Are people suffering from a persistent, debilitating, and apparently incurable psychiatric condition, such as incapacitating suicidal depression, entitled to physician and/or government assistance in dying? (This procedure is also called “physician-assisted suicide”, or “medical assistance in dying”: MAID). Of course anybody can kill themselves without the help of doctors or the government, but I’m talking about formal programs, often involving ingestion or injection of pentobarbital or secobarbital. This is available for those suffering from apparently incurable and suicidal mental illness in five countries: Belgium, the Netherlands, Switzerland, Luxembourg, and Spain (see details below the fold). All of these countries require, as is proper, a rigorous vetting program by mental-health professionals and doctors to see if all recourses have been tried and if the patient truly want to die and sees no point in living.
One alternative, legal everywhere and mentioned in the piece below, is voluntary stopping of eating and drinking (VSF), which, depending on what you do, will cause death within a week or two. Some countries, like the Netherlands, will give hospice care to mentally ill people who are not approved for MAID but choose VSF, helping those patients ease out of life when their bodies start to shut down.
While physician-assisted suicide is legal in many places, including 11 states in the U.S., as well as Washington D.C.—laws permitting it have recently passed in Illinois and New York, and will take effect this summer—these are all for people suffering from terminal medical conditions. The U.S. and all countries other than the five listed above do not allow physician-assisted suicide for other coniditons, whether or not the government assists or helps pay for it.
For a number of reasons I list below, MAID for psychiatric conditions has become quite controversial, While I tend to side with those who allow it, I also agree that stringent medical and psychological vetting is necessary before a doctor is allowed to help someone die who has such conditions. In the Free Press article below, author Rupa Subramanya first describes the death of Iris Dekker in the Netherlands, and then discusses the many issues around the procedure.
Click to read, though you’ll have to be a subscriber.
One gets the feeling from the posted article above, which is generally objective, that Subramanya really does oppose MAID for psychiatric conditions, and partly for religious reasons. In a new hourlong conversation with Coleman Hughes, however, Subramanya pulls no punches; she clearly doesn’t think MAID is ready for primetime. Coleman is a bit more in favor of it, but also has reservations.
First, a bit about Iris Dekker, who sought MAID in the Netherlands after over a decade of deep depression and suicidality. She in fact tried to kill herself twice, once by hanging and once by cutting, but her parents found her in both cases and aborted the attempt. She also had a physical condition that may have been related to her mental illness:
Depression was not new to the Dekkers. Omar [Iris’s father] has a history of it, as do other members of his family. But Iris’s was different. Her symptoms were psychological and physical—a condition called functional neurological disorder, associated with severe psychological distress and depression. It often presents with symptoms like paralysis, seizures, and chronic pain, and was once referred to in medical psychology as hysteria. Iris had spent more than two years in a wheelchair after a seizure left her unable to walk.
In the end, after she had tried everything, including electroconvulsive therapy and ketamine treatment, Iris asked for MAID. But she became worse while waiting for approval and so practiced VSF until she died, with her pain palliated by physicians, at age 19. Her parents didn’t want her to die, but in the end realized that there was no likelihood of a cure, and supported her. The end:
Watching her fade away, Omar felt the full weight of what was happening. He recalled the final night with his daughter as he held her in his arms and listened to her breathing. “In my heart, as a father—and also as a nurse—I was thinking, I have to do something,” he said. “And at the same time, I knew: No. This is what she wants.”
In her final moments, Iris could no longer speak or respond. When she took her last breath, Omar saw a smile on his daughter’s face.
“She looked so happy,” he said. “I couldn’t give her more love than letting her go.” Iris died on March 1, five days before her 20th birthday.
Letting go of those we love is very hard. We take it for granted that it’s humane when we’re dealing with pets who have terminal medical issues, but we cannot know when animals are undergoing unbearable mental suffering. But humans can tell us.
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It seems obvious, as I said, that Subramanya doesn’t like the idea of MAID, nor does she say how it could be implemented properly. Statements like these are what makes me feel that way:
The Dekkers agreed to talk to me in detail about their daughter’s decisions—and theirs. They also showed me medical records for Iris. I tried to understand how loving parents could be persuaded that the best decision for their daughter was an early death. What I found was a system that turns young people’s ambiguous wishes into a diagnosis of incurable depression. The process raises questions about the treatment not only of a few teens like Iris who choose to die by euthanasia, but countless others who are confronted with the idea that their psychological suffering is beyond help.
. . .With each failure, Iris and her parents heard the same conclusion from specialists: Her condition was “treatment resistant,” and doctors had exhausted their options. In fact, the conclusion that depression such as Iris’s can be incurable is itself controversial among psychiatrists. As one recent paper in Psychological Medicine noted, clinicians “cannot accurately predict long-term chances of recovery in a particular patient with treatment-resistant depression.”
In the podcast with Coleman, Rupa makes it clear that while she’s not opposed to assisted dying, she is pretty much opposed to the process when it’s applied to psychiatric illnesses or even, as is legal in Canada, to people who have incurable suffering from a medical condition, like going blind or having diabetes. I won’t counter her arguments, though I disagree with many of her claims. I just want to list below some of the reasons people oppose MAID for purely psychiatric conditions. All of these save the first are mentioned in either the article or in the podcast. I have made the list and give my reactions to it.
1.) Religious reason #1: only God can take a life or determine when someone should die, suicide is against religious dictates, etc. I will not deal with this because I don’t believe there are gods and thus don’t think these reasons are worth considering seriously. But they are of course worth countering and discussing. I simply won’t entertain the proposition that “God knows best.”
2.) You can never tell when depression might be alleviated; many people who tried to kill themselves because of depression have later recovered and think their suicidal ideation was mistaken. True, but for someone like Iris Dekker, who had tried everything, saying “you might get better” is letting someone suffer forever despite having made a gazillion attempts to find a reason to live. Note that Subramanya reports that psychiatric MAID is rare even where legal:
Even in countries that have been at the forefront of assisted dying, psychiatric euthanasia is still rare. The Netherlands had 174 cases of psychiatric euthanasia in 2025—about 1.7 percent of its euthanasia deaths and 0.1 percent of deaths overall. Of the 338 euthanasia applications received at the Euthanasia Expertise Center in 2025 from patients younger than 30 that involved psychiatric suffering, only 11 were approved. None were minors.
This worry can be alleviated by a process of rigorous vetting, which, given the statistics above, seems already in place. While it of course cannot guarantee that someone allowed MAID could some day recover from psychiatric illness, if they’ve tried many ways to get better and yet still remain suicidal after years, it seems cruel for someone else to say that we should let them live because we don’t know what would happen. It is in effect trying to control someone else’s existence.
3.) The slippery slope argument: MAID for mental illness will lead not only to expansion of the process to those who don’t really qualify, but also, as Rupa says, “people who were socially isolated, people who were homeless, people who were on disability and people who just felt a great sense of despair.”
Again, this can be alleviated by rigorous vetting, and by involving doctors and therapists who aren’t in the business of willy-nilly approving candidates for MAID, just as there should be procedures preventing doctors from prescribing opioids for no good reason. Of course no system is perfect, but when you see someone like Iris Dekker, who has suffered greatly for years and wants to die–and has tried to die by her own hand–slippery-slope arguments need to be contested. There’s no need to go all the way to the bottom of the slope once you step off the summit.
4.) Laws like Canada’s that allow MAID if you’re suffering not from terminal illnesses, but from other medical conditions, are not supportable because you can’t judge what is “intolerable suffering.”
Again, rigorous vetting is the best way to deal with this. Who better than (objective) mental-health professionals and doctors can judge whether suffering is “intolerable”. especially when multiple drug and/or psychiatric regimens ahve been tried?
5.) The social argument (from Rupa): suffering should be solved and endured collectively rather than by personal choice.
Here’s what Rupa says;
We’re fully rational actors making these decisions entirely on our own. But in reality, our choices are shaped by our relationships with people. It’s shaped by the environment that we’re in, and it’s shaped by economic conditions, whether we feel loved, supported, or abandoned. So his argument is that autonomy is never fully independent because we make decisions within this context. I think with Canada, and then you have a political class in a place like Canada that is more than happy to enable all of these things. And so I feel like all of these things have come together in Canada, in the Netherlands as well.
I don’t really understand this argument, but it figures in the example of Rupa’s father (see below). If someone is suffering and can’t be cured, why should this be a problem that can’t be solved by the individual? And of course the state does get involved when MAID is considered.
6.) Different doctors have different standards for “intolerable suffering.” Further, at least in Canada, some doctors, says Rupa, tend to get on oversight committees who are on board with MAID, so the procedure becomes easier to get. Rupa says this:
I think that some of the doctors I’ve spoken to think that they’re basically God. they feel powerful in making these decisions one doctor I spoke to she’s a prolific maid provider in British Columbia in Vancouver and she loves the limelight she loves talking about the patients she’s euthanized over the years and she started off I think she was a she went from delivering babies to now euthanizing people and she told me look and she said this elsewhere as well that I like to push the boundaries as much as I can when it comes to medical assistance anddying and that was pretty extraordinary to me. [JAC: remember, this is a transcript taken from the podcast, so there are infelicities of speech as well as outright errors in transcription.]
Again, choose well known and objective physicians; that is the best you can do. And of course usual more than just two or three doctors. Remember that MAID for mental illness is not yet legal in Canada.
7.) Hastening death is “the path of least resistance”, and in many cases may be less expensive and time-consuming than treatment for years and years. Here’s another quote from Rupa:
You do have cases where people can change their minds, but eventually the system decides that it should be the option. There was another case of a man with cancer who became delirious and very unresponsive in hospital. And according to this report, the doctors aroused him, shook his head and interpreted his blinks and the responses he was mouthing as consent and then proceeded to kill him that very same day. So basically, what all of this tells me is that. . . there’s a medical culture now which is hastening death. And, you know, as one ethicist put it to me, he said this is the path of least resistance now.
If the law is made with the input of ethicists, this should be prevented. Again, the solution seems to be rigorous vetting and oversight rather than letting people suffer forever. And of course you can give control over your medical treatment to others via “do no resuscitate” orders and the like (I have these).
8.) MAID “normalizes” euthanasia and suicide. Another quote from Rupa:
Hughes: Are you saying because of MADE, we’re entering this culture of normalization of suicide? And because of that, Some young people, they form that expectation that like, yeah, I have a right to die because of this culture. And then if they get rejected, they seek other means where like maybe in the past, without that culture of normalizing euthanasia and suicide, maybe they wouldn’t have even gone down the road. Is that sort of what you’re implying?
Subramanya: Yeah.
“Normalizing euthanasia” does not necessarily mean making it the go-to option. And we are talking about euthanasia, not “regular” suicide.
9.) Religious reason #2: One role of religion should be to keep people off the slippery slope. Here’s an exchange from the podcast:
Hughes: But if you don’t have a religious view that life is sacred and that suicide is a sin, then it’s possible to talk yourself into it and kind of reason your way into ending your life if you really are at a low point and you are suffering, right? Is that what this is?
Subramanya: Yes, I think religion is certainly one institution when you look at the fact that as I mentioned earlier We’ve become a very individualistic society where suffering is no longer done communally, it’s not experienced communally, but on your own, where previously, you know, you’d go to the church or to the temple or to the mosque or whatever religion you belong to. But now, you know, a lot of us live in isolation, especially young people, you know, who are, I think, we’re still seeing some of the effects of the pandemic rapidly. right now where young people have been struggling with loneliness and alienation and mental health issues and then where suicide is not treated as something that you prevent but increasingly something that you facilitate so religion for sure. If you’re talking about how institutions once played a very important role in making us feel connected, that’s changed quite a bit.
Subramanya seems to have forgotten that it is also religion that’s been the main obstacle to any form of MAID, even for terminal illness (Mother Teresa is one example of someone who thought Jesus will take people when he’s ready). Is Subramanya suggesting that we should try to foist religious solutions onto someone seeking MAID? Too late: religion is disappearing now, and you don’t go proselytizing someone who is suffering.
When Subramanya tells this story about her father, who found a reason to live, she seems to use it as an example of why anyone, however ill, can find a reason to live. But people differ in how they bear suffering:
. . . I learned that my father in India was diagnosed with primary central nervous system lymphoma. They found a cyst in his brain and he needed a very urgent brain biopsy. As I was writing about Keanu’s death, this 27-year-old young person with type 1 diabetes and blindness and that he had given up on life, I was watching my own father fight desperately to hold on to his. And five months later, my father can’t speak because the part of the brain on which they operated controls speech. He has undergone chemotherapy and radiation.
He’s doing really well. His cancer is in remission. But what strikes me most is Not just merely his resilience, it is his desire to live. I mean, despite the pain and exhaustion, the loss of speech, the humiliations that he’s experienced, that serious illness brings about in people. You mentioned your mother who had who died of cancer. He’s soldiering on. He still loves life. And he wants more time. He’s fighting for every single day. And he finds joy in ordinary moments.
So, you know, for me, you know, as someone who’s written quite extensively about death, I look at my father and I wonder like what Why is he so different from someone who is 73 years old here in Canada, perhaps given a similar diagnosis and chooses made? Or why does a 28-year-old give up on life? And I don’t think my father in India is an outlier in the sense that he wants to live as much as possible. I think in places like India, you still have strong cultural family ties. I think religion continues to be extremely important. And I think these are factors, these are things that are increasingly, they’re disappearing in the West.
Once again we see religion mentioned as a way to keep people off the slippery slope of MAID. But what if you are not religious and cannot force yourself to believe? Someone like me, for instance.
In the end, I see both the article and podcast (not Hughes) infected with religiously-tinged arguments. I’ve long viewed the Free Press, while ideologically appealing in several ways, as too soft on religion—too eager to see it as caulk for our “god-shaped” holes. This article may be one example.
Click on “continue reading” below to see descriptions of the five countries medical assistance in dying is legal for those with psychiatric issues:
From Grok:
My question: Which countries allow medical assistance in dying for psychiatric problems or other mental issues?
As of May 2026, a small number of countries explicitly permit medical assistance in dying (MAiD, which includes physician-administered euthanasia or physician-assisted suicide) where a psychiatric disorder or other mental health issue is the sole underlying medical condition (or the primary source of unbearable suffering). In these jurisdictions, the person must generally be an adult with decision-making capacity, make a voluntary and well-considered request, experience constant and unbearable suffering with no prospect of reasonable improvement, and have exhausted relevant treatment options. Psychiatric cases remain relatively rare (typically 1–2% of total MAiD cases where data are available).Here is the current list of countries where this is allowed:
- Netherlands: Euthanasia is legal for psychiatric disorders under the 2002 law if the patient has “unbearable suffering with no prospect of improvement.” This has been in practice for over two decades, with official reports documenting dozens of cases annually (e.g., 115 psychiatric cases in 2021).
- Belgium: Euthanasia is permitted for “constant and unbearable physical or mental suffering” from an incurable condition (including psychiatric disorders) since the 2002 law. Requests require multiple written statements, medical confirmation, and review. Psychiatric cases are reported (e.g., 26 in 2022).
- Luxembourg: The 2009 law allows euthanasia or assisted suicide for an incurable medical condition causing unbearable physical or mental suffering with no prospect of improvement. Psychiatric disorders qualify under the same criteria as in the other Benelux countries.
- Switzerland: Assisted suicide (not physician-administered euthanasia) is permitted. A 2006 Federal Supreme Court ruling explicitly extended this to individuals with “incurable, permanent, severe psychological disorders,” provided the person has decision-making capacity and the wish is autonomous (not a symptom of a treatable mental disorder). Right-to-die organizations facilitate this, often with psychiatric evaluation.
- Spain: The 2021 Organic Law on the Regulation of Euthanasia allows MAiD (euthanasia or assisted suicide) for a “serious and incurable illness” or “serious, chronic, and incapacitating condition” causing constant and unbearable suffering (physical or mental). While a 2023 Constitutional Court ruling sought to limit purely psychiatric cases to those with a somatic basis, practice and recent cases (including a high-profile 2026 euthanasia of a 25-year-old woman with mental illness after legal proceedings) confirm eligibility is possible under the law’s broad criteria.
It might be illuminating to interview people who have suffered from horrific chronic depression, but have recovered. It could help to formulate a humanistic policy on state-assisted suicide, and, perhaps more critically, give hope to people who have none.
Is the assumption that suicide can have no religious dimension to it?
There is nothing that says suicide cannot be an expression of esoteric transformation – such as in Hermeticism.
Medicalization is known to be abused in a process named “Factitious disorder imposed on self” (formerly Munchausen’s Syndrome).
“Establishing chemistry as a science of the nature of matter required the recognition of the nonexistence of phlogiston. Establishing psychiatry as a science of human behavior requires the recognition of the nonexistence of mental illness.”
-Thomas Szasz
Mental Illness – Psychiatry’s Phlogiston
J. Med. Ethics.
(5):297-301
2001
Also published with title :
Mental Illness – The New Phlogiston in
The Medicalization of Everyday Life
Syracuse University Press
2007
“Medical assistance in dying” is a gross perversion of medicine. I agree with all of the objections listed, except the religious-based ones. The idea cheapens life and medicine. It is also highly suspect in cases where healthcare is provided exclusively by the government. Would we able to tell when euthanasia was in the interest of the patient or the government? (A quick end, rather than protracted costs.)
I take it that you don’t think it should be allowed even for terminal illnesses, then, even when the patient is in horrible pain and can expect to be so for a considerable time?
You should read Coleman Hughes’ article on his mother, who had terminal cancer. The doctors “speeded up” her exit as she was suffering dreadfully at the end.
https://colemanhughes.substack.com/p/my-momand-the-case-for-assisted-death
I don’t have an opinion on assisted death for people who have non fatal conditions. I’m not sure.
I have the impression that the “up the morphine” approach for late stage terminal illness is pretty much standard procedure these days.
And yet in my very limited experience few physicians will admit that it happens. In some cases they deny that it happens at all, that the media reports are sensationalist nonsense. ISTM they are in a rather difficult situation (“do no harm”) and are unwilling to confront the issues head on.
If a physician did admit that it happened he would be implicating in murder the nurse who actually gave the lethal overdose with her own hand. Doctors don’t personally handle drugs in hospitals, particularly not tightly controlled drugs like narcotics, where most of these supposedly common mercy-killings occur. If a doctor wrote an order for a dose greater than what seemed by long nursing experience to be reasonable in the circumstances (necessary for comfort), the nurse would be professionally and legally obligated to question it, and to refuse it if the intent was to kill, or even if the effect (regardless of intent) was likely to kill. She would report him to the hospital (which grants his staff appointment) as a rogue risk to patients.
Typically in providing palliative care and pain relief — not all such patients are going to die imminently — we will order a range of morphine (or other opiate) such as 0-4 mg per hour by injection as necessary for comfort, but there is no upper limit (because of tolerance.) The dose range will be increased with a new written order if not sufficient. If a nurse were to take it on herself to give 4 mg every hour when the patient needed only 0.5, without discussing it with doctor to hide what she was doing, the nurse who covered her on coffee and lunch break would notice that the patient was seriously snowed and hardly breathing, and then question her about why she was giving so much morphine. And, absent a doctor’s order she would have no way to get a much higher rapidly lethal dose out of the pharmacy robot that secures these drugs. The doctors don’t even have personal access to them.
Given the human culture in hospitals today, it is not very likely that doctors and nurses would collude in the secret acceleration of death, which they would have to. More likely they would rat each other out to the police to protect their own selves from prosecution.
I have to admit, time’s been my way that I would have seriously considered something like MAID for chronic pain and chronic depression, if it were more readily available. I still would. It would be nice not to have to be terrified of the consequences of a failed “private” attempt, which might make physical problems worse and would be unlikely to help the mental ones. But that fear, and the consequent decision not to make an attempt in a given moment, doesn’t make life without those consequences any more tolerable–the fact of dangers of the possible alternative just becomes another source of fear and despair.
Yes, Robert. Like with all “vice” issues, the only thing worse than “state sanctioned” is private attempts.
Think about the prohibition on prostitution which forces it underground, into the shadows and exploitation zones, and previously in my office as a defense attorney (as an attorney, btw, not a “John”).
An even sharper example is drugs. The safest drugs we have when used correctly, like opiates, are turned into killers by our prohibition of them, or just banned for no good reason like psychedelics or marijuana.
Hope you’re well Robert, miss your youtube channel.
best,
D.A.
NYC 🗽
I could not easily agree with you more.
And in the US I expect the prescription opioid scandals have made many physicians overcautious about related issues.
I had a squash buddy. He tried to commit suicide. His daughter found him and saved him. He tried again and succeeded. It is sad. I did not know at the time; it did not show.
Now, there will come a time when my quality of life will not be worth the effort. I don’t want my resources to be squandered in keeping me alive for little benefit to society.
It’s “my” body. I want the government, religious types, medical ethicists, and moral zealots to keep their noses out of my life and non-life.
If you are arguing from a moral point of view … you don’t have an argument!
Exactly!
I have no wish to be a ‘cabbage in a nappy/diaper’.
Just so you know, Nell (and Rom), if you are a cabbage in a nappy you’ve missed the boat. You have to be fully capable of making an informed autonomous decision yourself in order for a doctor to be permitted legally to kill you. You have to be able to confirm that you haven’t changed your mind (or indicate that you have!) literally in the seconds before she gives the lethal injection.
I stress this because many in the public think that euthanasia is their way out of an undignified demented existence in a nursing home. Unless you can detect subtle signs that you are losing your grip and rush to get euthanasia before you lose capacity to consent, it isn’t. If you are more or less healthy with zest for life but then have a stroke or a head injury from a fall that renders you “vegetative”, your relatives can’t consent on your behalf to have you killed. They can refuse on your behalf any treatment that they believe you wouldn’t have wanted (to prolong your life, say.) But not killing you.
This isn’t medicine invoking God here. It’s the legal profession with practical earthly worries that relatives might have improper financial incentives, such as deciding it’s time to kill Grandma not because she’s suffering at all but because killing her now leaves more of her estate for the heirs to enjoy. Or, gee, that nursing home is costing us a fortune and she doesn’t recognize us anymore. Can’t we get it over with?
The 2014 Oscar winning film Still Alice deals with the issues around “waiting too long”. No spoilers here, but the film has a good chance of evoking horror in many viewers, more so than most “horror” films.
I agree. This is a very personal decision and government should have no place in it.
I see hypocrisy in the US position that people should not be allowed to die voluntarily, because life is so precious, while at the same time having an expensive health care system that is out of reach of many people who really want to live.
The government is necessarily involved, Lou:
1) You, like most commenters here, assume that when/if the time comes that you want to end your life it will be your deterministically sound mind making an autonomous, rational decision. But you don’t know that. For all you know now (and for all we doctors know then) you will have gone insane and deserve protection from the consequences of your irrational urges.
This is where the government comes in. It’s not a crime to attempt suicide. But police and doctors are required by law (“the government”) to hold for examination a patient who is threatening or who has attempted suicide to see if a mental illness is present. If the person is still actively suicidal, that is prima facie evidence (subject to rebuttal) that he is mentally ill. He’ll be held against his will in a psychiatric hospital. The government strictly regulates this involuntary admission, including the process by which a doctor decides to hold him or release him. The presumption (again rebuttable) is that anyone who wants to kill himself is mentally ill and needs state protection whether he seems to want it or not. And shouldn’t be given the means. (Duh!)
Thus, to act out your personal decision to end your life by your own hand, you have to get past the government and its Mental Health Act.
2) Anyone who helps you end your life commits a criminal offence unless the government has amended the murder and assisted-suicide laws to exempt him from prosecution. Only the government can permit a doctor, or anyone else, to kill (or assist suicide) because only the government can modify the Criminal Code. There is no way to grant your wish to be killed without involving the government. If it doesn’t want to get (further) involved, euthanasia remains first-degree murder and your helper goes to prison. And if the government says the exemption must fulfill conditions X, Y, & Z, but the doctor met only conditions X & Y, it’s still murder.
The government is necessarily involved, 1) to protect the mentally ill who have impaired autonomy and 2) to permit private citizens to consensually poison one another. It’s fine to argue that the government should be more lax here. But that in itself admits that it is the government’s proper role. Citizens can’t settle the matter just by libertarian free contracting.
“For all you know now (and for all we doctors know then) you will have gone insane and deserve protection from the consequences of your irrational urges.”
“The presumption (again rebuttable) is that anyone who wants to kill himself is mentally ill and needs state protection whether he seems to want it or not.”
This premise can’t simply be assumed. I could just as well assert my own premise that anyone who wants to commit suicide should have the right to do so, regardless of the reason.
This is a question of individual rights. The right to die in peace is one of the most fundamental of all freedoms, in my opinion. Keep the government out of it.
My last comment on this thread.
I happen to believe there is such a thing as rational suicide. Whether that means we are still obliged to stop you if we can is not clear to me, but probably best to err on the cautious side. However, there may be a moral argument that you will accept. Say you decide that your time has come and you approach me as your physician to do the deed. Shall you consider the effect on me? You are asking me to be a killer. Just because the law says it is allowed does not change the corrosive effect that has on me. Being an executioner, or a MAiD practitioner does change a fellow, you know.
We are training a generation of medical students to think differently about death; it is now an acceptable outcome, one that may be chosen. Do you not think this change of attitude will affect the way they approach other cases, ones where the patient wants to live? When desperately ill all the patient cares about is that their doctor has the skill to fix things, and is wholly on their side. Once the topic of MAiD has been brought up (and my province requires doctors to bring it up, unasked!) will the patient still have confidence that their doctor will do everything to keep them going?
I do think MAiD for the terminally ill is justifiable, but involving others in the process is the awkward part. I suggest you should be able to visit your doctor to get a certificate that you are in your right mind and have capacity, then you should be able to take that to your pharmacist and get the necessary pills. Guaranteed painless success, easy for the squeamish, and no one else need feel guilty.
The literal worst night of my life was spent in the “care” of a hospital system that through happenstance + incompetence + over-caution denied me adequate post-op pain relief. Ever since then my guiding principle when dealing with medicos has been INFORMED CONSENT, and I have been very insistent on it. I will not hesitate to file formal complaints if anything similar happens again, and may even go further than that (hopefully short of actionable defamation).
First off, as you say, religious objections to suicide and euthanasia are off the table. Any omniscient, omnipotent, Author of All shouldn’t need these meddlers to speak for Him. Death comes to every one of us sooner or later, so it’s not like these well-meaning people are actually saving anybody’s life, they’re only prolonging it. And if that happens to be a life dominated by pain, humiliation, and expense, then their good intentions are only compounding suffering.
I’m not religious but I have to say this is a shallow take.
One virtue of codified morality is that it will tend to be slower to bend to the times. If you think (as many do on this blog) that societies frequently suffer mass panics, then one way to counter-balance that is to give the distant past a voice. While a poll of (say) 21-year olds today would be deeply confused about the nature of sex, a poll of all their ancestors for a few hundred years would not be.
This is pretty much the same argument for a written constitution, with a difficult ammedfement process. It will never be perfect, but if it’s stood for 250 years, then it might be better than a quick poll of what ideas are popular this year. Any given year.
Anyway, these thoughts give me pause about western societies’ rush to embrace MAID. Our ancestors who thought suicide a deep sin weren’t stupid. I don’t wish extended suffering on anybody but I also think some idea of the sanctity of life has value which we should not be too quick to discard. Maybe that’s my version of the “slippery slope” / “mission creep” argument.
Maybe it’s much worse than that.
If you wish to go live in a community that sanctifies traditional wisdom then be my guest. But I very much appreciate the presence of modern medicine, human rights, and rationality; and the relative absence of warlords, witch trials, and superstition. There are plenty of places today where you can savour those and other traditions. Go for it.
Very difficult issue. One viewpoint…suicides are probably more common than the statistics indicate, especially in older populations. If assisted suicide is allowed, we may get a better picture of how many people in our society want to die. I don’t think the number is negligible.
I suspect this would force us to confront what factors in our society are pushing people to want to end their lives. With suicide currently being illegal or at least highly stigmatized, we probably grossly underestimate the number of people who see suicide as the only way out, and we are thus blithely unaware of how difficult life is for many people, especially in their “marginal decade” (i.e. the last decade of their life).
I feel that people should be able to decide for themselves if they want to go on or not. Supplying them a non violent way of doing so prevents them from finding potentially violent or less peaceful methods.
And their use of such methods very often causes significant damage to others: the EMT who responds to their driving at speed into a bridge abutment, the train driver whose locomotive they stand in front of, the spouse who discovers their hung corpse. Totally socially irresponsible. And unless they want to punish loved ones who remain, leave a note.
(FWIW, I had a close relative who died either from an improbable accident or from suicide. Not knowing is IMO worse than knowing.)
In general I dislike slippery slope arguments. I take the view that life is complicated and reality gives us many slopes we must navigate, some of which are quite slippery. Excessive fear of slippery slopes is just being afraid of reality.
Yet every country that has introduced MAID has experienced “mission creep”. However carefully the laws are worded and procedures are crafted, in short order the list of patients who qualify seems to get expanded beyond reasonable limits. It has certainly worked that way in Canada, the Netherlands, and other countries. I do not know of an exception.
As I implied above, expansion isn’t necessarily bad. Or do you think that the original laws should NOT be expanded beyond people with unbearable terminal illnesses?
Frankly I feel conflicted and unsure about expanding MAID to psychiatric conditions.
How about Canadian MAID track 2 (legal): people with medical conditions that are so unbearable that they ask permission for euthanasia?
I think that makes sense. I’m less happy about the idea of euthanizing for psychiatric conditions.
Milton: “The mind is its own place, and in it self / Can make a Heav’n of Hell, a Hell of Heav’n.”
IMO the issue is not the source of the suffering, but the frequent unreliability of psychiatric diagnoses. It’s a very tough issue indeed.
“The key point is that successive editions of the [DSM] manual have progressively dilated the ostensive definition of mental disorder. [..] Phenomena that might previously have been understood as moral failings [..], or ordinary vicissitudes of childhood now find shelter under the umbrella concept of mental disorder.”
Concept Creep: Psychology’s Expanding Concepts of Harm and Pathology
Nick Haslam
Psychological Inquiry
Vol. 27, No. 1 (January-March 2016), pp. 1-17
Re MAID in Canada: this is a gift link to one of the best articles I’ve read on the subject.
Here are some quotes:
MAID activists didn’t drive the legalization of MAID to enable people to avoid painful lingering deaths, but to give them ‘autonomy’.
There are a lot of similarities in tactics and arguments between the MAID activists in Canada and trans activists in the US. For example, Canada plans to permit children to elect to die, even against the wishes of their parents, and intends to expand that to a right to include non-terminal mental health conditions:
If parents won’t make the ‘right’ decision, they shouldn’t have the right to decide. I could go on and on…
I think that a person should in principle be able to end his own life. If we accept that principle—and not everyone does—the problems with physician-assisted dying must arise in practice, where the practices we’re discussing here involve actions taken by other people. That’s where the problems of coercion, who benefits, whether the killing violates religious doctrine, etc., come into play. I don’t think that there will ever be a mechanism involving other people that will be universally acceptable. But, so long as universal acceptability is not a requirement, some societies will allow physician assisted dying and others will not. We’ll probably just have to live with our differences.
Rupa Subramanya’s function in the Free Press is quite simple: provide a regular supply of columns that make Canada look bad, with the purpose of flattering the FP’s American subscriber base (which by now is mostly libertarian), so they can distract themselves from how awful Donny is. No balance from any more positive views about Canada, just relentless, bad-faith-assuming negativity.
I’m wary of extending MAID to psychiatric conditions, partly because of the difficulty of establishing a settled determination from a point of mental wellness, which is the only way of ensuring it’s not just the illness talking when the time comes. If that can be established however, I think a case can be made.
I didn’t check: is she always bashing Canada?
In the FP, yes. I don’t know about her output elsewhere.
Yes she does. I did not renew my subscription.
I think it’s more fair to say she’s a critic and perhaps a cynic. Her twitter feed has some Canada-bashing content, but much more of it (at least lately) has been India bashing. Or at least criticism of the dumb things some Indian immigrants to Canada (and the USA) do.
https://x.com/rupasubramanya/status/2058584840488747450
Somebody call that hero Dr. Kervorkian! (if you’re old enough to get that joke you probably need to get your prostate checked!) hehe
In Australia the Northern Territory has had a regime for this in place for decades and it works well.
Here’s a point I’ve noticed over the years and if I may put it indelicately:
If you think pro-lifers lie about medicine and embryology, they’ve got nothing on how euthanasia opponents do.
The latter bring up many, wild edge cases and those that shock the conscience, rarely mention the large number of suffering people assisted out of life gently, safely, and without pain.
I’m hugely in favor personally. I’d allow the drive-thru option. I’ve been called harsh, but I’ll take that over vegetable/cabbage half life and constant pain for me and my family.
D.A.
NYC 🗽
David ,
Dr. Jack Kevorkian was a Hero
He did Nothing Wrong
Dr. Kevorkian and all the other
Giants and leaders in the Growing
Voluntary Right To Die , Doctor Assisted Death With Dignity Movement wanted to Extend the Right To Die to people Suffering from Unbearable Mental illness
I agree with what seems to be the majority here, that a person has the right to decide for themselves whether they wish to live or not. I don’t believe in any form of afterlife or reincarnation, and I do feel that this life that we have is precious. But if I don’t want it anymore, that is my decision alone to make. Anyone who says otherwise is aggressively (even if passively) and illegitimately usurping control over my existence. Those who argue against MAID generally insist on forcing their own views on others, whether it is their perceived religious dictates or their more secular but no less authoritarian perspective on social “morals” and how others should view life and death.
With that said, I do acknowledge that there are potential problems that make the situation, at least in some cases, complicated and difficult. Psychiatric/mental MAID in particular may be harder to sort through. Human beings being what they are, mistakes and instances of abuse may happen, even with safeguards in place. Opponents of MAID seize upon these issues to insist that the concept is unworkable and must be prohibited, but this is backwards. We must start from the position that the “right to die” is a fundamental right that everyone possesses and then try to install guardrails to protect against problems while still fully respecting the core principle. As I said, we’re humans, so a few instances of abuse or mistakes will inevitably happen along the way, and those will be tragic, but it is part of the cost of freedom. The most intense and personal freedom of all.
One can end one’s life at any time. Reality. Medically assisted dying allows this to happen in an humane environment, without leaving for others to clean up the mess.
Yes, that’s exactly right and a point I should have made in my prior comment. I’ve told a joke for some time now about just needing to get a motorized wheelchair at the proper time. There’s a very high bridge over a waterway in the city where I live and I say that when the moment comes (and to be clear it’s nowhere near at present) I would just motor out to the center of the bridge and take a hard right. But it shouldn’t have to come to that, or pills, razor blades, a gun, or whatever. For anyone. Humanity must be humane, as much as we can anyway.
I just caution those enthusiasts lining up a doctor to kill them, that the euthanasia laws only permit a willing doctor to kill a patient (in certain defined slope-y circumstances.) They don’t compel him to kill you just because you want him to. Sneer and fulminate against the idea if you like, but a doctor is ethically required to be a moral agent and has to decide if the case you make for being killed meets his own moral criteria for killing. He might hold it as a self-evident truth, for reasons that are none of your business but might even be religious, that there are no circumstances in which he would kill you.
Therefore, it’s still on the patient to find a doctor who’s willing to do it. If no one will, your right to be killed evaporates. If you want to compel doctors to kill to respect an entitlement, that is a different conversation. Classically, it is an illiberal proposition for one free private individual to compel another, absent a freely entered contract setting out the mutual obligations. So let’s not go there (Too late.)
The discussion usually assumes euthanasia doctors will be abundant. No waiting. Brooke’s Atlantic article suggests they may be having trouble recruiting as the pioneers age out. The willing providers are becoming highly focused in this one niche, the way abortionists used to do and gender doctors still do. A one-way career track, for new grads to head down warily. A small cadre does almost all the euthanasia and little but. This suggests most mainstream doctors don’t want to have anything to do with euthanasia or the people who do it. Not a good sign for moving out of the shadows. Will pediatricians and psychiatrists be willing to meet the demand to kill children and the mentally ill? We’ll see.
It’s a valid point to note that no doctor, or anyone, can be required to kill, or to put it less provocatively, assist in the suicide of another person. If no one is willing to do that, then the patient is left to traditional methods to accomplish their goal. Or to continue to suffer. That has been the answer in the sad and messy world that we’ve been accustomed to, and if no better approach is found it will continue to be so. Contempt for someone’s desire to end their life will not make it go away. There may be no “right to be killed” but there is, or should be, a right to die if one so desires. We must do better than forcing this to be improvised by desperate people.
AIUI, in some Commonwealth jurisdictions, a doctor who does not provide MAID service is required to refer a requesting patient to a specialist who does. I don’t know about Canada in particular. And of course if the supply of specialists dries up then there’s a big problem regardless.
(This is a reply to your reply to my reply at #3 above)
I understand that no-one can admit to being personally or organisationally involved with intentional overdosing. What I object to is the cone of silence around the issue in general. ISTM that part of doing no harm is not doing harm to the trust that the public has in the medical profession. Evasion and denial are not conducive to maintaining that trust, especially since the public record of court cases shows that some intentional overdosing does occur. At some point the issue will have to be faced.
I don’t deny that some doctors silently break the laws against murder or assisted suicide, any more than I deny that some doctors cheat on their taxes or have sex with their patients. I showed why it would be inordinately difficult to get away with it. And with so little gain to the doctor doing it — he can hardly submit a bill for an illegal act, now, can he? — the risk-reward calculation would make it a no-brainer: don’t do it. Throw away all those years of medical school and residency just because some random patient wanted to die sooner? Not when he is perfectly entitled to say, “Sorry, I’ll do what I can to comfort, but the law won’t let me do what you want.” Illegal abortionists I can see: the cash money was nice and they weren’t good at doing anything else. But a doctor with a successful practice in oncology or neurology isn’t going to kill a patient unless he cracks one day. No reason to, and every reason not to.
Public trust is fostered when it is assumed with justification that doctors and nurses obey the law, and violators will be detected and punished. I don’t think you really mean that just because some doctors break the law, what they do should be open like civil disobedience but get winked at by the police and licensing authorities. That won’t lead to legalization, only to prison, because the authorities won’t play along. It would be terrible for public trust.
No, the only people with the authority to face this issue are the elected politicians in the legislature. They write the laws, on their own initiative or when prodded by the Courts, as here:
This is just on my 10% limit so I’ll leave this here.
I’d be suspicious of extending euthanasia to the mentally ill, because instead of “autonomy” it could just be the disease talking. Recent clinical trials suggest that a single psilocybin experience – under medical supervision – may be able to resolve treatment-resistant depression in as many as 80% of cases. The theory behind this is that in someone who is severely depressed, their brain has become locked into repetitive neural patterns that psychedelics can disrupt. The same mechanism has been invoked to explain how psilocybin can resolve cases of severe treatment-resistant Obsessive-Compulsive Disorder, another mental illness which can be quite debilitating.
Almost every morning, I have a little though : “why did I wake up ?”. We should be able to do as we please with our bodies and mind, and be helped through the process. I don’t believe in “every life is worth it”. In the world we’re in, 1 individual is nothing among the 8 billion others.
After all, once we’re dead, we can’t know what we miss or not. And without the need to hide it constantly, we might even be able to warn others, if there are any, of our intentions. No shock discovery then.
Statistically, 1 individual is nothing. But from my unrepresentative biased point of view, 1 individual is everything. So I’m clearly the one with the most right to decide.
Such a complex topic. In my anecdotal experience as a physician who’s cared for patients with terminal illnesses, autonomy is usually the thing patients are most desperate to preserve. We all want the freedom to choose our own destinies, especially as we approach the end of life (whether we have free will or not, we all demand from society the right to determine what happens to our bodies and our lives).
But when a treatable disease (the most common being depression, but there are others: psychosis, drug-induced tearful sentimentality, metabolic derangements like hypothyroidism, etc.) lies as the cause of a patient’s desire to commit suicide, we rightly prevent them from harming themselves (even going so far as to committing them against their will) and attempt to treat that illness. But just because a disease–like depression–is treatable doesn’t mean we’ll succeed in treating every case. There’s good evidence that some forms of depression are the result of a genetic predisposition. I have patients in my practice who’ve been severely depressed since early childhood and whose lives lie in ruins as a result. In my experience, our ability to help these types of severely depressed patients recover is quite poor. While it’s true that even the most severe depression can often be treated, I have patients for whom this has never been true, who’ve continued to be severely depressed for not just years but decades. If someone like that were to make what I would call a philosophical decision to commit suicide because their life has been and will most likely continue to be an endless painful austerity, one could argue the most compassionate choice would be to help them do so painlessly. Suffering is, of course, a subjective experience, so it will always be possible to argue the degree of suffering someone experiences isn’t great enough to warrant MAID. But it seems we could work out a process with enough safeguards in it to ensure MAID when applied in cases of mental illness that is truly refractory to treatment would be just and compassionate.
The Growing Voluntary
Right To Die , Death With Dignity Movement in America and Worldwide must Never Discriminate Against any type of Suffering person
Enough is Enough with all this
Pro-Life BS , Suicide Prevention BS
madinamerica.com has an article
“Why Should Suicide (Or Voluntary Death) Be a Civil Right?”
By Lilla Bertalan
February 15, 2018
People gave 385 comments as of
Today , People gave good arguments and comments in
Support of the Voluntary
Right To Die , Doctor Assisted Death with Dignity for Suffering Mentally ill and other Suffering people
And for Adults in America to have
REAL Freedom , Libertarian Freedom
(1) Too many folks see this issue in terms of preventing people from obtaining euthanasia or assisted suicide. It’s rather more a question of helping those who imagine they are at the end of their rope (well,…) when they are not and can be cured.
(2) I understand that some doctors don’t want to do it, and their wishes should be respected. I suspect there will be plenty who are willing.
(3) Requiring someone to be in their right mind leaves out everyone suffering from debilitating diseases like Alzheimer. I do not want to become somebody else or not know who I am; I’ve grown quite attached to the person I am. And I know what it did to my mother.
(4) I’m in my mid-eighties and starting to seriously slow down. If I reach the state, as I may, where I can no longer read (glaucoma) or go for walks in the park, and i have to give up living with cats because they might outlive me, I am fairly certain I will want to let go. I do not see where anyone else has the right to stop me, and I would much prefer a medical terminus to jumping off a bridge and or, as someboy said, driving my car off one. I don’t want my end to be anyone else’s.
I wanted to acknowledge Coleman Hughes’s thoughtful article as cited by Frau Katz in response to Dr. Brydon @3. I discussed this with my wife who was a long-time surgical oncology and ICU nurse.
Yes, some patients in severe pain from metastatic cancer can’t be kept simultaneously comfortable and alert. Palliative care physicians will sedate them with drugs in addition to narcotics to render them unconscious. (In Canada by the time I retired, this was being chosen by patients who didn’t want to avail themselves of euthanasia, more than you might think.)
Is this a distinction without a difference? If you’re in a jurisdiction that considers euthanasia to be first-degree murder, the distinction is everything. The doctor was taking a grave legal risk if he told the family he was deliberately shortening the mother’s life. He will spend the rest of his life worried that a family member who changes his/her mind about what happened will go to the police. Worse, the doctor who wrote the order jeopardized the nurse who carried it out. She legally ought to have refused but didn’t.
(Only nurses can sign for narcotics from the passcoded vault. A doctor can’t just help himself to a dose and give it to the patient with his own hand. The nurse would have charted meticulously that she didn’t “up the morphine” on her own initiative.)
The story thus requires the nurse to have been complicit in a decision that wasn’t hers. All the nurses on the ward would know in minutes that a death had been accelerated. Every nurse would then be a danger to the doctor because she could send him to prison. (A nurse in Nova Scotia did rat out to the police a doctor who gave a non-narcotic drug from her own pocket to a palliative patient, which killed him.)
So I have to doubt that the doctor actually euthanized Mr. Hughes’s mother. (Why was she so special that her doctor would take such a risk just for her?) I suspect he started terminal sedation and she died shortly (but not entirely predictably) a few hours later. (But then I don’t get the secrecy.) This “double effect’ would not have been against the law anywhere in the Western world. Readers who live in a jurisdiction that prohibits euthanasia should take some comfort from that.
Pro-Life BS and
Suicide Prevention BS Extremism is
PURE EVIL and a curse from the pits of Hell
More and More people are Publicly Speaking Out Against Suicide Prevention Forced Living Extremism and in
Support of the Growing
Voluntary Right To Die
Doctor Assisted Death With Dignity Movement,
Including and Especially for people with Chronic Unbearable Mental illness
The Growing Voluntary Right To Die
Doctor Assisted Death With Dignity
Movement in America and Worldwide Must Never Discriminate Against any type of Suffering person
Again we Need to Read the
madinamerica.com article
“Why Should Suicide (Or Voluntary Death) Be a Civil Right?”
By Lilla Bertalan
February 15, 2018
And all the 385 comments
Most People in America and Worldwide are Morally Opposed to any type of Suffering Human Being, Mentally ill, Terminally ill , etc. Being Forced to “live” in Misery Against Their Will at All costs to Suffer Even More
Pro-Life Suicide Prevention Extremists like
Kevin Hines, Wesley J. Smith &
Dr. E. Fuller Torrey are complete frauds
America Needs More Freedman
REAL Freedom
The “laws” Against Suicide in America and Worldwide Need to be Repealed Immediately
Thus Allowing for a Legal & Available
Completely Free of Charge
Voluntary Doctor Assisted Death for any and all Suffering People who Request To Die
Mentally ill , Terminally ill, Incels,
Homeless, Paraplegics, Quadraplegics, etc.
Quick, Peaceful and Painless Death , Completely Free of Charge
No Mess , No BS, No Fuss, No Muss
We cannot Discriminate in our
Growing Voluntary Right To Die
Doctor Assisted Death With Dignity Movement in America and Worldwide
Pro-Life BS and Suicide Prevention BS is so annoying and irritating
Most people can’t stand all this
Pro-Life BS , Suicide Prevention BS