Arguing Life, Death and Assisted Suicide

In the article “Sides discuss NY proposal for aid in dying”, the exchange between Diane Coleman, a founder of Not Dead Yet, the foremost disability organization fighting physician-assisted suicide, and  Dr Timothy Quill, who fought for the constitutionality of physician-assisted suicide in the landmark 1997 US Supreme Court Vacco v Quill decision, is very enlightening.

Diane Coleman of Not Dead Yet spoke simply and eloquently:

“I don’t think I speak for all (opponents), but the disability community’s core message is that if assisted suicide is legal, some people’s lives will be lost due to mistakes, coercion and abuse, and that’s an outcome that can never be undone.

There is inherent discrimination in assisted-suicide laws. Most suicidal people receive suicide prevention. Assisted suicide laws would carve out an exception to that, and that exception would apply to people who are elderly, ill, disabled, and those are devalued groups in society. … Assisted-suicide laws would say, ‘these certain people, we not only agree with their suicide but give them the means to carry it out.’ We’re saying it comes down to social justice. Equal rights means equal suicide prevention.”

And

“It’s really not about physical pain. If you look at Oregon reports, about reasons people want to commit suicide, the reasons are things like feeling like the person has lost their autonomy, they’ve lost their dignity, they can’t do the things they used to do. They feel like a burden on their families. Those are psychosocial reasons that relate to the disability that people have when they have an advanced stage or chronic condition.”

On the other hand, Dr. Quill portrayed assisted suicide as little more than a benign discussion:

“Whether or not this practice is legalized, seriously ill patients are asking us to talk about it, they’re asking us to consider it” said Quill, founding director of the palliative care program at URMC and a board-certified palliative care consultant. (Emphasis added)

But to the question “Why do people with a terminal illness want to end their lives?”, Dr. Quill telling states:

“Some of it has to do with severe symptoms. I would say that’s not the majority. The majority is people who are tired of dying. It’s going on way too long for them. The kind of debility and weakness that accompany it, particularly for people that are used to being in charge of their lives, is very, very, very hard. Some of those people want to talk about what options they have to accelerate the process.” (Emphasis added)

This is very different from the way physician-assisted suicide has been sold to the public as a necessary last resort for terminally ill people in “unbearable pain”. However, as a 2014 article  “Dignity, Death, and Dilemmas: A Study of Washington Hospices and Physician-Assisted Death” admits, pain is not even a requirement for receiving physician-assisted suicide  in Oregon and Washington state:

The authorizing legal statutes in both states make no reference to the experience of severe pain or intolerable suffering as an indication for a patient to make a request for physician-assisted death but rely entirely on the entitlement due a patient in respect of their personal dignity. A patient rights framework provides the primary moral structure… (Emphasis added)

Thus, physician-assisted suicide is really about power and control over death, not the  suffering of the individual. And it is this power and control that has led European countries like the Netherlands to expand physician-assisted suicide even to non-terminally ill people who cannot or have not made the death decision themselves such as babies with deformities and people with dementia, mental illness or other impairments.

Closer to the US, the Canadian Supreme Court  has legalized physician-assisted suicide but still  without formalized rules, even on conscience rights.  In the province of Quebec, legal injection euthanasia kits  can be distributed to any doctor who wants them.

The Assisted Suicide Agenda in the US

It is alarming that the influential American Academy of Hospice and Palliative Medicine that had this same Dr. Timothy Quill in the article as a recent past president and honoree of their Visionary award. But it should not be surprising that the AAHPM has changed its former position of opposition to physician-assisted suicide to a position of “studied neutrality” towards what it now calls “physician-assisted death”.  Neutrality is progress to physician-assisted suicide activists like Dr. Quill and organizations like Compassion and Choices that need to neutralize medical opposition as much as possible while quietly setting up relentless campaigns to legalize assisted suicide in every state. If enough states give in, a new Supreme Court decision may even overturn the Vacco v Quill decision and legalize physician-assisted suicide throughout the US.

But in the meantime, trying to sell “neutrality” to doctors and convincing the media to change the term “physician-assisted suicide” to  “physician-assisted death” cannot mask the inevitable and lethal damage done not only to individuals but also to our medical and legal institutions that can no longer ensure ethical protection for our lives.

Mass Shootings and Mental Illness

The rash of recent mass shootings is alarming, especially the most recent mass shooting in San Bernardino following so quickly after the Colorado Planned Parenthood one. Now, people are not only talking about mental illness as in the Planned Parenthood shooting but also the existence of evil as in the apparent terrorist attack in San Bernardino.

Can mental illness and evil be totally separate issues? I confess I don’t know the answer to this.

But I do know that our mental health system needs vast improvement from my own personal experiences.

My first husband and the father of my children was a brilliant, caring psychiatrist whose articles were published in medical journals. When I left bedside nursing to start our family, we had a plan for me to eventually join his private practice to specifically support the families of his patients. We both believed that families were ideally the best support system for people with mental illness and we hoped that such a plan would lead to better outcomes and help keep families together. Communication was key.

However, while our children were still small, my husband started slowly succumbing to severe mental illness himself despite treatment. I was frantic to help but at that time in the 1980s and even without the current HIPPA privacy rules, I was unable to get much information about his condition or how to help him from his psychiatrist even when there were multiple hospitalizations.

As his condition deteriorated, I was told by his psychiatrist that there was nothing I could do or not do to help the situation and that he was handling the situation. Then he told me that I should consider divorce for the sake of our children.

Since I believe in the sanctity of the marriage vows, especially the part about “in sickness and in health”, I soldiered on and got second and even third opinions for my husband. Nothing helped very much and I was still shut out from comprehensive discussion of treatment plans.

My husband finally abandoned our family and I reluctantly had to file for divorce. However, I still wanted to help him.

My now ex-husband eventually went on total disability for mental illness but since mental institutions were closed decades before for “less restrictive” measures, he became homeless and eventually shuffled from one assisted living facility to another until his death in 2014.

When our oldest daughter started using drugs at 14, I ran into many of the same problems with the mental health community. Even though she was a minor, she had the right to  “confidential health services”. This came about because it is thought that minors will be more likely to seek help from a doctor if confidentiality-even from parents- is assured in matters like sex and drugs. Unfortunately, as in my case, that meant that I could be mostly kept in the dark when it came to helping my child. I could pay for rehab but I couldn’t get much information or direction about helping my daughter. I contacted mental health organizations and tried to research support groups on my own with mixed results. My daughter died by suicide using an assisted suicide technique in 2009 when she was 30 years old.

We now have “mental health parity” under Obamacare which was intended to make mental health care better by increasing coverage. However, a recent Washington Post op-ed titled “The problem with Obamacare’s mental-health ‘parity’ measure”  shows how difficult it can still be for family or friends to get help for someone with a mental illness.

Mass shootings get our attention about gun control and terrorism issues but the mental health care crisis goes on. We need to do a better job and I still believe that mental health care must try to include and help the whole family for better long-term outcomes.

TWO ARTICLES ABOUT ASSISTED SUICIDE MAY PREDICT ULTIMATE COURSE OF MEDICALIZED DEATH

A July 31, 2015 article in Medscape (a subscription website for medical professionals) titled “Assisted Suicide for Mental Illness Gaining Ground” admits that:

“Euthanasia (referred to as assisted suicide in the Netherlands and Luxembourg, where it is also legal in cases involving suffering due to medical and psychiatric illness) has been legal since 2002 in Belgium, and the law was extended in 2014 to include emancipated children with suffering due to terminal illness.

Through a required process, patients must show their illness to cause “unbearable or untreatable suffering”; however, the definition is acknowledged to be subjective, Dr Thienpont told Medscape Medical News.

“By its nature, the extent to which the suffering is unbearable must be determined from the perspective of the patient him- or herself and may depend on his or her physical and mental strength and personality,” said Dr Thienpont.

Despite the ongoing criticism that very few assisted suicide requests in the US are referred for psychological/psychiatric consultations, this article examines a July 27, 2015 British Medical Journal article ““Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study”   that tries to make the case that mental illness itself can be grounds for assisted suicide.

In the meantime, an Irish website thejournal.ie has an August 2, 2015 poll asking “Poll: Would you consider euthanasia while still healthy?” based on a story about a healthy nurse who  legally ended her life in a Swiss clinic:

“A HEALTHY NURSE from England has opted to die via assisted suicide, rather than growing old.
Gill Pharaoh (75), a former palliative care nurse, chose to die at a Swiss clinic so she wouldn’t become a burden on her family or the health service.

In an interview with the Sunday Times shortly before her death, Pharaoh said her children struggled to cope with her decision, but understand where she is coming from.

Her husband accompanied her to the clinic.”

Unfortunately, the countries in Europe that have legalized euthanasia/assisted suicide apparently are the “canaries in the mine” warning us of a relentless march towards the acceptance of euthanasia on demand in the US and potentially worldwide.