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 :)

http://www.portlandtribune.com/news/story.php?story_id=122342291083984500

http://www.nrlc.org/euthanasia/asisuid1.html

http://www.hospicecare.com/Ethics/RWethics1.htm

Suggestions For Alternate Policies - Euthanasia in the Law

The need for an alternate policy regarding euthanasia in Canada is clear. Euthanasia whether we care to acknowledge it or not, still occurs. For many physicians this represents a fundamental dilemma they face in practice and due to the nature of the law they are essentially cut off from any sort of outside debate or expertise. They can even be isolated from the family of their patient in this decision, due to the legal liabilities that accompany euthanasia. This debate needs to be brought out into the open. We need to know about and acknowledge cases of euthanasia, not just the active instances, but also cases of passive euthanasia. Only by decriminalizing it and establishing clear limits for what constitutes abuse of euthanasia can we bring this issue out in the open and have an honest debate around its merits and deficiencies. The current legal system does not allow for this and thus we as Canadians must propose alternate policies to ameliorate this situation.

In a previous blog, we began to discuss Bill C - 407, which was introduced by the Bloc, a potential ally for policy change. Bill C - 407 was the most recent of a string of attempts to amend the Canadian Criminal Code to decriminalize assisted suicide, as long as it was documented and the correct procedures were followed. However, as noted in the entry, there were several problems with the bill. The chief one was that the language of the bill was vague, and the procedures were ill considered. This being said, if these problems were addressed in the bill, the revamped version may serve as a good alternate policy.

These are the issues that need to be addressed in the bill (some of which were covered in the last entry on Bill C - 407):

Who qualifies for euthanasia? This issue has been raised in several posts so far, and is addressed in Bill C - 407 to some extent, however, the eligibility was rather broad. Anyone who had refused appropriate medical treatment to alleviate their suffering was eligible for assisted suicide. This particular position is rather controversial for many Canadians. Many Canadians find this to be rather repugnant and do not condone the killing of individuals who have refused such treatment. This particular point builds on a previous post regarding different countries policies for eligibility for euthanasia and the varying levels of support for those policies. To realistically pass a euthanasia bill in Canada we must consider the varying opinions on eligibility and try to come to some sort of consensus. I believe that the more restrictive policy would be more acceptable to the majority of Canadians.

The issue of consent has not been extensively covered in the bill either. How do we define who is eligible to give consent? The bill stipulates that anyone “lucid” should be able to give consent. However, there were no significant procedures in place to define how we might determine who is “lucid” and who is not. In the legislation enacted in the Netherlands this issue was covered more extensively. As part of the request process an individual is required to undergo extensive psychiatric assessment to determine their level of suffering along with their psychological state. Obviously should any issues arise that may compromise the ability to give consent, the process is put on hold and the relevant issues are examined.

Additionally, according to Bill C - 407, someone could request and obtain euthanasia within approximately two weeks (theoretically, how this would have played out in practice is up for debate). This issue raised much concern from many interests groups in Canada, because the timeline seemed rather rushed. In the Netherlands, the relationship between the consulting physician and the patient requesting suicide has to be rather substantial and reasonably long term. The supervising physician must be extremely familiar with the case, and have had extensive contact with the patient, so that they are completely aware of the situation the patient faces and can make an informed judgement.

Bill C - 407 also stipulates that anyone so long as they are supervised by a “medical professional” can help an individual euthanize themselves. Additionally, they leave the definition of medical professional to the provinces to decide. For many advocates of the anti-euthanasia movement this leaves the impression that euthanasia is an unregulated medical practice because literally anyone can do it. While this may not be an accurate impression, it should be addressed in order for the policy to appear workable to the public.


Ironically, the bill also did not mention anything about the methods with which euthanasia should take place. What is the acceptable method with which we can kill someone (a rather controversial question)? Is suffocating someone to death an acceptable way to commit euthanasia? As far fetched as this sounds, many people believe that we should define every aspect of euthanasia, to protect others from its misuse and abuse. After all the word euthanasia (as I am sure we have mentioned) means “good death” and for many people an essential part of a good death is the method by which you were killed.

This is an extremely complex issue and these are just a few of the issues that we need to address in an alternate policy for euthanasia. There are several more issues that will be considered in future posts and we encourage readers should they think of any more to comment and tell us. If you were voting for a bill allowing assisted suicide, how would you want it to be conducted? Who would you allow to be euthanized? What possible issues could arise that might be reasonably prevented or at least addressed in this bill?

Religion & Euthanasia - Judaism

In our past entries we have look at religions such as Jehovah’s Witnesses and Christian Science and there stances on certain medical procedures, but we would like to switch gears for a bit. More specifically we’d like to take a look at the Jewish perspective on the subject.

Before we do though, something just occurred to us. Now when we talked about Jehovah’s Witnesses and Christian Science we focused on the refusal of medical procedures due to religious beliefs. According to the official euthanasia website, the differentiation between this type of behaviour and passive euthanasia is the ‘intent to kill’. But what if the patient does not know that they are basically killing themself. For example (I will use the refusal of blood transfusions as my example), what if a patient refuses a blood transfusion for a major surgery and the doctor knows that the person will die if they do so? What if the doctor tells the patient that they are basically committing suicide by refusing the blood transfusion for the major surgery? When does it start to count as euthanasia? Actually, can you imagine what type of dilemma this would cause for a doctor, in a patient role, who was also a Jehovah’s Witness? They would have to choose between their religious background and their medical background. On the one hand, they would have their faith that they believe in and moral rules that they have been living by for an extended period of time. On the other hand, they would have all of their medical knowledge that would be based on statistical fact. That is a moral dilemma that I would not want and one that I am glad I don’t have to deal with. But I digress.

Anyways, to get back on track, let’s talk a little bit about euthanasia and the Jewish perspective. Jewish Law has very strict rules regarding euthanasia. In Judaism, murder is one of the 3 cardinal sins and it can take 2 forms. The first type is to the detriment of the victim and the second type is to the benefit of the victim (the exact purpose of euthanasia). So even if euthanasia is done to help the patient, it is still considered murder according to Jewish Law.

The Jewish believe that all life was given by God and only he has the right to remove it. To draw on a quote from Jewish teachings, “He who closes the eyes of a dying person while the soul is departing is a murderer”. That’s a pretty clear cut statement. If I assist in someone’s death, regardless of reason, I am considered a murderer. Pretty straight forward...well almost.

Certain activities are still allowed under Jewish law, but it depends on how it is done. For example, if an individual wants to refrain from putting in a feeding tube, that is allowed to a certain degree. However, once that tube is already in the patient, it cannot be removed for the purpose of killing the client. Guess it all comes down to semantics and interpretation.

All religions have their views in terms of what is right and what is wrong. It is just up to each individual to determine what practices they will follow and what practices they will not. It is definitely clear though that the institution of religion can complicate medical practice. More cases regarding refusal of medical procedures to come in the next blog on religion.

Re-cap on our blog...

Here’s a re-cap for those of you just tuning in…

This is a blog we have created to discuss the different legal, health, religious, and ethical issues related to euthanasia. Although euthanasia continues to be illegal in most countries, it is constantly up for debate.

We began by explaining how the legal standing came to be. We discussed the different cases that were used as examples for future judgements. Along with those cases we explored more personal impacts that those individuals had on society and the euthanasia campaign. We mention the different choices that were made and how they were received by the public, if they were socially accepted or not.

Our discussion on abortion was very interesting. We received many comments expressing concerns on the comparison of abortion and euthanasia. Although we have cleared up the fact that we were comparing them based on the idea of ‘choice’, we were pleased that you showed interest and shared your thoughts. When is comes down to it, how do you determine what should be a law? And why is there no consistency with the idea of ‘choice’?

We have offered you facts and the history of euthanasia throughout the world, and hope that helped to give you an idea of the different progressions that took place. We also examined the different religious perspectives, and how each religion may differ or resemble another’s belief when it comes to euthanasia and assisted suicide.

We have brought you political statistics, and many case studies and personal stories that will help you understand different perspectives and in some cases, different motives. Recently we discussed Bill C – 407, which is the most recent Bill in Canada. We hope that you have read those entries and become familiar with the present Canadian policies.

Also, we will be posting more on the health care side of euthanasia and delve deeper into the moral and ethical predicaments. Please continue to comment on any and all entries that have sparked an interest, and we are always open to your feedback :)

Assisted Suicide Eligibility Criteria - Some Thoughts

As mentioned in some of the previous posts, assisted suicide has no legal status in Canada. Of the many bills which have proposed the decriminalization of assisted suicide, none have been voted into legislation by the House of Commons. For the sake of debate, if Canada were to change their stance on assisted suicide, who would you feel ought to be eligible for the service and what established foreign policy would you hope to emulate? The answer may seem straightforward to many, but examination of the different criteria for assisted suicide in Oregon, the Netherlands, Belgium, and Switzerland reveal the issue to be fairly complex.

If I asked you to imagine the typical person who requests assistance in committing suicide, the majority you would most likely picture someone with a terminal illness. Perhaps, you’d envision someone with AIDS, cancer or Lou Gehrig’s Disease. This view is consistent with the assisted suicide legislation in Oregon, where only terminally ill patients (less than 6 months to live as diagnosed by two physicians) are eligible.

Although most readers think of the terminally ill first when considering those eligible for assisted suicide, perhaps a few pictured non-terminal cases of severe suffering such as Lupus, chronic pain disease, or a variety of neurological conditions (i.e. reflex sympathy dystrophy). Unlike in Oregon, where such people wouldn’t meet the criteria, in the Netherlands and Belgium, a person requesting assisted suicide does not have to have a terminal illness, they only have to be experiencing “lasting and unbearable” suffering which is “constant” and “cannot be alleviated”.

Essentially for a patient to receive suicide aid, they must undergo an exam from a physician who determines whether they meet the aforementioned criteria. Prior to receiving their fatal request, a second physician must agree with the original physician’s opinion. However, the issue of what constitutes unbearable suffering is still very much a grey area in the legislation and appears to be up to each individual physician’s discretion.

People meeting the criteria for unbearable suffering can include the terminally ill, but can also include those who could potentially live for many years with their non-fatal illnesses. However, these people seek the comfort and release of death as opposed to living for a prolonged amount of time with the suffering they see as unbearable.

I think it is safe to assume that when asked to consider who is an acceptable candidate for assisted suicide that no one considered the mentally ill, such as someone with depression. Well, under the extremely liberal policy of the Swiss Government, those with mental illnesses may soon be eligible for suicide aid. This is an idea I’ll get back to a little later, but first I’d like to take a more in-depth look at their current legislation.

Unlike the policies mentioned previously, Swiss law does not require a physician to be involved in the process at any time. Since assisted suicide is expressly forbidding in all Swiss hospitals, many facilities exist within the country for the sole purpose of providing assisted suicide. These facilities do no employ physicians because those seeking help in taking their own life do not require a physician’s approval prior to receiving their wish. Therefore, the person merely has to arrive at said facility and demonstrate that there is a legitimate reason in which they wish to die.

Once again, what constitutes a legitimate reason to end one’s own life is a grey area. However, under Swiss law, as long as the person assisting with the suicide can prove that their actions were not motivated by selfishness but were instead altruistic, than they are free of punishment under the penal code.

As a result of this policy, people are eligible to receive suicide aid as long as the person (can be anyone really) who assists them does so in what they believe to be their best interests. Therefore, nearly anyone who feels as if they would like to die is eligible for this service under Swiss law, this includes the terminally ill, those with painful non-terminal illnesses, and those with physical disabilities. As you can see, this policy appears to allows for the mentally ill to seek aid from such facilities if they wish to escape from the psychological turmoil they associate with their illness.

The first such instance occurred in 2005, when a manic depressive Dutch man who was unable to meet the criteria for assisted suicide in his homeland, travelled to Switzerland to end his life at one of these facilities. The man had a long history of depression which culminated in several suicide attempts. This man was simply tired of the strain and unhappiness in which he lived his life.

Fear of legal repercussions (psychological suffering being reason for this service was unheard of) prevented said facilities from helping the man. Eventually the highest court in Switzerland would rule that no distinction should exist between psychological and physical suffering and thus the man possessed equal rights under the law to receive assistance in ending his life. This case set a controversial precedent regarding mental illness and assisted suicide.

Although all the policies share the same goals (autonomy & alleviation of suffering), I suspect differences would exist in the level of support each would receive if enacted in Canada. Feel free to leave some feedback and voice which policy you would be most accommodating to and why. Love to hear from you!

http://www.hospicecare.com/Ethics/RWethics1.htm
http://www.portlandtribune.com/news/story.php?story_id=122342291083984500
http://www.medscape.com/viewarticle/557817