Suicide by doctor?

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Editor’s note: On October 5, 2015, California Governor Jerry Brown signed a physician-assisted suicide law covering nearly ⅛ of the U.S. population. Ironically, the law goes into effect upon completion of a special legislative session on healthcare. Physician-assisted suicide is now legal in California, Oregon, Washington, Montana and Vermont.

Should mentally ill patients have “the right to die?”

I came across an extraordinarily troubling post by Wesley Smith over at First Things describing the increased availability and acceptance of physician-assisted suicide in Europe for persons with mental illness. From Smith’s post…

A few years ago, I spoke about end-of-life care at a town-hall event; it quickly devolved into an intense debate on assisted suicide. When the time came for audience questions, a self-described “mentally ill” woman took the microphone and declared that she had a right to doctor-prescribed death. More than half the audience burst into applause.

Helping the mentally ill commit suicide was unthinkable not long ago. Today, it is a growing practice.

In 1994, the Dutch Supreme Court ruled that physician-assisted suicide was justifiable in patients with “unbearable mental suffering” A study published in the New England Journal of Medicine in 1997 surveyed half the licensed psychiatrists at the time in the Netherlands and of the 83% of the sample responding to the survey…

64% (N=345) thought physician-assisted suicide for psychiatric patients “could be acceptable.” Of that group, 70% (N=241) reported they could conceive of a situation in which they would be willing to assist in suicide.

A study of general practitioners, elderly care physicians ad clinical specialists from the Netherlands published earlier this year in the Journal of Medical Ethics reported the following…

The response rate was 64% (n=1456). Most physicians found it conceivable that they would grant a request for EAS in a patient with cancer or another physical disease (85% and 82%). Less than half of the physicians found this conceivable in patients with psychiatric disease (34%), early-stage dementia (40%), advanced dementia (29–33%) or tired of living (27%). General practitioners were most likely to find it conceivable that they would perform EAS.

This past February the Canadian Supreme Court unanimously ruled that persons with “a grievous and irremediable medical condition” have a right to physician-assisted suicide. Ashton Ellis provided analysis of the decision in this post at The Public Discourse…

In Carter, however, eligibility for assisted suicide is not tied to a severely curtailed life expectancy. Rather, it is triggered whenever an illness, disease, or disability is present that can’t be fully cured.

It gets worse. The Carter Court explicitly states that either “physical or psychological suffering” merits access to assisted suicide. If such suffering becomes “intolerable” to a person, she can get help killing herself merely because she can’t bear the thought of a diminished life, however she defines it.

shutterstock_158472119The ability of patients with treatment-resistant depression to request assistance in committing suicide appears to be permissible under the ruling in Canada and has been a hot topic of discussion. This past May, a professor from Queens University in Ontario argued in the Journal of Medical Ethics that persons with treatment-resistant depression should be entitled to assistance in committing suicide…

Competent patients suffering from treatment-resistant depressive disorder should be treated no different in the context of assisted dying to other patients suffering from chronic conditions that render their lives permanently not worth living to them. Jurisdictions that are considering, or that have, decriminalised assisted dying are discriminating unfairly against patients suffering from treatment-resistant depression if they exclude such patients from the class of citizens entitled to receive assistance in dying.

A “mental health advocate” blogging in the Huffington Post in the aftermath of the decision in Canada appears to champion this new rationale for “parity” in how mental illness is viewed relative to other medical conditions, and sees trauma victims as potential “beneficiaries” of this new right…

I have advocated extensively for mental illness to be treated and looked at the same as physical illnesses. That’s why if we’re going to accept physician assisted-suicide as an appropriate remedy for people suffering from an irremediable physical illness then we must accept this to be an appropriate remedy for people living with mental illness.

When I think of when physician assisted-suicide may be appropriate for somebody living with mental illness, I think of the people who appreciate the consequences of their choices both good and bad, people who have extensively received treatment for mental illness which is reported to be ineffective by the patient, and I think of people who have suffered from psychological trauma that has destroyed their lives that don’t see envision a future for themselves.

shutterstock_65290903For readers who conclude this is an abstract discussion, here’s a link to data on physician-assisted suicide in Belgium. In 2013, 1.7% of all reported deaths in the country were attributed to physician-assisted suicide. The number of assisted suicides for patients with “neuropsychiatric disorders” has increased every single year since 2007, from 25 in 2010 to 33 in 2011, 53 in 2012 and 67 in 2013. This paper describing the process of organ harvesting from persons who underwent physician-assisted suicide included a 62 year old man experiencing self-mutilation. This news report from last week describes a 24 year-old who was approved for lethal injection as a result of chronic suicidal thoughts. Last year, age limits were removed on the “right to die” in Belgium, extending the right to die to children, or parents acting on behalf of their children.

Here in the U.S., 26 states have enacted, or are actively considering legislation to permit physician-assisted suicide as of this past February.

A personal concern of mine involves the ability of physicians to invoke the right to “conscientiously object” to demands they respond to requests for assistance from patients who desire help in committing suicide. Recent events in the U.S. suggest strong public support for the policy that religious freedom is relinquished by those who provide services to the general public, as all physicians are licensed to do by their respective states. The language of the decision in Canada leaves to legislatures the responsibility to reconcile the rights of patients with the rights of physicians. From another post by Wesley Smith

Doctors who morally object to killing patients might be forced to participate. The court gave Parliament 12 months to pass legislation consistent with its sweeping opinion, stating that “the rights of patients and physicians will need to be reconciled” by such legislation or left “in the hands of physicians’ colleges.”

That may leave doctors who embrace Hippocratic values twisting in the wind. Quebec, which legalized euthanasia last year, requires all doctors asked for death by a legally qualified patient to give the lethal jab or refer to a doctor who will. Professional medical societies in Canada also appear ready to quash physician conscience. The College of Physicians and Surgeons of Saskatchewan, for example, recently published a draft ethics policy that would force doctors with a moral objection to providing “legally permissible and publicly-funded health services”—which now include euthanasia—to “make a timely referral to another health provider who is willing and able to .  .  . provide the service.” If no other doctor can be found to do the deed, the original physician will be required to comply, “even in circumstances where the provision of health services conflicts with physicians’ deeply held and considered moral or religious beliefs.” In other words, a willingness to kill patients who want to die may soon become necessary to practice medicine in Canada.

At what point does the “right to die” become a “duty to die” for those with severe mental illness? Might persons with chronic mental illness be more susceptible to manipulation by spouses, children and extended family members? What happens when health care cost-containment efforts by the government or private insurance companies limit access to more costly treatments? What will extending the “right to die” to mental health patients with “intolerable” suffering do to increase the vulnerability of persons with other chronic disabilities?

What shall the church do to uphold human dignity and the sanctity of life, especially for persons with chronic mental illness and those with physical or psychological suffering associated with severe or chronic disability?

Joni Eareckson Tada spoke of her own experience of hopelessness and depression following the diving accident that resulted in her quadriplegia in this blog post

But the truth is pain is not among the top reasons for why people choose assisted suicide. Instead, they are psychological issues which can be effectively treated. When I broke my neck and doctors told me I would never again have use of my hands or legs, I sank into suicidal despair. But looking back, my problem was never my spinal cord injury: my problem was clinical depression that later lifted through the support of family and Christian friends. Besides, who is to say when quadriplegia, multiple sclerosis, muscular dystrophy or ALS is classified as “terminal”? There are tremendous risks to this new law, including suicide contagion, elder and disability abuse, and the inevitable expanse to broader groups of people to reduce their choice. So rather than making it the state’s responsibility to help despairing people kill themselves, let’s pour more effort into improving pain management therapies and strengthening the hospice movement. Let’s lift people out of depression through compassionate care. Because after all, we must do all we can to protect, defend, and preserve every life — especially those with disabilities

Updated October 5, 2015

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KM Logo UpdatedKey Ministry has assembled resources to help churches more effectively minister to children and adults with ADHD, anxiety disorders, Asperger’s Disorder, Bipolar Disorder, depression and trauma. Please share our resources with any pastors, church staff, volunteers or families looking to learn more about the influence these conditions can exert upon spiritual development in kids, and what churches can do to help!

About Dr. G

Dr. Stephen Grcevich serves as President and Founder of Key Ministry, a non-profit organization providing free training, consultation, resources and support to help churches serve families of children with disabilities. Dr. Grcevich is a graduate of Northeastern Ohio Medical University (NEOMED), trained in General Psychiatry at the Cleveland Clinic Foundation and in Child and Adolescent Psychiatry at University Hospitals of Cleveland/Case Western Reserve University. He is a faculty member in Child and Adolescent Psychiatry at two medical schools, leads a group practice in suburban Cleveland (Family Center by the Falls), and continues to be involved in research evaluating the safety and effectiveness of medications prescribed to children for ADHD, anxiety and depression. He is a past recipient of the Exemplary Psychiatrist Award from the National Alliance on Mental Illness (NAMI). Dr. Grcevich was recently recognized by Sharecare as one of the top ten online influencers in children’s mental health. His blog for Key Ministry, www.church4everychild.org was ranked fourth among the top 100 children's ministry blogs in 2015 by Ministry to Children.
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One Response to Suicide by doctor?

  1. Ann Holmes says:

    Compelling question, Steve! Share your thoughts (as I’m sure you have them) on strategies! It’s stunning the ethical issues facing the church and individual believers in our day! Wow!

    Like

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