshamoo I wish there was someone or something that could help you to feel better and to want to stay alive. I hope that you will find the right treatment one day. You are only 39. Please don't give up 💐

Jesus you can't even die when you want to! :) Light-hearted jokes can be made in awful situations

I have looked at euthanasia in Europe. I looked into it quite seriously earlier this year. They sent me brochures and said that it looked likely that I would qualify.

I've had to really think about it. I know I don't want to live. I know I don't want to be in this endless suffering.

On the other hand what stops me is I think - i don't want to let those bastards (the people that abused me) kill me. I don't want to let them kill me.

I might try to keep fighting on. It's important to talk about euthanasia I think

I don' t want anyone to read into this too much, as hopefully our leaders will get their shit together and sort out the financial mess the world is in, but i have made the decision to die around the age of 70 if things don't change. I'm not able to buy a house and it is getting too late due to age. I don't want to live in poverty in old age and be a burden to my kids, and I expect my older OH would be on his way or passed on by then. For me making this decision has been a relief. i dont have to worry about money or being homeless or destitute when I retire anymore, and I can enjoy the years I have left and make the most of them.

If I can do it in a way that is controlled and more likely to be painless then great.

In terms of MH, you would have really had to try every option first. It's difficult, as it is open to abuse, but at the same time some people have had rotten lives and will find a way to do it in a painful way or a way that means they are just left severely disabled (I work in an area where I see a lot of this). It really should be the last resort if someone is severely suffering, but has full capacity to decide.

Please do keep fighting on @Mooshamoo . The best revenge is a life well lived

Because this isn't a simple area to legislate or process. But it simply can't be allowed in law to have one type of healthcare available for people without mental illness whilst excluding others from it because they have a mental illness.

Assisted dying is an emotive issue and you will never get agreement from all sides. It's not a million miles away from legislation of abortion, there will never be agreement across the population but people have a right to choose what happens to their bodies/lives and ultimately we have to be equal and fair in that provision.

Sorry posted too soon!
It's a very basic interpretation to say that all mental health people accessing this would be suicidal. If we're going to dumb it down that much then by definition any person seeking be assisted in their death is suicidal. It's much more complicated than this.

If you're worried that assisted dying is going to be encouraged for the depressed teenage who's ODd on a coupled of packets of paracetamol because their partner cheated on them then you don't have anything to be concerned over because it absolutely won't.

There are unfortunately small numbers of people all over the world existing in perpetual agony desperate for their lives to end and absolutely no expectation of any improvement until they die. This is who it is for. The current practice in the UK when people get to this stage is to stave them of food, water, medications (other than strong sedatives and analgesics) until they die. Just on my shift last night I had to sign the recognition of life extinct of two such patients who'd be sedated with a cocktail of drugs carefully balanced so it couldn't be said it was the drugs that ended their lives, but the fact they hadn't eaten or were being given any fluids. Having this distinction is in my view just a technicality and we very much assist people to die in already in this country. As the law changes maybe it can be done without the pantomime and less suffering if this is the patients choice.

The current practice in the UK when people get to this stage is to stave them of food, water, medications (other than strong sedatives and analgesics) until they die.

Pardon me, but what mental illness do these patients have?

Typically major depressive disorders which is fairly understandable when existing in pain - mental or physical.

No, that doesn't sound at all right. Are you in the UK?

Withdrawal of food and fluids is sometimes used in end of life care when the patient's organs are beginning to shut down and their system can no longer handle them, and medications can be stopped when they are no longer in the patient's best interest because they are nearing death.

This thread is not about terminally ill patients, it's about whether people who are not dying should be allowed assisted suicide if their mental illness causes them unbearable and unrelievable suffering.

I’m having trouble grasping this. Are you saying that there are patients who because of their depressive disorder are essentially sedated into a vegetative state and then gradually starved & dehydrated to death? These patients have no terminal illness whatsoever.

Or are you saying that this is what happens to patients with a painful terminal illness (cancer, dementia, etc) who are at end of life on palliative care and often develop a depressive disorder as well due to pain and impending death?

The Canada MAiD allows euthanasia for the second circumstance, and is thinking of expanding it to the first.

Can you clarify that whether you were saying that currently in the U.K. patients who only have a depressive disorder and no terminal illness whatsoever are being essentially de facto euthanised in such a fashion?

@LangClegsInSpace
It doesn’t sound right to me either.

I had never heard of 'recognition of life extinct' so I googled. All I could find is this document for paramedics, which is a set of flow charts for them to decide whether to stop CPR, or not start CPR and they sign it to confirm that the patient is dead.

https://warwick.ac.uk/fac/sci/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/recognition_of_life_extinct_by_ambulance_clinicians_2006.pdf

There's a massive cross over between mental and physical health, and ultimately we're all dying, it's quite difficult to judge how long any person has left and how much that time or quality of it is worth, there's no universal answer it's for the individual.

Mental health factors in hugely in how people manage themselves. There are absolutely patients in the UK who in part because of their mental health exist in a terminally agitated state which is sedated to varying degrees from oral benzos which just make them sleepy/docile to syringe drivers to keep them unconscious.

Again this isn't something that happens to people that are just 'low in mood', can't face going to work.... This is the extreme. It sounds like the law in canada was discriminatory in that it didn't allow people with severe mental health diagnosis to access the same treatment which was available to people with more physical diagnosis to provide equality.