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's the paramedic equivalent of a death certificate (which can only be issued by a doctor), essentially it's a legal document that confirms a patient's identity and that they are deceased.

Once we do this if it's an 'unexpected death' the patient is conveyed to be under the care of the local coroner who's job it is to understand the cause of death. If it's an expected death, one where the patient has been seen recently by a Doctor and they are expected to die then after we 'ROLE' the patient goes to the undertakers as no further investigation required and the GP will issue the death certificate.

No, nobody is put on these kinds of end of life care measures because they are severely mentally distressed and 'ultimately we're all dying'

Well done for further terrifying MH service users though.

They are because I arranged transport for the body of one last night, the patient who had their wishes listened to and was able to pass peacefully at home with their children. No cancer, no heart failure, no copd, no kidney diseases.

Ones own death can be terrifying if we really contemplate it, everyone will have their own feelings about it though. It's important everyone is treated equally though and we don't have one law for one group and a different for others.

Are you saying the patient was mentally unwell and had been kept at home according to their wishes, had food and fluids withdrawn, was sedated into unconsciousness and died because of some combination of that, but they were not terminally ill?

Because unless there is something missing here, that doesn't sound legal.

Who was providing their 'care'? Who prescribed the sedation? Which box did you tick on your form?

I can't be exactly specific because it would be identifiable. But essentially they had refused to eat orally for several months and were often extremely agitated according to notes. There was some advanced planning in place and with sedation they were discharged home. As their condition deteriorated they were moved to a syringe driver to keep them comfortable and they passed peacefully.

The process in this type of instance is that in family call either the GP or 111 when the patient stops breathing, then either the GP or ambulance service attend. If it's us then we first 'recognise' that the person has died, there'll either be an advanced directive or a dnacpr in place which means no resus is attempted and there's a box to acknowledge this, along with the others like no pulse, no breath sounds... We then call the GP/OOGP to confirm the history and that a Doctor is happy the death doesn't require further investigations, if they are then the family make arrangements with a funeral home and we leave the patient in the house for that to occur. If no family is there (which I've not had happen before) we would make arrangements for transport.

Totally agree especially as we know so little about the brain compared to other parts of the body.

It's normally multidisciplinary teams but always doctor led. This isn't something that's done in secret you understand this is something people opt for and it's about being allowed to die in the most comfortable surroundings in the least distress possible, if that's your choice/wish. For some that wont be the choice they make they would want to be in hospital trying every treatment possible in the hopes of recovery, I've transported many patients to hospital who've clearly expressed a wish to try life prolonging treatments (like antibiotics) in the hopes of recovering when it seems extremely likely they're in their last hours of life, it's not my position to deny people what treatment options they are seeking in these instances. Others have different plans and choose alternatives.

The legal part of course means that none of the treatments hasten death. All the medications are delivered at carefully measured dosage through drivers which are locked and cannot be altered. There really isn't anything that should be thought of as scary, what's scary would be if we refused to treat patients in tremendous pain or states of extreme agitation, or force fed people for whom there was no possibility of recovery.

Right, so there was some very important info missing:

The patient did not have food and fluid withdrawn, they voluntarily stopped eating and drinking.

That's legal, and as long as you have the mental capacity to make that decision then nobody can force you to eat or drink. It's a slow method of suicide but suicide is legal.

And as long as you have mental capacity it's also legal for HCP to administer palliative care in that situation, as long as that care does not amount to assisting your slow suicide, i.e. they do nothing to actively hasten your consciously chosen death by self-starvation.

As others have said, the mental capacity act and the mental health act are both quite complex and the way they interact can be confusing, so maybe it's theoretically possible that a person with a serious mental health condition but nothing much physically wrong with them could nevertheless be assessed as having the mental capacity to make this particular decision - to starve themself to death.

But I think any such case would have ended up in the courts and we would all have heard about it.

There's a page here about VSED and your rights:

https://compassionindying.org.uk/resource/voluntarily-stopping-eating-and-drinking-vsed/

'100% of health and care professionals with experience of responding to questions about VSED would find it helpful to have guidance on the legal and clinical aspects of it.'

Read the case studies on that page. Even people in their 80's or 90's who are in very poor and declining physical health, with no mental health diagnosis, sometimes end up being sectioned when they decide to voluntarily stop eating and drinking.

So I do not believe that any doctor, faced with a patient who is seriously mentally unwell, but physically well, would be happy to proceed with such a treatment plan without the backing of a court ruling on their mental capacity. And such a ruling would be important case law so we would have heard about it, just as we have heard of Diane Pretty and Tony Bland.

The usual thing to do for a seriously mentally unwell person who wants to starve themselves to death is to admit them to hospital under section for their own safety and if necessary to treat them against their will.

Nobody likes the MHA when they're being sectioned but posters here have shared their stories of how, with hindsight, it has kept them safe and helped them recover.

It's also true that a very small number of people never, ever recover and are never well enough to be discharged and spend their whole life trying to kill themself. But as the law stands we don't say, 'OK, you've done X amount of years on section, off you go home now to end your own life if that's still what you want.'

We can debate whether that should be the law but that is not the current law in the UK.

So I think there is still some missing info here, or else you have discovered Shipman V.2.

But you are now talking about terminally ill patients at the end of life!

Nobody thinks decent palliative care for people who are dying is scary.

What is scary is the smerging together of terminally ill patients and patients who are not dying.

What is even more scary is the smerging in of patients who are not dying and also have conditions that are likely to impair their ability to understand, weigh, retain and communicate decisions about their care, whether that's because of mental illness, learning disability, neurodiversity or brain injury.

MHA would only apply when conscious I believe, when the patient was unresponsive it would have been relatively simple for a doctor to use mental catacity act to make a best interests decision and administer fluids/nutrients but in some instances it isn't. From the notes the patient had been barely responding for a number of weeks so plenty of time to consider this. Numerous doctors and teams, no difficulty when oogp involved to sign off on patient going for funeral arrangements, it certainly didn't seem to be considered abnormal and def not the first time I've come across it.

But I agree like you say whether conscious or not the law does provide options through MCA and/or MHA to force a patient to have treatment if its felt to be in their best interests in the extreme circumstances like this. But there are also a occasions where these options are not taken or thought to be in best interests and the patients previously expressed wishes are followed especially if no nok/poa is pushing for alternative when the patient lacks capacity.

You are perhaps seeing things through an urgent paramedic framework and are missing the much slower, more considered decisions that will have been made regarding the patient's mental health and mental capacity, well before they were 'barely responding for a number of weeks'.

Yes, for terminally ill patients.

Please can you clarify whether you are talking about terminally ill patients in your posts or patients with severe mental illness who are not terminally ill and who are generally physically well?

This thread is about the latter group.

Earlier you said, '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.'

If you genuinely believe this is current practice for mentally ill people who are physically well but who want to die then you need to whistleblow because it's unlawful and ethically wrong.

Also please note the difference between someone being starved of food and water and someone making a conscious, mentally competent and voluntary decision to stop eating and drinking.

I can’t believe it. There has to be either confusing those who are terminally ill and at end of life with those who are mentally ill only and are not anywhere near end of life.

It could be a continuation of the confusion on this thread regarding mental illness and dementia, because dementia is not a mental illness.

Yes, I really hope it's something like that. The alternative doesn't bear thinking about.

No, that's unfair and nasty @ZittingBiting

And I'm pro-choice when it comes to Euthanasia ... with the giant proviso that it has to be carefully implemented and carried out (executed isn't really the word here, is it)