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.

@ShimmeringShirts please rethink your plan. Many a train driver has had their career ended and their life ruined because of your proposed method

Yes, scrape the surface of the it’s a kindness, and you see the ableist judging that certain lives are not worth living and the kindness is really to free the people caring for them or preferring an inheritance over care home fees. We as a society are not ready to handle the ethics of euthanasia for the mentally ill- because it would be expanded to those with cognitive deficits due to genetics or accident (autism or brain injury).

It seems like assisted suicide to me. I find it abhorrent

I 100% support this 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.

I have many, many stories of how inventive people can be if they really want to die or self-harm. Which is why many psychiatric wards will not allow the obvious things like belts but also underwired bras, scrunchies, hair grips and staples in magazines. One unit I worked in which had new carpets had a patient ball up the excess fluff you get on a new carpet and shove it down her throat which resulted in her being rescuitated more than once.

Other patients who were several years into 1:1 nursing would on a sunny day, sit in the garden while on psychiatric medication that is photosensitive so they'd severely burn. So staff had to balance not letting someone outside with restraining and dragging someone inside. Shit for everyone involved.

And attempt to eat themselves to death ordering takeaways to the ward. Which it is extremely difficult for staff to block due to the rights of the individual.

It's very odd to me and always has been, that a lot of people seem to think we should treat MH problems 'the same as physical health problems' in terms of sympathy and understanding but don't consider them to be the same as physical health problems in terms of sometimes there being no more medical (psychiatric) treatment available.

I felt in those days, that I was abusive. Trying desperately to stop someone from killing themselves when it was their right to do so and all available treatment hadn't worked.

I’m sorry you felt abusive, I hope it helps to know that not all of us trying to kill our selves in acute wards do actually want to die. Yes the experience is humiliating and traumatising, but not all medical care is pretty or nice, it’s about what is necessary. I am beyond grateful to staff like you that kept me alive. Did you ever get to hear from patients after discharge who had gone on to be more stable? It would be so demoralising to not see the positive impacts of your work.

It's perhaps harder to judge if your main experience as a HCP is in acute care. Because you don't know what quality of life the repeat returners have in between admissions.

@TrufflySnufgl6 you weren't abusive. I echo @SwitchDiver

This is already happening in NL.

In her evidence to the inquiry, Baroness Hollins said:

As a clinician and as a researcher, I see how the lives of people I am particularly concerned about — people with learning disabilities and autistic people — are not valued, and how their own lack of confidence and their own quality of life can lead to changes in the perception of those who are caring for them. We saw it during the pandemic, when people with Down’s syndrome had a six times higher death rate. A lot of that was due to “Do not resuscitate” and assumptions being made about the quality of life.

My research in the Netherlands has found that the evidence there is unusual. They actually provide case histories of people who have had euthanasia. It is normally euthanasia in the Netherlands — I think 96% of cases — because it is easier and more effective, and because the complication rate from physician-assisted suicide is so high. We did not expect to find those in the learning disability and autism community represented among those euthanised, but they were. We found 38 cases, described in our study. This will be an underestimate because they are not all described. We found 38 cases of people with learning disability and/or autism who were euthanised simply because of the symptoms of having a learning disability or autism. That is the sort of safeguard that I am concerned about.

... I am particularly concerned about the extension to people with mental illness, and to disabled people, particularly people with learning disability and autism, who are so open to suggestion.

@LangClegsInSpace two things:

1. Baroness Hollins is a Roman Catholic. This is very clear from her bio. It's hard not to expect religious bias from her.
2. She presumes that autistic people cannot consent to euthanasia. I am the parent of an autistic young person with comorbid mental ill health. My DC absolutely has capacity.

As I have said many times - it's complex. I want my DC to have a choice if they want one.

@LangClegsInSpace maybe run this article through Google Translate before you decide that Baroness Hollins is onto something dreadful in the Netherlands:

I have always supported euthanasia as a humane option but the reality of it is not what I once thought, I imagined it for those terminally ill who had no prospect of recovery and a painful death inevitable.

I feel wholly uncomfortable with euthanasia for people with mental illness. I understand that there are people with no prospect of recovery despite treatment but social provisions for mental health are so inadequate and the disparity of rich versus poor is massive, I feel really uncomfortable about it. If we had great mental health support and this was very tightly controlled for very rare cases I could maybe get on board but I fear this will be a slippery slope.

@QueenoftheNimbleFlyingCat the UK as it is now isn't the place for it. But the questions need to be asked and discussed so we can build a society where that choice is possible. Dismissing it out of hand isn't the way to go, the spotlight has to stay on.

It's a valid choice. Euthanasia should be a valid option for anyone who feels their quality of life is that bad.

Thats my concern. I spend a lot of time with autistic people and they can be very suggestible.

She's also an Emeritus Professor of Psychiatry of Disability, a past President of the Royal College of Psychiatrists, past president of the BMA, Chair of the Board of Science at BMA, a past member of the Mental Capacity Act 2005 Committee and a current member of the Joint Committee on the Draft Mental Health Bill.

She was not invited there to give a religious viewpoint and she didn't (although Dignity in Dying's own stats show there is not a huge religious bias on this issue anyway). She was invited to give evidence because of the vast wealth of experience she has, especially in issues related to capacity, disability and mental health. The overwhelming impression I got from her is that her focus is on safeguarding and I agree with many of her points.

Even if I thought she was only really saying that because she's a catholic, the safeguarding issues she highlights do not go away.

So I don't care if she's a catholic, it's the sort of lazy smear I've come to expect in other important areas of debate from people keen to avoid engaging with people's actual words and views.

Maybe you should watch the evidence session? There were two people there from Dignity in Dying as well so a range of views were expressed.

https://committees.parliament.uk/event/17890/formal-meeting-oral-evidence-session/

Reassuringly (for me), nobody there was advocating for assisted dying for mental health reasons. It seems that's quite an extreme position for the UK. Even Canada has paused the implementation of that because of safeguarding concerns.

She presumes that autistic people cannot consent to euthanasia.

No, you presume she presumes that. She talks a fair bit about mental capacity decisions.

@LangClegsInSpace that isn't how your quote reads at all. I have no problems with being cautious in these things, but in the case that I posted, the whole process took close to three years. So don't tell me it is not possible to do this in a rigorous, carefully assessed way, at least elsewhere in the world.

And no, I do not think it is currently possible in the UK; however, your post implied that people with autism/learning disabilities were being euthanised wholesale without any safeguards in the Netherlands and that is just not the case.

Baroness Hollins highlighted the Netherlands as if it were an example of bad practice and that isn't OK.

From a mental health nurse: this.

There are cases where mental illness doesn't respond to treatment, sadly this is particularly true when the person is too affected by trauma that they cannot work with psychology even with xyz medications on and off-licence to reduce distress/suicidality.

There are absolutely cases where the person could make a capacitious decision to die. Emotional pain can fucking hurt and there is a cohort of people who are being forcibly kept alive after years of psychology, OT, nursing and pharmacology have not worked.

I would assume this would cover dementia? Having seen my grandmother disappear to dementia, if I went the same way I think euthanasia would be a kindness for me and my family members. I would expect there to be clear guidance.

however, your post implied that people with autism/learning disabilities were being euthanised wholesale without any safeguards in the Netherlands and that is just not the case.

Where did my post imply this? How do you get here from 'We found 38 cases ...'?

Baroness Hollins highlighted the Netherlands as if it were an example of bad practice and that isn't OK.

Of course it's OK if that's what she believes, based on her research!

I happen to agree with her that NL and Canada are both examples of bad practice. Even the other side were keen to reassure parliament that of course we wouldn't be like Canada or NL, we'd be more like Oregon.

I find the difference in mental health professionals versus recovered patients opinions quite stark on this thread. I can see it from both perspectives but a few patients have said that they are against this whilst the professionals have said they are for it - I assume because you have seen the full spectrum.

Crikey, I find this rather scary.

@LangClegsInSpace so do you think that people with autism are not ever capable of consenting to assisted dying based on how their autism affects their lives? (And that is without considering the fact that autism often has other MH comorbidities)

I'd also be interested to hear what in your opinion exemplifies the Netherlands as an example of bad practice. My personal experience of family members who have had assisted suicides, alongside the experience of family members who either could not (because pre legislation) or were rightly denied (my dad) makes this an interesting question to me. Please note that I am not saying that everything always goes perfectly in NL - it doesn't. It can't - not anywhere. I do not see this as a reason not to try at all though.

It is a slippery slope and strongly suggestive of a descent into eugenics. People who are deemed to not have the capacity will have the decision made for them so many people who wish to live will end up euthanized against their wills. Canada and the Netherlands are both led by people who portray themselves as being very tolerant and liberal which makes it even more horrific.

will

Yes, I agree. I have seen similar concerning trends. It’s terrible to in the context of those with autism + capacity to choose as most of their distress isn caused by autism but by a wider society that does not accommodate or support their neurodiversity.

Some very interesting points made here. I agree with those who say the Canadian model is flawed. The same person who approves the application can actually carry out the procedure and if you live in a tiny town up north the lack of accountability this builds into the procedure is frightening. Whilst people are autonomous they don't live in a bubble, for those parents who nurse their children through physical and mental illnesses and who devote their whole lives to alleviating their child's suffering the idea that they could just disappear one day in a state provided suicide with multiple inputs from people who didn't tell you, the parent, is frightening. Rupa Supramanya's article on this is interesting Free Press

I cannot get behind the "Mature Minors" consent for mental illness that they are proposing nor can I get behind the euthanisation of babies under one with "severe malformations” and “grave and severe syndromes” for which their “prospective of survival is null, so to speak" as proposed by the Quebec College of Surgeons, as if survival is null, then it is unecessary. "Syndromes" is too vague as well, do they mean Downs? It's just too dystopian for me.

It builds into society the idea that you must never be a burden nor should you ever put up with suffering. Clearly some suffer a great deal more than others and people have shared some very painful experiences here but with rates of MAID at 5% in some provinces I feel it's a slippery slope and is doing more to save the government money and exploit the most vulnerable in society. Duchess Lois on twitter is another example, indigenous on a reservation, had a botched sex change operation and has now applied for MAID. It was all avoidable had she received good mental health care in her teens.

Duchess Lois