The Law Should assisted dying access be extended to the mentally ill?

[Cmarsh]

Death by Doctor May Soon Be Available for the Mentally Ill in Canada

TORONTO — Canada already has one of the most liberal assisted death laws in the world, offering the practice to terminally and chronically ill Canadians. But under a law scheduled to take effect in March, assisted dying would also become accessible to people whose only medical condition is...

news.yahoo.com

Canada making attempts to put into law an extension of Doctor assisted dying to those with severe treatment resistant mental illness.

Currently in Australia most states and territories have a mental health act that gives doctors the power to place a person into enforced psychiatric care if deemed to be at severe risk outside the bounds of that care.

If people with a severe mental illness report that the pain of living is too great, should they be allowed by law to access doctor assisted dying?

There are a number of discussion points a potential law change for doctor assisted dying for mentally ill people bring up.

Is it discrimination to exclude people who have a severe, seemingly unsuccessful response to previous attempts at treatment from legal assisted dying?

Does it reflect a lack of good treatment access to mental health care by giving people with mental illness access to assisted dying?

Would access of people with mental illness to assisted dying save others (often their family members) from the trauma of finding their loved one dead in a very confronting way like hanging or gunshot wound?

If doctors did approve a person with mental illness for access to assisted dying, how do we know those doctors are sure that person has no hope for recovery?

 

[ferball]

Nazi loving Canada wants to start euthanising "crazy" people.

 

[Crankyhawk]

It is tricky. Certainly would have massive issues if it was being used on those with treatment resistant psychosis were it is unclear what their true non psychotic wishes are.

But I certainly see a group of patients who have experienced massive early trauma which has failed to respond to long term therapy and they have ongoing desire and attempts to end life due to pervasive suffering. Hospital environment is often not therapeutic for these patients. Long term cognitive therapy or DBT is difficult to find and often expensive. Yet we force them to go to hospital when attempted suicide but we have nothing in hospital to address the root cause.

 

[Brad Goodman]

I’d struggle to get on board with it, this kind of decision needs to be made rationally - are they capable of that?

 

[Crankyhawk]

I’d struggle to get on board with it, this kind of decision needs to be made rationally - are they capable of that?

Patients with mental health issues can still consent (eg for surgery) having mental illness (even under an involuntary treatment order - specifics differ between states) does not imply a lack of capacity to consent

 

[ferball]

It is tricky. Certainly would have massive issues if it was being used on those with treatment resistant psychosis were it is unclear what their true non psychotic wishes are.

But I certainly see a group of patients who have experienced massive early trauma which has failed to respond to long term therapy and they have ongoing desire and attempts to end life due to pervasive suffering. Hospital environment is often not therapeutic for these patients. Long term cognitive therapy or DBT is difficult to find and often expensive. Yet we force them to go to hospital when attempted suicide but we have nothing in hospital to address the root cause.

So because we can't afford to help them they should top themselves?

 

[ElectricG]

I’d struggle to get on board with it, this kind of decision needs to be made rationally - are they capable of that?

I guess it would have to be bolstered by evidence of a long history of them both suffering with the condition and wanting to end things.

I also struggle with it. The messaging re: depression and mental health issues to this point has always been don’t do it. But I guess we’d be saying don’t do it until you reach the specific criteria required for doctors to partake in your assisted suicide. Weird.

 

[Crankyhawk]

So because we can't afford to help them they should top themselves?

It is more nuanced

• currently the default response to suicidality is send patient to the emergency department
• which leads only to in hospital or to discharge to some form of community based support
• while we are slowly getting practitioners who can do dbt, the numbers are much less than demand
• many of these patients have chaotic lifestyles (eg substance use as a self medication for the trauma) and attending appointments often a challenge
• and then there are a select few who have had years of therapy yet still have that pervasive distress. It is this very small subgroup who may be considered for exercising a choice about their life fe.

 

[Crankyhawk]

I guess it would have to be bolstered by evidence of a long history of them both suffering with the condition and wanting to end things.

I also struggle with it. The messaging re: depression and mental health issues to this point has always been don’t do it. But I guess we’d be saying don’t do it until you reach the specific criteria required for doctors to partake in your assisted suicide. Weird.

Medical staff currently being given very mixed messages from the legal framework (speaking specifically around the new Victorian mental health and wellbeing act 2022)
While we can use restrictive practices to stop someone leaving they are supposed to only be used when the risk of harm to self or others is imminent. Judging this becomes hard when the patient expresses suicidal ideation on a consistent basis over months/ years. We are also told to allow patients autonomy, and the group of patients I am describing derive minimal benefit from hospital based care (often suicidal from combination of early trauma and current psychosocial challenges)
In addition suicidality is dynamic (the degree fluctuates) but the psychiatric hold ;assessment order) lasts 24 hours and can only be removed by a psychiatrist (who in general are only available business hours). So then the patient is forced to wait in the often counter therapeutic environment of the emergency department, and staff aren’t often sure if they need to be forced to stay if they try to leave, which leads to use of restraint and chemical sedation which in itself adds to trauma…

Like I said very difficult

 

[Gethelred]

I wonder if there was a clearly delineated way to allow people to do it if there is no other option, there would be less people committing suicide by themselves. As in, treating euthanasia like addiction; legalisation but through the lens of treatment for addiction. Try and funnel as many of those afflicted into getting help and putting as many obstacles in the way.

If there's anyone who's a mental health expert, I've read that some suicidal impulses are frequently unmotivational; they want to do it but cannot bring themselves to go through with it. Would making it legal force them into those avenues, or would it result in them simply being more likely to pursue it?

 

[Crankyhawk]

I wonder if there was a clearly delineated way to allow people to do it if there is no other option, there would be less people committing suicide by themselves. As in, treating euthanasia like addiction; legalisation but through the lens of treatment for addiction. Try and funnel as many of those afflicted into getting help and putting as many obstacles in the way.

If there's anyone who's a mental health expert, I've read that some suicidal impulses are frequently unmotivational; they want to do it but cannot bring themselves to go through with it. Would making it legal force them into those avenues, or would it result in them simply being more likely to pursue it?

I think the answer would be “it depends” (yes I know that sounds like a cop out) factors driving towards and away from suicide are highly personal dependent and it is difficult to derive a rule for many.

 

[Number37]

I think the answer would be “it depends” (yes I know that sounds like a cop out) factors driving towards and away from suicide are highly personal dependent and it is difficult to derive a rule for many.

If a set of criteria was established for a mentally ill person to access assisted dying wouldn't that provide an incentive for them to meet that criteria?
We've been telling the mentally ill "don't do it" since day dot...establishing a set of criteria is saying well now you can do it, and we will help you do it...which is mixed messaging, isn't it?

It all sounds a bit Catch-22-ish. You can't do it if you say you want to do it, but you can do it as long as you don't say you want to do it.

 

[Crankyhawk]

If a set of criteria was established for a mentally ill person to access assisted dying wouldn't that provide an incentive for them to meet that criteria?
We've been telling the mentally ill "don't do it" since day dot...establishing a set of criteria is saying well now you can do it, and we will help you do it...which is mixed messaging, isn't it?

It all sounds a bit Catch-22-ish. You can't do it if you say you want to do it, but you can do it as long as you don't say you want to do it.

I suspect hypothetical criteria would involve demonstration of attempts to have evidence based treatment, satisfying 2 accredited psychiatrists (similar to the 2 doctors for medical assisted dying) though that in itself creates an access barrier against those from rural areas.
I suspect crushing poverty would be a driver for some to seek this which would also be a concern. I’m currently seeing a rise in suicidality caused by lack of housing, I have nothing to offer (my hospital really has no ability to find crisis housing due to the lack of available places in our area and it would be massively impractical to just admit everyone)

 

[Leeda]

Nazi loving Canada wants to start euthanising "crazy" people.

And you'd love to jump out and scare the poor buggers into oblivion...nice work Frothy...I guess you have
put the batteries in your Hack Me. "

 

[Number37]

I suspect hypothetical criteria would involve demonstration of attempts to have evidence based treatment, satisfying 2 accredited psychiatrists (similar to the 2 doctors for medical assisted dying) though that in itself creates an access barrier against those from rural areas.
I suspect crushing poverty would be a driver for some to seek this which would also be a concern. I’m currently seeing a rise in suicidality caused by lack of housing, I have nothing to offer (my hospital really has no ability to find crisis housing due to the lack of available places in our area and it would be massively impractical to just admit everyone)

Can't someone then say I jumped through your hoops and it didn't work, can I have my assisted dying now?

Putting all the onus on the individual is not always fair either.
Society is marginalising more and more people, then when we finally break them, we have no idea how to "fix" them.
I'm not convinced that assisted dying is the answer. It sounds like a bit of a cop out.
Perhaps, instead of assisted dying, we could start by not marginalising so many people?

 

[Crankyhawk]

Can't someone then say I jumped through your hoops and it didn't work, can I have my assisted dying now?

Putting all the onus on the individual is not always fair either.
Society is marginalising more and more people, then when we finally break them, we have no idea how to "fix" them.
I'm not convinced that assisted dying is the answer. It sounds like a bit of a cop out.
Perhaps, instead of assisted dying, we could start by not marginalising so many people?

The last is a nice thing to do but it is beyond my scope to answer. Or to solve.

 

[Leeda]

Can't someone then say I jumped through your hoops and it didn't work, can I have my assisted dying now?

Putting all the onus on the individual is not always fair either.
Society is marginalising more and more people, then when we finally break them, we have no idea how to "fix" them.
I'm not convinced that assisted dying is the answer. It sounds like a bit of a cop out.
Perhaps, instead of assisted dying, we could start by not marginalising so many people?

Talk to the people who are within these parameters and wanting peace..it is not you but them who want a level of satisfaction and happiness

 

[Leeda]

Can't someone then say I jumped through your hoops and it didn't work, can I have my assisted dying now?

Putting all the onus on the individual is not always fair either.
Society is marginalising more and more people, then when we finally break them, we have no idea how to "fix" them.
I'm not convinced that assisted dying is the answer. It sounds like a bit of a cop out.
Perhaps, instead of assisted dying, we could start by not marginalising so many people?

Tech Nun fitty..

 

[Cmarsh]

I guess it would have to be bolstered by evidence of a long history of them both suffering with the condition and wanting to end things.

I also struggle with it. The messaging re: depression and mental health issues to this point has always been don’t do it. But I guess we’d be saying don’t do it until you reach the specific criteria required for doctors to partake in your assisted suicide. Weird.

There is a significant cohort of people with long term mental illness, mainly treatment resistant psychosis, that reside in long term supported placement facilities where their lives are still very unhappy and tortured by their illness. This is a cohort that are often under guardianship where third parties make medical and healthcare decisions on thier behalf due to thier lack of capacity for informed consent.

At least some in this cohort would be candiates for assisted dying as their lives continue to be very painful despite years of treatment that doesn't help them.

Problem is they couldn't make consent for assisted dying as current assisted dying laws need to be done with full informed consent of the recipients, which at least some people with long term mental illness cannot do.

The result? These people continue to suffer unbearable lives. We as a society need to figure if we are ok about that and if not, amend the law accordingly.

 

[Johnny Bananas]

If proper mental health treatment has been tried for a while and the thoughts are not abating, then yes, I think people should have the right to decide if they want to live or not. But I'd want there to be assurances that they have indeed received proper mental health care.

There are still barriers to mental health care in Australia. It ought to be entirely free of charge to the end user and the number of practising mental health professionals needs to be increased, so that people don't have serious difficulties in getting an appointment like they currently do.

If after that treatment, people still don't want to live, then the option should be available, if assessments have been performed by at least two separate registered mental health professionals (psychiatrists or clinical psychologists) plus a cooling off period. I suppose that's a fair bit of bureaucracy, but that's the price that needs to be paid to ensure everything has been done ethically and as a last resort.

 

[nobbyiscool]

I'm not sure that we should allow mental illness to be treated as terminal.

Believe me, I understand - it's been 25 years for me, and if anyone could be classified "terminal" it's me.

But you have to live in hope that things will improve I think. Not sure I could get on board with doctors euthanising people over what is essentially a loss of hope.

 

[Cmarsh]

Article highlighting the barriers still faced by the suffering to access VAD.

A mother's message and the hospital that didn't want to hear it

A dying mum could only communicate by blinking. She needed hospital staff to help convey a message, but they didn't want to hear it.

www.abc.net.au

Also highlights the continued influence of the Catholic church over healthcare, and I would also mention education in this country.

It does raise questions over whether institutions that obtain public funds should be able to dictate whether or not patients recieve legal medical intervention.

 

[paulige]

If proper mental health treatment has been tried for a while and the thoughts are not abating, then yes, I think people should have the right to decide if they want to live or not. But I'd want there to be assurances that they have indeed received proper mental health care.

There are still barriers to mental health care in Australia. It ought to be entirely free of charge to the end user and the number of practising mental health professionals needs to be increased, so that people don't have serious difficulties in getting an appointment like they currently do.

If after that treatment, people still don't want to live, then the option should be available, if assessments have been performed by at least two separate registered mental health professionals (psychiatrists or clinical psychologists) plus a cooling off period. I suppose that's a fair bit of bureaucracy, but that's the price that needs to be paid to ensure everything has been done ethically and as a last resort.

Really well considered response - the part in bold is of particular importance.

I’d go slightly further and say not only should people “not have serious difficulties” accessing care, but that people should have no difficulties whatsoever accessing care.

Mental health support is so horrifically underfunded/under-provided in this county. Even if life’s lottery finds you lucky enough to be able to afford it (which far too many aren’t), you’re still likely looking at a lengthy waitlist.

To even consider it for an individual, I feel the following would need to be ticked off:

• all known treatments with proven chance of success made fully accessible, and completely free for the end user
• over time, and while in a state of sound mind, the individual is given a clear explanation of each and every treatment option, by a highly trained professional (or it is explained to multiple guardians/next of kin, where the individual is unable to advocate for themself)
• a lengthy cooling off period (6 months, a year, more?), during which the individual must be in regular (weekly) contact with the professional/s who will ultimately make the call on approving or denying their request

… and this isn’t even the bare minimum.

Basically, proof beyond any doubt that all options have been exhausted, and the chance of improvement is ~0%.

But yeah, this would unfortunately cost a lot of that made up stuff we call money, and after we account for the absolute pillaging of our natural resources for a pittance, corporate socialism (e.g. jobkeeper for Harvey Norman, among others), and tax cuts for (or inadequate taxing of) the uber-wealthy and corporations, there just isn’t enough to go around.

 

[Cmarsh]

Funny how people think just by increasing the number of mental health practitioners people's mental health would be so much better.

The fact is the treatments aren't that good. I know many people with long term difficulties whom have accessed care consistently for a long time and their lives are still shite.

 

[Gethelred]

Funny how people think just by increasing the number of mental health practitioners people's mental health would be so much better.

The fact is the treatments aren't that good. I know many people with long term difficulties whom have accessed care consistently for a long time and their lives are still shite.

To a certain extent, some mental health problems are unavoidable because of things that have happened to you. If you're depressed because your partner left you and you share custody, you don't own a house and you're stuck in a job you hate with no ability to escape your situation, all the mental health assistance in the world isn't going to make this stuff suddenly not be true.

If your life's shit, it's still shit after you've seen a psychiatrist.