Sunday, November 16, 2008

Euthanasia & Depression

We’ve noticed lately that the blog has taken on somewhat of a pro-euthanasia vibe and in an attempt to give equal play to both sides of the debate. We feel it is important to discuss one of the major arguments against its legalization. As the title foreshadows, this argument centers around the mental health of those who seek assisted suicide and euthanasia.

If someone who is terminally ill, or is paralyzed from the neck down in an accident requests for someone to help them die, it is automatically attributed to their illness or disability. When a healthy, non-disabled person attempts suicide, it is seen as a cry for help, a sign that they require psychological assistance. Is it possible that the ill and disabled who wish to die are also crying out for help in the same manner and that society is too preoccupied with what they already “know” to get them the help they need?

We don’t need to tell you that once a person is euthanized there is no going back, the process cannot be undone and life cannot be restored. This is relevant because recent research argues that many who seek euthanasia suffer from mental illness and might chose to reverse their decisions if they were to receive proper psychological treatment.

Under the Death with Dignity Act in Oregon, only those with terminal illnesses can apply for aid. The policy also specifically states that candidates can’t be suffering from any impairment. Although it is not specifically expressed in the policy, I would tend to believe that suffering from a mental illness such as depression would cloud one’s judgment and leave them impaired. This stance would explain why In Oregon, doctors are required to refer patients applying for “death with dignity” to a psychiatrist if they appear to have a mental illness.

The above argument may seem to counteract the argument that euthanasia is killing those with depression considering the listed safeguards. However, a study conducted by researchers at Oregon University found that as many as 25% of those successfully taking advantage of Oregon’s Death with Dignity Act meet the standards for clinical depression and are never referred to a psychiatrist. Although doctors are intelligent people they lack the specific training to recognize the signs of depression or other mental illness in just a single appointment.

A similar study conducted in Oregon found that 28 out of the 58 person sample who ended their lives under the Death with Dignity Act met the criteria for a mental illness (15 depression, 13 anxiety). Of these 28, none were referred to a psychiatrist by their doctor before they were supplied with the necessary materials to kill themselves.

A Canadian study found results supporting the argument that many euthanasia seekers are suffering from depression. Two hundred terminally ill patients were interviewed and 59% of those wishing to die were depressed, compared to only 8% of those not interested in hastening their death.

All of this is interest but it raises a very important question, if treated for mental illness, would their spirits and hopefulness improve to the point where they would no longer desire death? Well the same Canadian study reported that that when re-interviewed two weeks later after receiving psychology treatment, 4 out of every 6 patients who had previously wanted to die, had changed their minds.

A second major point of contention in this topic, is whether or not depression truly impairs mental competence. Some people may argue that it does not cause psychosis or severe disruption of brain functioning. However, it has been shown to clearly impact mood in a negative manner and has been linked to low self-esteem, feelings of self-blame and worthlessness, and feelings of hopelessness which is the primary trigger for suicides.

Lastly, I will point out one common sense argument that make every argument I’ve just made seem kind of silly. Then there are the realists who point out that depression is to be expected from this population, these people are dying after all. When viewed from a common sense perspective, it only seems rational that most terminally ill people who apply for euthanasia services would meet the criteria for a diagnosis of depression. As one author puts it, “you’re dying and you’re in pain, but you’re too depressed for assistance”. Seems kind of silly doesn’t it?

There is no right and wrong when it comes to this topic, but both sides can present formidable arguments as seen above. Feel free to comment and let me know how you view the issue and as always no judgments, just good discussion :)

1 comment:

Anonymous said...

Although I believe mental illness can be as painful and crippling as any other illness,I believe assisted suicide for someone suffering from mental illness such as depression in an otherwise healthy body is not a viable option.There are treatments -there is hope, unfortunately our medical system has not caught up with mental health issues. Many people suffer unnecessarily for years because the proper resources are expensive or not available and they cannot get the treatment they need.

I also agree the the disabled and dying are depressed , but it is a depression rooted in the reality of their lives for which there is no help and no hope.