Euthasia in cases of severe mental health

[Devon01]

Woman who survived Brussels airport bombing is 'euthanised' in Belgium mol.im/a/11291995 via dailym.ai/android

Yes or no?

Here's a beautiful story of a man who helped a stranger that was planning to jump off a bridge. Thankfully, he didn't respect that man's right to end his own life. He talked him out of it. Not forcing him to live, but persuading him that it was worth it. Now they are friends, the man is no longer suicidal and is so grateful for the one who saved his life.

amp.theguardian.com/society/2014/jan/30/man-reunited-stranger-suicide-attempt-london-bridge

Nobody lives a life without suffering, grief, pain. In our darkest, lowest, most hopeless moments, I hope that we all are met by someone like that man who tells us our life is worthwhile, who shows us love and urges us not to give up on this precious amazing life that we have.

Of course people recover from complex and severe trauma!

Good grief!

I've been a therapist working with complex trauma for 15 years (in a team in the NHS) myself and my colleagues see people recover all the time. Without being selfish, why on earth would our job exist if it was impossible to recover?

Nope. If my kids die before me and someone tried to stop me I’d be taking the bugger with me.

100% THIS!!

You are both absolutely spot on.

Good post.

IT's absolutely horrendous and there is no justification. People in acute mental health crises cannot be expected to see that there is a path to them being in good mental health again. This woman could have been in good mental health by the time she was 30, 35, whatever, and gone on to live a fulfilling life.

I think it's an absurd and dangerous precedent to set.

My partner's dad commited suicide when DP was a baby at 23. My partner around that age experienced similar feelings of hopelessness but is now loved and has DC and is happy. It is not okay to start killing people because of poor states of mental health. It's simply not true that it can't really be cured.

I actually read this article myself earlier today and it broke my heart.

I can't see it mentioned so far on this thread, but a neurologist has actually submitted a complaint about this young girl's request for assisted suicide being approved. He says that not all treatment options had been explored and there were alternatives that could have been tried. He believes the decision was wrong and has asked for a review/complaint.

I can't get on board with this request being approved at all. She suffered an awful trauma at age 17. Of course that will have affected her. No surprise at all. But it's only six years later and she's still only 23 years old. She has so much more developing/maturing left to do and I don't believe that it's possible to say that she's plateaued with no possibility of any improvement, ever.

I think that euthanasia/assisted suicide for mental health disorders is a very tricky area anyway as I'm not sure how you can think clearly and logically when you're in the throes of distress. But the mental health issues here, combined with her very young age AND the comments from the neurologist re alternative treatments makes me very uncomfortable with this decision.

Also, the poor mum of the girl was interviewed for this article, I felt just broken for her. The pain she must be going through now is just unthinkable.

I find it strange that some people are only comfortable with this if the person has a documented terminal illness with death imminent in 6 months

This is often the rule applied to euthanasia, in countries where it is legal. I personally think that it is hard enough to get euthanasia legalised , and things like the 6- month / terminal illness rule make it more palatable for the law-makers to get euthanasia passed . Once it is passed and people realise that the sky hasn't fallen in, then maybe the law can be altered to include other possibilities.

I'm strongly in favour of euthanasia, and I'm just glad that where I live it is already legal.

According to the DM article:

1. She tried to kill herself first in 2018 after a fellow patient sexually assaulted her at an inpatient clinic.

1. Her mother reported that one of her issues was that she never felt safe after the bombing.

From ages 17-19 she was utterly terrified of being around other people as part of her PTSD. Then she gets sexually assaulted in hospital. I've been sexually assaulted in hospital and out of hospital and I there's a massive difference. It's hugely significant and unthinkable that this wasn't a contributing factor to her death. If you feel actively unsafe (which isn't the same as "not liking") in hospital, it makes seeking help and trusting hard. Both of which are required for physical and mental healing. If you have prior PTSD, it's quite unimaginable what this does to you.

1. She was taking pills for breakfast and up to 11 pills daily.

1. She felt numb, "like a ghost".

Medications for mental health problems can be very helpful for some people. But for some young people they can also cause other problems. Feeling like you are detached and not able to feel is actually not a positive state. It can pause the abject suffering, for sure, but it doesn't make you actually feel good. It's actually a feeling of not being human. It's rare to find someone who wants to feel like that for the rest of their lives. Shanti felt like that for a good few years, the years where your friends are getting to explore the world, make new relationships, go to start jobs or uni. From a social experiences perspective she hadn't at 23 had a chance to become an adult. We talk about the kids who turned 18 during covid or started uni during covid and didn't have the chances to go through the normal things at their ages. Same - to and even greater extent - for Shanti. This is important because when she's making the decision to end her life, what is she able to base it on? Her chronological age here shouldn't be considered as much as her life experience age. It's not the same as a 23 year old who has had an average life who suddenly at 22 was diagnosed with motoneuron disease. Shanti hadn't the chance to experience life.

Additional points:

• The human brain is not fully matured before the age of 23-24.

This is a difficult point because we consider 18 to be maturity. But biology doesn't care about what we think. Bio-psychologically she was on the cusp of maturity. Unless children can choose euthanasia, it has to be queried, in combination with the above point, whether anybody below the age of 23/24 with mental ill-health is really competent to choose death. Technically, legally I don't think it would ever be changed from 18 to 24, but psychologists and psychiatrists also have a moral duty and know that the brain isn't matured because the law says we're an adult.

• I've suffered from PTSD since I was 16 but been responding to traumatic events since very early childhood. I'm 43. I also live in a country where euthanasia is legal. I've had YEARS of therapy. As an example I've been doing EMDR for about 5 years. It's ducking awful and generally not recommended for that length of time or for the nature of my trauma, but as it's slowly working, then I'm continuing (with a clinical psychologist trained and experienced in dealing with my situations). Seven years is no time to get over major trauma. It's a very sad reality. I've thought of euthanasia a lot over the years but I have kids. The idea of slipping away peacefully surrounded by people who care had actually been very uplifting thought at times. Why? Because the pain would be over, and I'd be able to feel happy, excited even, and the love of people important to me. And what is that really? It's just me wanting control over the pain and to feel happiness.

So my conclusion. If a young person thinks they have no way of living in this world due to PTSD - complex or otherwise - including the full range of awfulness that comes with it, that reminds them over and over and over, with no escape, even when asleep, that they are not in control of their life or future, that humiliates them in public and reminds them on a daily (and nightly) basis that the world is unsafe and the people in it are dangerous, then it's absolutely understandable. You'd actually have to be insane to experience all that, never mind the precipitating event(s), and feel that you had a future to look forward to or that the present was worth living. So Shanti made the best decision for her in her circumstances. I wish her eternal peace. I wish for her mother whatever she needs to not feel the haunted sadness expressed in that photo.

HOWEVER, it's an abject failure of the psychological and psychiatric services that any young person ends up feeling this was the only option. It's worth noting that there's no pill - alone or in a cocktail - that heals PTSD. So psychological therapy is required. But there's also no single therapy that is guaranteed to heal PTSD, often it's a cocktail of therapies over time that's required, in particular for major or multiple traumas. I'm not blaming any individual, but the mental healthcare systems everywhere need a major overhaul and more so when it comes to dealing with severe trauma. The over reliance on pills, especially long term is extremely problematic, in particular in young people. Shanti thought the pills were keeping her alive. That should not have been a message she received or one that was left unchallenged. Ever. The pills weren't keeping her alive, she was. Removing a young person's agency and putting it in mind altering medications, even if they were temporarily helpful, is actually abusive. How can someone have any hope of a better future if the ongoing present feels monumentally shit and in order to remain in that shit she needs to take multiple medications? I've heard that sort of talk fairly often and it's bad, but abhorrent when it's supported by the "healthcare" system.

Perhaps they should insist on a 5 year pending time before the euthenasia is carried out.
Enough time to possibly recover.

I’m pro euthanasia but I realise the difficulties in ensuring that it is the ‘right’ choice for the individual.

How do we determine that? I’ve never been mentally unwell and don’t know an awful lot about treatments and recovery for people with psychiatric illnesses, so cannot make a truly informed decision. My gut says the individual deserves the right to choose though. Why do I, or anyone else, ‘know better’ than the person suffering?

I remember this story of a young man who flew to Switzerland for euthanasia after becoming paralysed. Plenty of people could live long and happy lives with the same disability, and so could argue he should attempt to too. I’m very physically active in all aspects of my life (career and hobbies) and I’m not convinced I would want to live were the same to happen to me.

I have seen terminally ill family members die slowly and uncomfortably in this county and do not wish for the same. I watched a very close family member ‘actively die’ for three days in a hospice, nurses could only administer small doses of fentanyl to keep him comfortable. We constantly swabbed his dry mouth with water for over a week. I have seen family members with Alzheimer’s decline over years and be incredibly distressed. I would happily sign a piece of paper now to say I’d like to be euthanised to avoid the same fate.

Woah, steady on, a little defensive there! I know this is an emotive topic. It was an open question - I am of the opposite view so I want to understand those who think differently’s view - what is forward thinking about it? What does that mean? I am asking genuinely.

There is an established assessment tool for differentiating between actual suicide attempts and acts of deliberate self harm (DSH).

Two of the parameters assessed are proximity to help and time to help.

IE, was someone in the room with them, in the next room, out the house but contactable by phone, or did they reasonably expect to be alone, barring any "sliding door" moments.

If a friend took an overdose in a situation when they were expecting me to find them then I would of course call for help, so that they could be assessed for their act of DSH, which is a symptom of many mental illnesses, and hope that they received treatment.

The many suicide victims I have been to have all made sure they were not found until long enough after the act that no one could interfere with their decision and have researched and used methods with very very high effectiveness.

There is a difference, DSH is a severe and unpleasant symptom of mental illness, but it is not attempted suicide.

There is however distinct blurring of the boundaries as DSH escalates, but even when the person dies a good coroner will make that distinction in the death certificate. Eg. A friend of a friend death certificate stated death my misadventure following her umpteenth paracetamol overdose, because when your 5ft nothing, drinking a lot and taking multiple DSH paracetamol overdoses (people in the house with her, own phone to call 999) you are playing with fire.

I've thought about this a lot. I think if you believe that mental illness is illness, it follows that

1. Not all mental illness is curable
2. Some incurable mental illness causes suffering incompatible with a reasonable quality of life Therefore: If you support euthanasia for any illness where there is no realistic prospect of the person obtaining a reasonable quality of life, you must logically include mental illness in that.

Now, the problem is a) capacity to give informed consent and b) decision as to when treatment options have been exhausted. In the UK there have been cases that have gone to the high court where judges have refused doctors permission to force-feed patients with long-term anorexia against their wills, leading to to their death but in those cases it was a matter of withdrawal of treatment and in the case I'm thinking of the woman was extremely rational and coherent that she had tried everything medicine presently had to offer, and that continuing treatment would cause her intolerable suffering. Okay. That seems pretty clear-cut to me. Actually administering a euthanasia drug is slightly different. On the other hand, there are cases when the 'capacity' argument has been abused. For instance, there is a patient in America who wishes to due to the fact he is paralyzed from the neck down with no prospect of recovery. Doctors say he can't consent because he's depressed. He says of course he's depressed. He's never going to move again. Depression is literally the rational response to that situation. So my conclusion for what its worth is: yes, I support euthanasia for mental illness where patient and doctor are in agreement that all treatment avenues are exhausted and there is no realistic prospect of a quality of life acceptable to the patient. But as always, the devil is in the details. This case seems premature.

I would assume they do.

This young women had had 7 years to demonstrate if she was likely to make significant enough improvements to reach a quality of life that she seemed acceptable for herself. This should be based on her criteria for quality of life, and no one else's.

2 psychiatrists "approved", it seems her mother became supportive, she had 6.5 years of psychiatric treatment (several suicide attempts) and still suffered severely. No way I could weigh in from that information, to say this decision was wrong. People who were closer to her, to her life, who knew the full details, couldn't find that opinion.

If you support euthanasia for any illness where there is no realistic prospect of the person obtaining a reasonable quality of life, you must logically include mental illness in that.

I agree with this premise totally. However, firstly there isn't evidence that PTSD cannot be treated sufficiently well to obtain a "reasonable" (although that's subjective) quality of life. And secondly there is a lot of evidence** that where traditional methods fail, there are numerous others that can work. The problem is that psychiatrists are usually not trained in these other methods and also often don't know about them, plus they're not always available.

So then the question is should someone with severe PTSD be euthanised because the doctors haven't explored every single option - even if that's because they don't know the other options, or just assume they won't work because they don't practice them?

It's utterly impossible that all avenues were tried since 2018 (when she entered inpatient care). I mean literally impossible, because it can take time to find the right one(s) for the individual, plus significant time to see an impact - not in every case, but in some - and that was only 4 years ago.

This is a serious ethical situation in the treatment of trauma generally. However, it's multiplied here where the end result was the euthanising of a young woman. Hence, I believe, why there is a case being raised by the neurologist.

the whole 6 months from death for people with degenerative diseases is an entirely unrealistic view of how terminal illness works. How would that respect the wishes of someone with dementia who doesn’t want to reach the point of loosing their dignity

Amen! The women in my family get major dementia and then live extremely long lives. Won't be me. I'm not the slightest bit depressed. I generally enjoy my life every much, other than anxiety, but I've known since I was 18 that I will NOT be dying the way my grandmother did. Not happening. Ridiculous clauses like this mean that if and when I get that diagnosis, which is genetically very likely, my hand may be forced sooner than it otherwise would be. And that's nothing to do with mental illness. Its literally rational suicide.

Maybe she didn't want years of attempting different treatment options. This may have been part of her rationale for assisted suicide. This would not be everyone's choice, bit it is okay that it was her choice.

This.....

I’d like to know what happened to this women in her childhood. This is such a tragic end to her young life

@DeKraai To add, your argument could be applied to many conditions, look at the results they have published with MND recently, should people with MND be forced to wait it out, in a living hell, in case an experimental treatment comes along before they would die anyway.

In any medical or mental illness situation, patients are allowed to decide whether or not they want to go ahead with a treatment. Treatments frequently have side effects so are not benign.

Informed choice is what is important. The final decision is totally personal.

I agree. She had suffered quite enough.

This. We are helped into the world we should be helped out of it.

Yes there needs to be stringent checks but I don't agree with living at all costs. My thoughts are with her family and I hope she is at peace

Brilliant post @DeKraai

I wish you well in your journey ❣️