I may have mentioned this case before, but it’s one that’s guaranteed to cause arguments, for it involves the Netherlands’ policy of allowing doctor-assisted suicide of patients with incurable and debilitating mental illness. The description is at the Free Press, and you can read about Zoraya ter Beck by clicking on the screenshot below:
The U.S, has no such policy, although the following states and countries have medical aid in dying for physical illnesses (see the Wikipedia article for notes and qualifications):
Physician-assisted suicide is legal in some countries, under certain circumstances, including Austria, Belgium, Canada, Luxembourg, the Netherlands, New Zealand, Portugal, Spain, Switzerland, parts of the United States (California, Colorado, Hawaii, Maine,Montana, New Jersey, New Mexico, Oregon, Vermont, Washington and Washington DC) and Australia (New South Wales, Queensland, South Australia,Tasmania, Victoria and Western Australia). The Constitutional Courts of Colombia, Germany and Italylegalized assisted suicide, but their governments have not legislated or regulated the practice yet.
I haven’t looked carefully at all these places to see if they allow physician-assisted suicide for the mentally ill, but as far as I know the Netherlands is unique in this respect. Canada was supposed to allow it, but has put it on hold.
Opposition to general euthanasia is often based on religion (“God will take you when it’s time”), and opposition to euthanasia for mental illness is based on the supposition that the illness may be temporary, so that people might recover and be glad they didn’t choose doctor-assisted suicide.
In my view, not only should people with any intractable illness that causes great pain should be allowed to die legally, and I don’t exempt mental illness. In fact, severe depression or bipolar disorder can be the equivalent of cancer: although mental illness might not kill you by itself, it can make life not worth living, so that death would seem to be an ethical choice for both the patient and the state. Further, at least in the Netherlands there are sufficient protections in place to ensure that a person who has a good chance of recovering will not be euthanized, and that the illness must be intractable as judged from previous medical interventions.
But I digress: click to read (it’s archived here):
The details:
Even as a child, Zoraya ter Beek had a persistent wish to die. Growing up in the quaint Dutch town of Oldenzaal, she never felt as if she fit in. At the age of 21, she was diagnosed with autism; a year later, she started wearing a “Do Not Resuscitate” tag around her neck. Last Wednesday, her wish was finally granted: after a three-year wait, Zoraya ended her life through physician-assisted suicide. She had just turned 29.
. . . .Zoraya received little or no support from her family. When she turned 18, she moved out of her childhood home to live with her boyfriend, Stein. He was ten years older than her, and her parents didn’t approve of the age difference. When I first contacted her, Zoraya had been estranged from her mother and three older sisters for six years. Her father died last year from cancer.
As a young adult, Zoraya felt unable to study, or embark on a career. She told me Stein, who is an IT programmer, was worried about how she felt, and encouraged her to get therapy. Over the course of a decade, she tried everything to relieve the symptoms of her mental illness—including, at last, 33 rounds of electroconvulsive therapy, where electric currents jolt the brain.
Zoraya’s last treatment was in August 2020, after which she says her psychiatrist told her: “There’s nothing more we can do for you. It’s never going to get any better.”
“After we heard that, we all kind of knew what that meant,” Zoraya told me, referring not only to herself but her boyfriend, her friends, and her doctors. “I was always very clear: if it doesn’t get better, I can’t do this.”
I ask you: who would insist that this young woman, in deep pain from mental illness that could not be cured or even helped, stay alive? And why?
And so Zoraya went ahead:
Earlier this month, she told The Guardian: “People think that when you’re mentally ill, you can’t think straight, which is insulting.”
“In the Netherlands,” she added, “we’ve had this law for more than 20 years. There are really strict rules, and it’s really safe.”
Zoraya had great faith in not only the law but also the medical profession.
“Doctors want to help people feel better,” she told me. “Doctors don’t become doctors to kill people, even if that’s what you’re wishing for.”
Nevertheless, Zoraya had a plan B—or, as she called it, an “escape plan”—in case her application didn’t get final approval. It was a suicide kit, which she told me she’d obtained from Exit International, an NGO that advocates for the legalization of voluntary euthanasia.
In the end, she didn’t need it. Zoraya had hoped to be euthanized on her birthday, May 2. But there had been some last-minute bureaucratic delays. Nevertheless, her assisted suicide was approved a couple of weeks ago.
Another argument against assisted suicide for the mentally ill is that it could lead to a “slippery slope,” in which people who aren’t that ill, or pretend that they’re suffering, use it as an exit when they could be cured. But although the number of cases of euthanasia for mental illness is increasing, I know the Netherlands’ criteria are sufficiently strict to halt any slope. The increasing numbers reflects, I think, the public’s increasing acceptance of euthanasia as a humane way to end a miserable life, as well as increasing dissemination of information:
The fact is an increasing number of people suffering from mental illness in the Netherlands are choosing to end their lives. Zoraya is right that the assisted dying law has been around for years, but even as recently as 2010, there were only two recorded cases of medically assisted suicide that involved psychiatric suffering. Last year, there were 138.
But Zoraya is all on board with the regulations as they are, and agrees that they should be strict. And so, with the help of a doctor, she ended her life:
Zoraya told me she didn’t want a funeral, because she didn’t think her friends would want to say goodbye. But she did want her boyfriend to be with her at the end. When I spoke to her, she described how she wanted to die:
I will take my place on the couch. [The doctor] will once again ask if I am sure, and she will start up the procedure and wish me a good journey. Or, in my case, a nice nap, because I hate it if people say, “Safe journey.” I’m not going anywhere.
On Wednesday, a friend of hers posted an announcement on X: “Zoraya passed away today at 1:25 p.m. Or as she saw it herself: she went to sleep.”
Few details of her death have been reported—except that her boyfriend was at her side.
It’s sad to envision this, but we are not at the point where conditions like Zoraya’s can be treated. But again, who can gainsay that she did what was best for her? Who could be so churlish as to say she must stay alive.
The answer: the faithful.
If you want to see religious jobs who argue that prayer and recognize the value of suffering should have kept her alive, read this article in the Catholic Herald: “Zoraya ter Beek deserved doctors who cherished her life as precious.” A quote from that:
As Catholics, we have a powerful message to tell that there is value to be found in suffering: when we step into church, we are met with the sight of Christ crucified, and are reminded of the agony he bore because he loved us. In fact, it’s because Christ experienced being human that we can be sure that he understands and cares for us in our suffering. Still, most of us are not lawmakers. We’re not campaigners or politicians. Trying to justify our Catholic beliefs to the world can seem overwhelming – almost pointless, when our faith is so often denigrated.
As Catholics, we must continue to remind ourselves of the power of prayer; not exclusively praying for a change of heart of those in positions of power who may choose to legalise assisted dying, though that is of course important, but rather praying in order to cultivate closeness to God in our own lives. We must rely on God first, and only then can we show others that we can help them bear their pain. We must confide in the one who bore the greatest pain for us, and petition, in prayer, to be given the strength to imitate his goodness and his compassion in our own lives. Finally, we must never lose hope, even in cases where a person appears determined to die. We must pray for them to the very end, for by God’s grace, no soul is ever truly beyond saving.
This is the maliciousness of religion: keep the suffering going, for superstition tells us that God will make it all right in the end. It’s horrible.
Here she is in a video made by The Free Press:
Whatever one’s views are on euthanasia, I do think that this and cases like it are excellent examples that “slippery slope” arguments are not fallacies.
You’re going to have to explain that. The increase in number of cases over time doesn’t mean that it’s become easier to kill yourself; as I said, there are at least two alternative explanations.
I seem to remember the philosopher, A C Grayling dismissing slippery slope arguments by saying something like: having one cup of tea will lead to another, and another, etc. etc. until the tea drinker’s life is unbearable. An obvious non-sequitur.
If your psychiatrist tells you “There’s nothing more we can do for you. It’s never going to get any better.” get a second opinion. That treatment was nearly four years ago, and none since then. How could she still be so sure that her condition was hopeless?
She did get a second opinion., as far as I know. Plus she tried many treatments under different doctors. Drugs, electroshock, talk therapy. What would you tell her to try next–just go from doctor to doctor forever?
The article says:
Zoraya’s last treatment was in August 2020, after which she says her psychiatrist told her: “There’s nothing more we can do for you. It’s never going to get any better.”
“After we heard that, we all kind of knew what that meant,” Zoraya told me, referring not only to herself but her boyfriend, her friends, and her doctors. “I was always very clear: if it doesn’t get better, I can’t do this.”
That seems to mean she got no treatment after August 2020. She took the opinion “there’s nothing more we can do” as final and applied for euthanasia, which did not happen until May 2024. If she received more treatment in the years leading up to her euthanasia, then the article is misleading.
She has a right to suicide, and we have a right to question her decision. Maybe she made the right decision, but this article is not completely convincing.
When you say that you “have a right to question her decision”, what does “questioning” it entail? Do you mean that you have the right to review it further, to passively disapprove, or to comment negatively on it? Or do you mean that you have the right to actually obstruct her ability to act on it if you disapprove? Since you also say that “she has a right to suicide”, I assume the former applies. If the latter, however, I “question” whether you have, or should have, such a right.
Whether or not she made the “right” decision, it was her decision to make.
Having a right to do something does not place you beyond criticism for doing it. You have an absolute right to vote for Trump. But if you do it, you are a moron.
This lady has right to euthanasia, in my opinion, but we have a right to wonder whether she did the right thing. Based solely on this article, I’m not so sure.
Stopping her might require a court to find her incompetent to make major decisions about herself. She does not seem incompetent to make the decision, but she might still be wrong.
I am wary of decisions made by very vulnerable people who may have limited decision-making capacity, decisions that are to apparent detriment of the decision-maker but to supposed benefit of the society.
I agree that no one has the right to decide whether someone else should be allowed to die without pain and at a time of their choosing. In my opinion, that is a fundamental right of all humans, and although it’s very sad, this young woman should have been able to choose how and when she died.
However, I too, worry whether she made the “right” decision, but not because I would wish to deny her autonomy. My concerns are around the basis for her decision as it was made on questionable advice. As such the medical profession that provided advice and the political establishment that sanctioned it are complicit in her unnecessary death.
Why is this bad? Because the advice was bogus. Unless there is clear evidence of serious brain injury, the science of psychiatry has not yet advanced to the level where such a claim can be reliably made. Therefore, the psychiatrist asserted as truth something which he could not possibly have known: that there was no prospect of recovery. He did this understanding that it would form the basis of a life-or-death situation.
This also paved the way for other potentially curable sufferers of mental illness to decide to die and to do so with the blessing of the medical establishment and government.
Mental illness is never as cut and dried as that though. If a psychiatrist says it will never get any better, you need to find a new one, because what they are really saying is that they are not smart enough to help. We live in an era where there are lots of new and emerging treatments for intractable depression, many of which have demonstrated outstanding efficacy. The list includes psychedelics like psilocybin and dissociatives such as ketamine.
In my early twenties, I became seriously mentally ill, and for many months, I was unable to function independently. It was as if the world and I had disintegrated into a nightmare. It was horrific; I was living in an unrecognisable and alien world that I couldn’t escape. I spent time in hospital, I had to drop out of university for a year and I was unable to partake in a sport where I had previously been very competitive and successful. My mental state was so fragile that I had to return home and sleep on a camp bed in my parents’ room – at 21!
I slowly got better over the following 12 months but never fully recovered and spent the next 20 years in a relentless pit of desperation and hopelessness, alternating with extreme sleeplessness and anxiety. I was prescribed over 20 psychiatric drugs during that time, none of which helped, and several psychiatrists said there was nothing else to try.
Eventually, through my own research and perseverance, I realised that I likely had ADHD. This was about 7 years ago, and I’ve never looked back. I saw a specialist psychiatrist who diagnosed me with ADHD, he referred me to another specialist who diagnosed me with autism, and I was finally diagnosed with bipolar disorder. After 2 decades I finally received effective treatment (including ADHD meds and mood stabilisers), and improved dramatically.
I suffered 20 years of wishing I was dead and contemplating my end many times over. I used to experience vivid visions of killing myself regularly while I was engaged in banal activities like sitting on the toilet or making coffee! These just arrived in my head with no warning and were very disturbing. After being in such a hole for a long time, I thought, or rather I KNEW, that I would NEVER recover. However, now I’m on the right treatment, my mental health has been transformed. I have a wonderful family and have managed to build a good career. In fact, in terms of my state of mind, I’m pretty much back to where I was before my first breakdown. This, after years of believing with all my being that I could never get better.
The brain is an incredibly adaptable organ, it’s also acutely sensitive to our lives, circumstances and myriad other factors. For a psychiatrist to say there is no hope is shocking to me, not least because we understand so little about how it actually works. It’s unacceptable, in my opinion, because there is always the possibility for improvement in our mental health. I’m disturbed and saddened that this young lady chose to go down this route and even more disturbed that she was supported by the medical establishment. It doesn’t sit well with me, and it makes me very sad.
I am very glad that you finally got better! And I agree about the lady in the post, I think the medical establishment and the entire society failed her.
In an article on euthanasia, a physician hit the nail on the head with the sentence:
“It is impossible to give meaning to someone else’s life”.
.#
It’s always seemed to me that nothing is as absolutely and uniquely yours as your own life. If you decide it’s not worth living any more and you’re mentally competent, it should be your choice to end it. No one should be able to tell you that you need to continue to be miserable or in pain based on someone else’s unjustified presumption that even a miserable life — life for life’s own sake — is preferable to no life at all.
+1
+1
Hear hear.
I agree.
The complexity comes in when a person who wants to die requires someone else’s help. Then things get difficult. Was the person coerced? Does the person really want to die or is the helper being too helpful? Must doctors, or governments, or caregivers provide assistance leading to death, or can they decline? The list becomes long, but in my view the fundamental right of a person to end his or her own life should not be infringed. To me, the need in this area should be to establish a way to confirm that the person really wants to die.
Add one more voice to the chorus. You are absolutely right.
Spot on! 100% correct.
Exactly.
+1
That is already the law pretty well everywhere in the WEIRD countries. The unsettled issue is whether someone else can or must help you. Generally speaking, the same freedom you proclaim not to be compelled to live is the freedom enjoyed by every other person not to be compelled to submit to your demands or requests. In a free society the citizen can try to persuade and he can seek to contract but he cannot compel.
I’m experiencing cognitive dissonance over this. I agree people should be free to end their own lives, within reasonable limits of time, place, and manner (like campus protests) such as not allowing children to end their own lives.
But an adult mammal of reproductive age wanting to end his or her life seems like prima facie evidence of an inability to think straight (contra Zoraya’s claim), for which a good therapeutic solution is needed and maybe in Zoraya’s case just hadn’t yet been found. All mammals have a strong evolved behavioural adaptation to stay alive and reproduce. A breakdown in that adaptive phenotype is a medical condition that should be treated.
I’m struggling to resolve that for myself. Maybe the solution is to think of Zoraya’s mental health condition like an untreatable cancer that can only be addressed with palliative care? IDK whether we understand conditions like hers in the same way we understand some untreatable cancers?
All mammals have a strong evolved tendency to want to reproduce. Does that mean you think that people who use condoms aren’t thinking straight?
No that’s not what I think. I regret that my expression of dissonance here was so opaque (and that other commenters focused on reproduction). I did a bad job expressing myself, and I’ll try again:
It’s a normal part of our evolved nature to want to live because living increases our likelihood of reproducing. A breakdown in those evolved behaviours for surviving in someone like Zoraya seems like evidence that she is not able to think through things clearly, because for a mammal “thinking clearly” means in part trying to stay alive.
That’s all I meant: if criteria for the state (via medical professionals) to help someone kill themselves include the requirement to be thinking clearly, mental illness that makes an otherwise healthy person want to die seems not to meet the criteria.
Maybe that means “able to think through things clearly” is not a good criterion to use. And maybe this is just evidence I’m not able to think this through clearly myself (cf. dissonance). Again I think individuals should be free to end their own lives within reasonable limits of time, place, and manner.
A woman I know actually had an untreatable cancer. Once a friend visited her and brought her out of the hospital to spend time together. After that, the patient admitted that she was glad she hadn’t resorted to euthanasia as she had considered, because life could still bring little joys.
I hope she had some more joys before the cancer killed her.
“Adult mammal of reproductive age.”
This seems like such a cold comment. If she were infertile, would you have experienced less cognitive dissonance?
No one thinks that this type of depression is normal. Of course it should be treated – not just because of one’s reproductive capacity.
The problem is that some mental illnesses are very difficult to treat. This is a sad story, but not because Zoraya didn’t have children.
I don’t know exactly what Mike meant but she looked healthy and this reminds me of when an otherwise viable person suddenly dies from a cardiac arrhythmia. It just seems there must be a way to prevent this death. I have seen people with serious medical problems say “where there’s life there’s hope” and want to fight to stay alive. So why do they want to live and she doesn’t? I don’t know what she was going through (which makes all the difference) and it is her life, to do with as she wishes. I just wish there was another answer than her death. Once you are dead there are no more possibilities.
I didn’t say anything about her personal history of reproduction. My comment is about evolutionary adaptations that shape ~all mammal behaviour, including adaptations that cause adult humans and other mammals to try to stay alive and reproduce. This urge to stay alive is foundational to our biology, and the failure of that behaviour to manifest at a young age is evidence of something wrong. Age is relevant because senescence happens, and evolution doesn’t act strongly on phenotypes expressed after reproduction has waned. An inclination to end one’s life in old age seems ~normal in that light. That’s the only meaning of my comment. IDK whether it’s “cold”, and it’s not meant to denigrate Zoraya or her decision to die.
[edit to add] I appreciate Garnet’s comment and the nudge to clarify my meaning.
Generally, you are right that most animals want to survive. If they hadn’t had that disposition during their evolutionary history, the trait wouldn’t have survived either. But there is natural variation, this is implicit in nature, and essential to the way evolution works, otherwise there would be nothing for natural selection to work on. We should expect that some people do not fit the usual paradigm and for whatever reason might not want to survive.
This way of thinking might sound cold and callous, which is exactly the reason we can take no moral messages from nature. To put this another way we should all be careful about not committing the naturalistic fallacy.
In order to understand what matters, we need to assess what feels important to the individual and find the best possible solution for that person, while fully accepting that this may not be an easy decision to make either for the ethicists or the medical professionals, and there are no guaranteed rights and wrongs.
“Horrible” “malicious” “superstitious”? You write “This is the maliciousness of religion: keep the suffering going, for superstition tells us that God will make it all right in the end. It’s horrible.” Your clearly heartfelt expression sounds superstitious; the words of an atheist convinced that certain things are neither real nor possible or right. I do not for a moment consider you malicious, but I do think this you’ve taken a unwise position on this horrible story.
Oh, really? Do you have convincing evidence that there is a God? And yes, I’ll say that I can’t rule out God completely, but I’m about a 6.9 on the 7-point Dawkins scale on which 7 means “I’m certain there’s no God.” As a scientist, I cant take that position.
So tell me what my unwise position is. Is it that I do not accept God? Or that Im parroting Mother Teresa’s view that suffering is good and should be tolerated?
Please do not post further until you explain what you’vesaid above
You are as Dostoevsky’s Aloysha said – railed given he was a great doubter – in ‘The Brothers Karamazov’ trapped, with me and other humans, within Euclidean dimensions. Even a lay grasp of quantum research or String Theory shows that science’s leading edge advances on propositions, and theorising. Empirical evidence of these suppositions is hard to come by – actually non-existent. I hover between atheism and wonder and back. I am making neither of the unpleasant suggestions about your thinking. It is wholly reasonable and generous, so please feel no need to defend your position on any Dawkin scale. I have no evidence, let alone ‘convincing’ evidence, about God. I was ticking you off for using words like malicious and horrible. I am more hesitant than you to adopt so firm a position on assisted dying. I used to support and even lobby for legal euthanesia within all the carefully designed restrictions you describe, until I understood in my old age the ingenious depravity that some humans with skin in the game can bring to bear to circumvent the strictest of legal precautions. Please don’t take offence at my patronising reflections on your very decent thinking.
Whether or not you agree with his conclusions, there’s absolutely no whiff of “superstition” in what Dr Coyne wrote. That accusation just sounds like another variation on the obtuse and obfuscatory claim peddled by many religious apologists that “atheism is just another religion”.
I note also that you did not bother to explain how or why his position is “unwise”. Again, very like the pablum offered up by religionists; assertions made without solid evidence provided in support.
Thanks for your reflections and forgive my turn of phrase if it comes amiss. I was being a little arch with that word ‘superstition’, but I do react against this demand – regularly referred to by the excellent Richard Dawkins – for evidence, or ‘firm’ or ‘solid’ evidence, given that the case for String Theory or Quantum Mechanics isn’t firmly or soundly evidenced, or indeed evidenced at all in any empirical ways, though superbly and intrictly reasoned in complex multi-dimensional mathematics as far beyond my grasp as the weird idea of resurrection, miracles and virgin birth or the Trinity. My reaction was against the use of words like ‘horrible’ and ‘malicious’ to derogate the thinking, which I shared, that assisted dying isn’t such a good idea or practice given the capacity of bad people to circumvent the strictest of regulations.
Yes but there is no religion of string theory that dictates how one should live one’s life , who one should marry, what role one plays in society, if one should suffer, etc.
As much as a billionaire working one day in a sweatshop has no idea what it is like to poor, a God suffering like a human, or pretending to, out of an eternity of not suffering has no real clue as to what it is like to suffer a human, therefore the point is moot.
Forcing increased suffering on people for such reasons is “Horrible” “malicious” “superstitious”.
Immanuel Kant strongly objected to suicide based on ethical reasoning rather than religious beliefs. According to Kant, individuals have a moral duty to protect their own lives and show respect for their inherent humanity. He argued that taking one’s own life goes against a universal moral law, a concept deeply ingrained in his philosophical principles concerning the fundamental nature of morality.
I disagree with Kant as I don”t believe there are any “moral laws”. There are just preferences that become codified as morality for various reasons.
If morality is “the moral beliefs and practices of a culture, community, or religion or a code or system of moral rules, principles, or values” (Britannica), what is meant by “I don”t believe there are any “moral laws””?
I tend to think that while there not be natural “moral laws”, there is still a basis in reality for such laws to exist. If not, how could you say that the very first person on earth to whom it occurred to think “slavery is wrong” was in fact right, and those who thought he was off his rocker were wrong? Where and when would that sentiment “become” right- only after it became the majority opinion?
The fact that my life and welfare matter to me, and your life and welfare matter to you, seems to me reason enough to believe that both yours and my life and welfare do and should matter, and that it is logically inconsistent to think otherwise.
Logically I say, but in honesty, I haven’t thought up a good proof. Still working on it though. 🙂
You say ‘I disagree with Kant as I don”t believe there are any “moral laws”’. That seems to contradict your dismissal of the proposition that atheism, and attached ideas, is also a matter of faith. We could go round and round on this science versus superstition issue (:)). I greatly enjoy your writing. I have no desire to contest you at argument. Your thinking and writing stimulate my old brain. My favourite saint is ‘doubting Thomas’. Thomas doubted faith (until touching his saviour’s wounds) as I do, as well as doubting atheism (what’s the equivalent for an atheist of putting your finger in a wound?). I am much taken with the words of the theologian Paul Tilllich when he points out that “the opposite of faith is not doubt, the opposite of faith is certainty.”
Assisted dying is becoming a hot topic in the UK, and Labour have promised to allow a free vote in Parliament if they win the election. Whenever the issue surfaces, we get a lot of pushback from specialists in palliative medicine, who assure us that they can address all the conditions that may cause people to contemplate assisted dying. The problem is that they can’t, and people can all too easily suffer from such a degree of pain, indignity or mental anguish that the only solution for them is to end their lives. Nobody has the right to overrule them if they are determined to take this serious and tragic step.
And ‘they are sharing Jesus’s suffering’ is the excuse made by that old charlatan Anjezë Gonxhe Bojaxhiu (‘Saint’ Mother Teresa) for not providing proper medical treatment for the Indian street women she took into her hostel. Utterly ethically bankrupt.
The UK health care system is notoriously strapped of cash, to the degree of encouraging gullible women to give birth with only a midwife to assist, and even at home.
Once a system is set in place to assist the suicide of people in pain, I doubt very much that expensive palliative care will be offered to them for free. They will be regarded as a mere drain on the budget, like people with untreatable mental illness.
Edward Shorter wrote a book on psychosomatic illness that is worth a look at. There’s effectively no measurable abnormality, but still the patients demand treatment, and get it.
Here, the treatment is one step further – ending life.
I’m not arguing any conclusion here. I am asking if there really is no material basis for a condition claimed to be “mental” – is this a catch-all? I know the psychiatrists say things, but is there a .. what.. empirical cause-and-effect basis, a ruling out alternative explanations, like with say oxygen, vitamins, light… damage from prior exposure to who-knows-what… that makes it no longer “mental”, but incorporates the material world?
So complex, and consequential. Because this mental health stuff is pushed at every level lately.
But praying it away according to a doctrine from antiquity won’t work, for sure, besides maybe like a meditative effect.
You are right, of course, and I paused when I made that distinction between mental and physical illness. All of it is physical. It’s just that mental illness cannot be terminal, which is the usual reason for allowing euthanasia.
You’re absolutely correct. We certainly don’t understand enough about the brain to conclude that recovery is not possible. While all mental states have a material basis and can, in principle, be observed, we are nowhere near the level of technology and understanding that would make such observations worthwhile, especially from a clinical perspective.
As Rutherford said, ‘All science is physics or stamp collecting’. Although that is undoubtedly true, we cannot yet begin to understand the enormous conglomeration of atoms and forces that conspire to generate our mental state. We are certainly a country mile off establishing reliable cause-and-effect relationships for all but the most basic mental responses.
For these reasons, I feel it’s outrageous that the Dutch medical authorities accepted the conclusion that she couldn’t be helped.
Even more problematic (ugh sorry, a horrible woke word, but one that is appropriate here) is the fact that psychiatry has NEVER and can NEVER stand independently as a discipline. It can only ever be understood from within the societal context (norms, beliefs etc) in which it was developed. After all, fundamentalist Islamists or Christians are, by definition, psychotic. Similarly, a modern psychiatrist brought up in the Middle Ages would not view your literal belief that the devil is controlling your actions as delusional. However, the same doctor brought up in modern society would think you were mad.
I should mention that I am in no way anti-psychiatry. I have been helped enormously by psychiatry and psychiatrists, to the extent that my life has been transformed. I owe those doctors a tremendous debt of gratitude. However, I wanted to expand on what you said about the physical origins of mental illness and the problems of making such enormous decisions on that basis.
Well, as I have said before, I am dubious about assisted suicide, in general. A couple of things that I will say is that it should never be about convenience for others or public cost. And I think there is a danger of providing a path to increasing the supply of organs for transplant that might cause undue pressure. (Anyone who has ever ready Larry Niven’s ‘Gil “The Arm” Hamilton’ stories about the organleggers will know what I mean.) I am also dubious about the care and attention any bureaucracy will pay to the special circumstances of a patient. Bureaucrats like everything clean and simple, which frankly sounds like a recipe for rubber-stamping suicide. Not to mention if assisted suicide were to become a fad, like “gender transition.” Also, I am inclined to think it should be reserved for those who are not physically capable of killing themselves.
Something about this case bothers me too. It’s not religious. It’s just some kind of instinctive revulsion. I can’t explain it.
I agree. I also suspect that, the same way as children not old enough to be allowed to buy beer are regarded as competent to decide sex change, people with conditions making them incompetent to manage a bank account will be considered selectively competent to demand assisted suicide.
Not that I am suicidal or depressed or terminally ill but I discussed this subject of physician assisted dying with my GP during a routine check up consultation and he said at the time that even were I suffering greatly from a terminal illness he would never be a part of this procedure and this despite us knowing each other for a considerable time such that we were more than just “doctor and patient” . When pressed for his reasons he said that his life was treating and saving people and his whole career would be destroyed in his mind by this procedure. I understood fully his reasoning, he is retired for some time now, and it must be a very difficult decision to even consider this procedure as a doctor and I am sure that there are many who feel this way. I wonder how easy it is to find help in these circumstances when one has decided that death is the only solution. I would add that I am in favour of this personal choice but I wonder collectively how the medical profession feel about this side to their work that they may be asked to facilitate. This is not a new procedure and has been common in some countries for a long time but I don’t recollect reading or hearing much about the physicians and their views, maybe I do not read the applicable literature?
All I know is that it’s quite common for doctors to hurry along the process of dying when a patient is terminal and in pain, doing so by increasing the amount of morphine.
That’s what, I understand, does often happen, Jerry, and I think it is a wise and considerate way for doctors to act.
For me the physician’s position in Robert’s post illustrates what perhaps is the central problem in ethics. I know you’ll know this Jerry, but still maybe worth expanding in this thread. On one side the argument is whether there are moral absolutes written into the fabric of the universe. In this view murder, lying and sexual infidelity are just self-evidently “wrong”. Kant’s categorical imperatives fit into this category. This overall position is defined as the deontological approach. From this perspective, human life (although often not non-human animal life of course) can be thought of as having a special essence, and which must be preserved at all costs.
The opposite position, consequentialism, is that no such absolutes exist and right and wrong can only be determined by the consequences of the action taken. One version of consequentialism is “utilitarianism”: which in its simplest form is often termed “the greatest happiness principle”: an position most associated with Jeremy Bentham: it consists in the idea the best action is one which maximises the greatest happiness for the greatest number.
From an evolutionary perspective deontological solutions don’t work. Who decided what the absolutes are? Where did they come from? Why would human life have any special essence compared, for example, to a chimpanzee? Kant tried to establish his deontological position through reason of course, but he still depended on his feelings about what was right or wrong. On the other hand consequentialism does fit with an evolutionary framework. Nature is no guide whatever to what is right or wrong, but we can often determine what the best outcome might be using the best estimate of what the outcome of an action might be in respect of the impact on fellow sentient beings.
It seems to me that the physician Robert mentioned leaned more towards the deontological approach, which could lead to appalling distress to a patient if a doctor was trying to preserve someone’s life at all cost despite any deleterious impact there might be on them.
Oh I forgot to note – probably because this is so disturbing:
One one hand, we have doctor-assisted medically-oriented suicide.
On the other : legal execution, medically assisted.
From what I have gathered, there is nothing humane about this. The condemned may be motionless, but e.g. the heart (the literal heart) is ravaged – IOW there is pain.
How can the actual procedure of medically-assisted suicide be so different from medically-assisted execution? I’d have hoped it was identical, with all the available pain medication, etc. but maybe the state can’t afford the pain-free procedure.
I think part of the apparent barbarity of “medically-assisted execution” is that we only ever hear of the cases where it went badly, and some of those involve “patients” with severely damaged veins (due to many years of IV drug abuse), and some who fight the procedure. Another part is that executioners aren’t keeping up with the latest advances — I hear that a whiff of nitrogen is all it takes, causing almost instant unconsciousness and then, nothing. And finally, judicial execution isn’t euthanasia, it’s punishment, so there is little incentive to make it painless. So medical aid in dying and capital punishment aren’t remotely comparable.
Many of the companies that produce the drugs used for lethal injections cannot and/or will not sell their products for use in executions – the EU has banned the export of drugs for exeicutions since 2011, for example.
Since then some novel cocktails have been used in the US, with sometimes unpleasant results.
https://en.wikipedia.org/wiki/Lethal_injection?oldformat=true#Complications_of_executions_and_cessation_of_supply_of_lethal_injection_drugs
Executing prisoners in the US already costs a fortune, due to legal appeals, special death row facilities, etc. A few dollars more for pain medication is unlikely to be a deal breaker.
Drug companies wont furnish pure drugs that can do the job effectively, like pentobarbital. Thus if you are executed via injection, they often use grey-market or “compounded substances. Executing a person, if done with the right drugs, should be like putting an animal to sleep. But drug companies dont want to furnish the right drugs to use for killing people. I can understand that, but I don’t like it.
Similarly to the executions, not all cases of medically assisted suicide / euthanasia are humane.
“When the doctor surreptitiously slipped a sedative into the patient’s coffee, she took away the patient’s chance to physically protest her death. When the doctor began administering barbiturates to end the patient’s life, the woman tried to get up and the doctor asked her family to hold her down. The doctor said she was fulfilling a written request the patient made for euthanasia years earlier and that since the patient was not competent, nothing the woman said during her euthanasia procedure was relevant… On the morning of the euthanasia, when her family was present, the patient was even making plans to go out to eat with them.”
https://apnews.com/general-news-8278f8a6224a47e88b46ea434eda26b4
The heart (the literal heart) doesn’t feel pain except from ischemia when a coronary artery is suddenly blocked or demand exceeds supply in what we recognize as angina of effort. This is not what happens in executions or in euthanasia. I don’t know how you can state that an unconscious paralyzed criminal being executed with skillfully provided lethal injection feels pain, unless he were to wake up and tell us. The hard part in executions is finding a vein to catheterize if they have all been scorched by years of i.v. drug abuse. This can indeed be an ordeal especially if the tech is not highly skilled. That, and the unavailability of thiopental, in one reason why states are trying to find alternative methods of execution. Medical euthanasia uses different anesthetic drugs but prisons can’t willy-nilly change drugs without legislative approval.
It’s difficult to imagine anyone being given a paralyzing drug and a drug to stop the heart without being put to sleep in deep anesthesia first but anything is possible if things get grim enough I suppose.
I’m guessing you must realize by now that the woman in question is already dead
I do now…belatedly. Our internet was out for three days and I simply didn’t read this post carefully, recalling Rupa’s earlier article. I feel stricken that she is actually dead.
Well this thread has been interrupted many times and comments haven’t posted in order anyway so, don’t feel bad. Take care. Seems the more we’ve come to rely on the internet the less reliable it is.
I would be interested in the list of medications, types of talk therapy, duration of treatment and any newer types of therapy that might have been tried like psilocybin or ketamine. Since some affective brain disorders are linked to mitochondrial dysfunction a three month trial of a keto diet (I know it sounds weird but read the book ‘Brain Energy’ before you discard it) would be worth a shot. If I were in the same situation I might have made the same decision but it would have been interesting to have high resolution MRI studies done before death to measure regional volumes of gray and white matter, CSF studies, and appropriate postmortem studies on the brain, including complete genomic analysis. One of the mental health organizations should consider setting up a worldwide study protocol for these types of patients. I imagine that funding would be difficult and such a study would take decades to complete.
Gonna check it out – thanks.
This is definitely a difficult issue. I am not religious at all, but I wonder whether this exit strategy is providing the medical community with a way out of dealing with difficult cases. It’s not too different in my mind than someone wanting their healthy limb cut off in body dysphoria — a doctor can amputate, but is that really a good solution? How will this help the field of medicine progress?
The other question I wonder is why does someone like this need assisted suicide? It’s different in those who are physically uncapable of ending their lives. (Has there been any study that looked at suicide numbers vs. physician assisted suicide for the mentally ill?) And, thus, in this case, I would argue why are we getting the government involved?
Finally, I think the slippery slope issue is alive and well in Canada’s assisted suicide debate currently as the health care system is financially struggling and, thus, with suicide added there was even greater concern.
Hi professor – I’m a big fan of yours!
Just wanted to say that. 🙂
Also…I think “the government involved” mainly involves seeing the gvt doesn’t prosecute the doctors.
Looking forward to your book I heard about lately.
D.A.
NYC
Thanks!
why does someone like this need assisted suicide?
That’s a good question. This way she gets guaranteed success, and a dignified, peaceful death. It also allows her to be open about her wishes and the procedure, so her loved ones can be involved before and during, as well as after.
Yes, the government was planning to add new categories besides terminal illness, but there was pushback.
Still I personally know of a case here in Canada of a young man who was basically depressed. He had to wait a year, but got it in the end. In his twenties. That bothers me. Not for religious reasons.
This is a very difficult issue. I do think a slippery-slope concern is valid. The US has a terrible health care system (I am not referring to the quality and character of physicians and nurses, who are mostly excellent). I can imagine certain categories of people becoming expendable due to cost. We have seen people exploiting the elderly for financial return in other situations. There is evidence that poor people and racial minorities receive worse health care in the US. Why would this be different?
Mental illness more complicated than many types of deadly physical diseases. It is less well understood, less well diagnosed, and often poorly treated. I admit it bothers me more for a 29 year old with a mental illness to commit suicide than a person with advanced ALS.
Now that I am old I want control over ending my life. I am not suicidal, but if I am sufficiently ill or in pain, this should be my choice. Nor do I want a lingering illness both destrying my quality of life and leaving my husband financially compromised. So you see I have conflicting views. I trust myself, but I do not trust everyone in the “system” to protect the vulnerable.
Sometimes, VERY rarely, suicide is the right answer. I don’t say this lightly as I have been affected by 3 suicides that *weren’t*. But if every day is a living hell with no chance of respite I believe it is kind.
The problem I have is who judges that. Powers of Attorney are essential to make your wishes clear, but circumstances can change. Those who hold Power of Attorney may have an interest in your will. We aren’t all lucky enough to have people we’d trust with that decision.
I don’t know the details of this Belgian case, but I’m not sure that “psychological grounds” alone would satisfy me unless there were other reasons, but I agree that some mental health conditions can be hell too. It’s just that they can’t be observed as well.
https://www.bbc.co.uk/news/world-europe-24373107
Perhaps one standard for incurable physical pain and a stronger standard for mental health?
If someone is determined to take their own life isn’t it better to help, rather than risk a botched job and leave them in a worse position?
The UK doesn’t have specific laws on this, but medics implemented the Liverpool Pathway to speed death for those in the final stages. It has officially been withdrawn, because families often weren’t told. They used it on my dad, I would have agreed anyway if they had asked. I hope it is still being used for those in distress.
This is a hot issue in France these days. The assembly is currently debating a law to allow assisted suicide. The proposed legislation is deficient, in my opinion, because it requires the person to be in command of their mental faculties, which of course leaves out victims of Alzheimer’s and similar diseases. It is also meeting enormous resistance, probably because of the influence of The Church in this “laïc” country. So France is behind other European countries including Belgium and Switzerland, to which many French go in order to end their lives. It seems to me that the principle opposition is — again — religious. Damn, we’ve been trying to get out of that since Spinoza and the Enlightenment. Makes me wonder a bit what century we are really living in.
I am so pro-euthanasia my directive calls my loved ones to pull the plug if I have a bad hair day. Really – if you’re into reducing human suffering such a stance (maybe less extreme!) is essential.
The best I’ve read on this in the last decade was THIS:
https://www.richardhanania.com/p/canadian-euthanasia-as-moral-progress
By Richard Hanania defending the Canadian model last year.
Much recommended.
D.A.
NYC
For the record, we do not have not euthanasia or assisted suicide in the United States. There are however ten U.S. states as well as the District of Columbia that permit “medical aid in dying”, under which a patient who is terminally ill (expected to die of an incurable disease within six months), and who is physically able to self-administer a medication, can be given a prescription for a sedative which can end her or his life. Under the law, this is considered a palliative treatment for symptoms of the disease, and the manner of death is legally “death by natural causes” due to the disease, not suicide. Someone who is suffering a mental illness but not otherwise already in the process of dying wouldn’t be eligible. Compassion and Choices is an excellent advocacy group that works to inform the public and promote MAID legislation in those states where it is not already available.
Thanks for that clarification!
Reading the article and then reading through the comments my current thoughts are, . . .
1) I think adult, cognitively competent people should be allowed to decide to end their life.
2) I think that assisted suicide should be made available, with a rigorous screening process to determine that the person is mentally competent to make such a decision. Such people should be able to die in a painless and dignified manner, not just for their benefit but for the benefit of their family and friends.
3) It might be advisable to have assisted suicide separate from the general medical care system. That may make it easier to avoid the development of incentives to assist folks that didn’t really ask for it. It would also avoid the conflict between the core doctrine of medical professionals (first do no harm, save lives) and helping a patient to die.
4) To my mind slippery slope arguments in general always have a certain degree of validity because there will always be a certain percentage of bad actors. The real question is, can assisted suicide be implemented and regulated well enough to keep abuse to an acceptably low level? And what is an acceptably low level? I think “extremely rare” is probably about right. I think that is possible to do with assisted suicide.
I have real difficulty with people suggesting more and different and newer therapies and so on for this woman, as if she had just traipsed lackadaisically into a decision to end her life.
A person is suffering daily, more or less constantly, and that person has gamely tried everything available to them, in a nation where, apparently, this includes repeated ECT treatments, and no doubt every legitimate medication and scientifically valid and accepted medical intervention. This person does not find joy in continued existence, but instead finds merely (or even almost entirely) pain. Why should this person have to keep trying newer, weirder, more experimental and/or esoteric things, just to stay in a life to which they are not attached, a life that is associated almost completely with their own suffering
Everyone will die eventually, anyway–all saving of lives is just saving them for later, when you get right down to it. Why should a person not be able to get medical assistance for ending their life in such a situation? Someone with terminal cancer can sometimes, in some places, get such help. Who is to say that the pain of intractable cancer is not sometimes less than that of intractable mental illness, particularly since the latter can often carry on far longer than the former is prone to do, and families sometimes will gather around and show love and support for people with terminal cancer, but will often shun and avoid and disconnect from those with chronic mental illness?
The brain is an organ, and like all organs, it is not perfect. What’s more, it’s the most complicated organ–the most complicated THING–that we know about in the universe. It does not always function optimally, and can readily turn against itself, simple-minded nonsense about mammalian survival instincts notwithstanding. Sometimes such dysfunction is obvious and catastrophic, as in various dementias, psychotic disorders and the like. But sometimes it is subtle–at least from the outsider’s point of view. [From within, be assured, it is NOT subtle, unless you consider soaking in a bath of acid that never kills you as it erodes you over years and decades, but to which, by its nature, you never become accustomed, to be subtle.]
Particularly in America, we don’t even have resources set up for people suffering from depression or other mood disorders or more complex neuro-psychiatric or neurodevelopmental or psychosocial disorders to get even basic, let alone state of the art care–such as it is with all its limitations. Sometimes people in such circumstances will “self-medicate” with various illicit drugs, and that will tend to make things worse, and they will be vilified for it and this situation, they will often end in death due to overdose–which could, at least in some cases, be considered a form of erratic and semi-accidental suicide. But it’s a LOT messier and ultimately more costly to society than first, really trying to treat mental illnesses effectively and provide support, and then, if and when nothing reasonable works, helping people to have a little dignity as they die. Surely it must be better than putting someone in the position to make a noose and hang themselves in their closets or jump from a high parking structure or swallow a whole bottle of Tylenol or slit their wrists or shoot themselves.
As for Kant’s supposed moral law requiring a person to sustain their own life, I’ll quote Colonel Slade and say “F*ck you, too!” What a sham. The burden of proof of his universal moral law is on him, and from what I can see, he certainly didn’t meet it beyond any reasonable doubt.
As for religious objections, they’re beneath contempt and not worthy of really even entertaining, except to note that it’s the same kind of mentality that wants to ban abortion but will not provide real care for children born of mothers that weren’t able to care for them…at least no care that doesn’t involve pedophile priests and sadistic nuns.
If YOU don’t want to commit suicide, you don’t have to. But you shouldn’t try, even for the sake of argument, to get in the way of someone who has reasonably exhausted all feasible avenues of treatment by the highly limited and fallible medical community (who DO try the best they can, generally, I want to note). Are YOU going to take responsibility for making that person’s life worth living, for being there with them and for them, whenever they are suffering? If not, you really ought to step off.
Robert your comments here are excellent. I only quibbled with the last line. I was going to reply with something like “hey man don’t tell others to step off and not have an opinion.” Then I realized I would be telling you what opinions to have. So I’m not telling you that, and instead just saying thanks for your contribution.
+1 she came to this decision because she suffers day in and day out. We wouldn’t ask someone suffering with cancer to try a new diet we read about or to switch doctors. There comes a point when everything reasonable has been tried. The error being made in these suggestions is there is an ideal that people think this woman can get to. But that ideal is not possible. She will never be well just like someone with terminal cancer will never be well. One day maybe we will have cures. Today we do not. Her choice is to continue suffering or to die. Those are her only choices.
+1
Well said.
I am a psychiatrist in Vienna, a member of the Chancellor’s Bioethics Commission and I was involved in getting assisted suicide approved in Austria, (although unfortunately it is still an obstacle course to get approval).
And strangely enough – I can’t explain it rationally – I find it very difficult to accept that mental illnesses are also incurable – although I know it is so.
Accordingly, its hard for me to accept that assisted suicide should also be permitted in this spectrum of illnesses; probably because – contrary to all evidence – I don’t want to accept the incurability. but rationally it should be allowed.
I don’t think it is strange: the problem is not accepting that some mental illnesses cannot be cured, the problem is predicting which individual patients will never improve. For we should all feel dreadful for approving someone for assisted suicide, if they would have had a spontaneous remission from their mental illness.
Many of us disapprove of the death penalty because sometimes exonerating evidence comes to light. I don’t see how that differs much from killing someone who may have later got better.
However, we accept the terminality and the unbearable suffering associated with physical illnesses – so why not with mental illnesses too?
Perhaps because it would take a literal miracle for someone with widespread cancer to recover, so it is reasonable to assume they will not. Mental illness remissions do occur, but how to predict in which patient?
While cancer and clinical depression are both complex, heterogeneous diseases, the application of euthanasia to mentally depressed individuals is complicated by absence of reliable blood tests, significant placebo effect in treatment options and no reliable way to monitor disease progression without patient influence (possibly misleading the doctor).
I find arguments from ethics and morality a little incoherent in a no-free-will world.
Anecdotally of course, I have endured depression my entire life, and several times have considered packing it all in. Then IV ketamine came along and saved me. In answer to your titular question, yes, I think it’s unethical. Choose life.
But how long are you going to make someone suffer while waiting for a drug or intervention that can cure them. A ketamine equivalent may not come along for this woman.
You haven’t given enough weight to the key word: choose. The choice belongs to the person who is suffering, not to others who want to speculate about possible future cures, societal disarray, etc. Or how peeved god is going to be. In the end, if the sufferer does not choose life, it’s no one else’s place to force them to live a life they do not want.
I’ll stop after this because I don’t want to hog the thread. Just as I feel young people are ill-equipped to decide if they should insult their bodies and jeopardize their health by undergoing draconian surgeries and chemical treatments to take on the outward appearance of a sex that is not their own, I also feel that that the mentally ill–and not that it should matter but I count myself among them–are not capable of making a decision about whether they should continue living or not.
I realized very late in the day after reading Danny’s comment that this is where my dissonance comes from. And I’ve overcommented (more so than others) so this will be my last.
Again I think people in unrelievable pain and suffering have the right to decide they don’t want to live with that.
But in cases like Zoraya’s the organ that’s used to decide whether the pain and suffering is intolerable (and therefore dying is the best choice) is also the organ that’s damaged and is the source of pain and suffering. So should we give more weight to the person’s obvious terrible mental anguish, or to the person’s demonstrable mental disability that impairs their decision making? I don’t know.
And sorry for overcommenting. Great discussion. I learned a lot.
We do for patients with dementia and other cognitive impairments.
I agree with you, and I am very glad for you!
Apologies for a long reply.
I think the majority of people regard MAID for the terminally ill as, at the least, a defensible position. I was a Canadian GP for 30 years, working in a rural area and running a small hospital. I did a lot of palliative care (I took a course in it and told them I wanted to be an informed consumer), and I know it is far from perfect, so I would have agreed to perform MAID for the terminally ill if I had still been at work when it came in.
But we are witnessing it being expanded to the mentally ill, the socially dependent, and even disabled children. This is not something most of us are comfortable with. And it gets worse when the government begins to see this as an economically desirable tool for curtailing public expenditure. 6% of deaths in Quebec are now medically assisted, and across the country, there was a 30% rise in 2022 from the previous year. No doubt careful calculations of cost-savings are being performed in ministries that are responsible for spending on caring for needy citizens, and bureaucrats are licking their lips at the thought of how this would assist their budgets. The latest proposal is for ‘targeted organ donation’ which would allow someone choosing MAID to say in advance to whom their organs should go. How much of a free choice is it when your family member who needs a kidney starts to talk to you about “wouldn’t it be great if…”?
The slippery slope is no longer a theoretical risk: it is here and we have started the long slide downhill. And the government has an excuse—the Supreme Court of Canada has the ability under our Charter of Rights and Freedoms to dictate law to parliament, and that is what has happened. If the terminally ill have this right, it cannot be legally denied to other citizens, and so parliament has to come up with laws permitting it. When the Charter was written into our constitution in 1982, there was much debate about how this would change our legal and constitutional landscape, but this particular wrinkle was not predicted. Judicial oversight can go too far, and the ultimate authority should lie in an elected parliament answerable to the electorate and no one else. For some strange reason I am more comfortable with every suicidal adult having access to painless and guaranteed success than I am with a government offering to end things for citizens that are getting expensive to look after. Doctors ought not to be in the business of polishing people off, as it encourages bad habits (if you get my drift). Once you have your chit from the doc saying you are in your right mind, you present it to a pharmacist and get a pill and some instruction. Squeamish pharmacists may exclude themselves, or simply give a printed handout if they don’t want to describe the details, which would be something like “Go home. Swallow this pill. By the way, have you settled your bill here before you leave?”
As someone with an incurable cancer, I want my doctors to help me live as long and as well as possible. Only I should be able to say if I have had enough. Teaching our young physicians that death is always an option for difficult cases will, inevitably, corrode our doctors’ sense of what their duty to their patients should be. It places an unfair onus on the sick, the poor and the disabled to “do the right thing for society” rather than to make a free choice if they ever get to that stage. How much pressure might be applied to young physicians to go beyond the terminally ill and include these less clear-cut cases? It isn’t unimaginable that professional bodies would sanction physicians who were choosy or squeamish in this regard for discriminating against a class of applicants, just as we are no longer allowed to follow our conscience when it comes to declining to treat gender dysphoria without being punished. This is getting beyond a horror story: it’s a horror show and I want no part of it.
You could make the same arguments about organ donation. “But I know the patient and he needs a heart. Maybe I won’t try so hard to save this person”. Those arguments just don’t hold up and the conspiratorial “the governments are going to kill people to save money” just don’t either.
No?
https://www.cbc.ca/news/politics/veterans-maid-rcmp-investigation-1.6663885
and there are many stories of this kind, people with disabilities being advised to consider MAID rather than get the help they ask for.
I followed that report. A year later the follow up from Veterans Affairs Canada reported that a single employee suggested medical assistance in dying (MAID) to four veterans, and that the issue is not widespread in the department. Not exactly the devious push to off the elderly you suggest. https://www.cbc.ca/news/politics/veterans-affairs-maid-one-employee-1.6774645
“Don’t like my opinions? I have others!” as Groucho said.
https://www.ctvnews.ca/politics/paralympian-trying-to-get-wheelchair-ramp-says-veterans-affairs-employee-offered-her-assisted-dying-1.6179325
This was not one of the four above. Furthermore, and this is anecdotal, I am surprised at how easily my colleagues have taken to offering MAID. (Not that they would perform it: they used to send me their patients requesting abortion as I would take care of them and they need not sully their hands.) But I’m not suggesting there is a conspiracy to consign the expensive citizens to the morgue; I am saying there is a danger that civil servants are examining the cost savings, and that alone is cause for concern.
Keep Cherry 🍒 picking I guess.
So we see that a single “bad apple” in the proper position is given the capacity to influence many vulnerable people.
Governments have repeatedly killed people to save money.
In normal organ donation, that argument doesn’t arise. The doctor treating the patient who might turn out to be a cadaver organ donor cannot be involved in deciding who gets the organs. The organs retrieved go into the pool for allocation by need and likelihood of benefit and neither the doctor who looked after the donor while he was alive nor the surgeon who removes the organs after brain death have any say or knowledge about who gets them. The system was explicitly designed that way to avoid exactly this sort of perverse incentive.
Christopher’s concern about a person requesting euthanasia being able to direct her organs to a specific person, as if she were a living donor donating a kidney or a portion of her liver to a relative does raise real issues about undue influence. In a small town, both patients might well be patients of the same GP, although living-donor operations are done in larger centres after extensive investigation and preparation where the retrieving doctors and the transplant doctors would not be the same people. (You need two operating rooms set up simultaneously — the organ comes out of one room and goes to the other one immediately.) The logistics of actually suspending euthanasia mid-stride as it were to retrieve the organs before finishing the job would be another complication. The surgical team retrieving an organ or part from a living donor expect to wake the patient up after the operation is finished and would probably baulk at not doing so. “Not our line of work,” they would say.
I like your idea of every suicidal adult having access to painless and guaranteed success. I think it’s been well established that people who are assured of such means will, more often than not, choose to keep going on. It is when we lose control over our condition and feel trapped in our pain (be it physical or mental) that we make rash decisions. Knowing relief is at hand has its own palliative effect.
I’m sorry that you have an incurable cancer. I hope you are able to control any pain and that a cure is found.
You expressed my worries in an excellent way, better than I could.
My god my god why have you forsaken me. Take this cup from my lips. Did this not teach jesus compassion for others in pain?
What most worried me about this was that the young woman was autistic. My understanding is that autistic people tend towards perseverative thinking.
In other words, it seems possible that she might have latched onto the idea that “I am never going to feel better and dying is my best option” while in a particularly low mood, and been unable to let go of that idea.
For what it’s worth I’ve been diagnosed with Major Depressive Disorder (MDD), and am well aware of the feelings of hopelessness sufferers can endure. Nevertheless, in my experience at least, the lowest lows don’t last forever, though they seem like they will when you’re sunk in them.
I seem to remember a case in the UK, where a young man was so debilitated by mental illness that he couldn’t function, his life was a torture for him, and he eventually took his own life. When his family were interviewed after his death they were not saddened by his demise, but gratified that he was no longer suffering.
From an evolutionary perspective, we know that nature has no ethical dimension and because of the natural variation we see in nature, we should not be surprised that situations like this might arise, in fact we should expect extremely tragic cases like this to occur.
How absurd of the Catholic Church to encourage people to embrace their suffering, when most of have no real conception of how difficult life might be for sufferers of severe mental illness.
Cases like this illustrate the clear need for empathy, and respect for the wishes of the individual.
The call for “empathy, and respect for the wishes of the individual” was also used as a rational to treat the youth suffering from gender dysphoria with hormones and puberty blockers. The medical community promised stringent regulations and multiple checkpoints to safeguard the children from unnecessary treatment. Enough time has passed to know the result. The parallels between assisted suicide for mental health and treatment of gender dysphoria are striking as both require doctors to act as gatekeepers to a “treatment” for what appears to be a socially contagious treatment option.
Good point. I don’t want to get into gender dysphoria treatments here as it’s off topic, but I think the general point is finding the best treatment option for the individual must involve caring for them by finding the best option for that individual, which in many situations will be far from easy.
To force the elderly to accept becoming ‘cabbages in nappies’ is barbaric. Dementia is a real and growing problem. I see absolutely no point in spending years being ‘waited on at both ends’. Imagine not being able to read. No thanks. I believe in OARS – old age rational suicide. My body, my choice – without free will it means I cannot do otherwise!
How would it be implemented? While the person was in the early stages and still able to decide?
Or would be done by others once it was in later stages?
Here’s someone who chose suicide in the early stages;
https://www.nytimes.com/2015/05/17/magazine/the-last-day-of-her-life.html
I am convinced that for this reason, dementia should not be a ground for euthanasia. My own father was horrified at the prospect of developing dementia but didn’t seem to suffer once he actually developed it.
I’m uncomfortable with the idea too. I don’t know what I’d do.
You are quite welcome to kill yourself legally whenever you wish. When you feel you are becoming feeble-minded you can do it in your own time. No one forces anyone to live against their will, free or determined.
Just a couple of points for framing.
I’ll say first that I will believe this woman actually wants to die when she actually goes through with it. I suspect she is craving attention rather than death from the way she sounds in Ms. Subramanya’s story.
It is not really an ethical question as to whether someone has a right to die whenever they want. It’s clear that people in most countries and states have a right to commit suicide and that they face no legal sanctions if they survive an attempt. This applies to someone who attempts suicide in the context of mental illness, to atone for the unatonable, or for no apparent reason at all. You don’t have to have a good reason to commit suicide. (It’s not like homicide where you do.) Most people who do attempt suicide cooperate at least superficially with treatment to save their lives. We we can treat an unconscious person without his consent in an emergency even if he left a note, and so we do because we must.
The long-term suicide completion rate for people apprehended, by always watchful police, in the act of climbing the railing of the Golden Gate Bridge was about 10% in a carefully done California coroner’s study. This is much higher than the population rate but it is not the 100% figure you might think from a group who tried to jump off such a high bridge into cold water. Anecdotally, many people who survive a suicide attempt regret the attempt the moment they pulled the trigger or jumped. So empirically, people who ask for medical assistance in killing themselves with 100% reliability might be biting off more than they intended to chew. They seem to be asking for circumstances which prevent absolutely the protective agents of the state, or Providence, from intervening.
The ethical problem is the recruitment of a second person, the assistant, in the act. If your friend asked you to shoot him to death in his bathtub, would you? Or if he asked you to help him hold the pistol properly to make sure it would produce a lethal wound when he pulled the trigger? Both of these are criminal offences, murder and assisted suicide, for laypeople. Yet the result of euthanasia legislation has been that doctors must comply with the request, no objections, or else hunt around for someone who will do it.
I’m not sure about how the laws work elsewhere, but in Canada, the exemption from murder offered to a doctor who kills a consenting patient has morphed into an obligation for doctors to be murderers on request. Requiring us to murder people with mental illness is going too far. While some sufferers from depression may well feel pain worse than cancer, although we have only their own say-so to go on, much like gender dysphoria, and how would they know cancer pain if they’d never had advanced cancer? — the doctor has no way of knowing who will remit and who will not, and who will regret just as the propofol silences them.