Category Archives: Medically assisted suicide

Assisted Suicide and Mental Illness – Where Do You Stand?

Image by Gerd Altmann from Pixabay

By Marvin Ross with commentary by Dr David Laing Dawson

Numerous countries throughout the world (including some US States) allow for medically assisted death for people who are suffering. The original Canadian legislation contained the caveat that the person requesting must have death as an imminent reality to qualify. The individual had to be competent, agreeable and have grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition. That left out those whose lives met all of those criteria save for imminent death and  those with mental illness.

This past September, the Quebec Superior Court struck down the imminent death section and gave the government six months to amend the law. Once the amendments are in place (consultation with the public are ongoing and government has requested an extension), assisted suicide will be open to all who meet the strict criteria including those with mental illness.

The inclusion of mental illness is causing considerable debate and there have already been cases where those with mental illness have taken their own lives in private because they could not be granted assistance. Andre Picard, in the Globe and Mail, cites a woman in Quebec suffering with intractable bipolar disorder who finally resorted to suicide by putting her head in a plastic bag and crawling into the trunk of her car.

In a letter sent to media just before she took her own life, she wrote “People with cancer can die with dignity and be comforted, surrounded by their loved ones. A person with mental illness must die alone, in the trunk of her car. I so badly wanted to be accompanied and helped.” As Picard wrote Véronique Dorval, a 38 year old biochemist, suffered from bipolar disorder, which she described as a “cancer of the soul.” Medication provided little relief from her suffering, and debilitating side effects.

In Windsor, Ontario, Adam Maier-Clayton attempted for quite some time to be given the right to die with dignity because of the terrible suffering he was experiencing as the result of :

generalized anxiety disorder, obsessive-compulsive disorder, major depressive disorder, depersonalization disorder and psychosomatic pain that was “just horrible,” a burning in his eyes, head, biceps, chest and elsewhere.He and his father said they tried everything —including medications, counselling and experimental treatments —but nothing worked.”

When he could not qualify for assisted suicide, he checked into a motel alone, and ended his life by overdose.

The arguments against allowing suicide for mental illness patients, according to Picard are that “It is impossible to determine if a mental illness is irremediable, and vulnerable patients will be encouraged to die because of a lack of mental health services or evil-doers who want to rid society of people with disabilities.” Both are not valid says Picard. In the Netherlands that has a very liberal law, fewer than 1% of patients who take this route suffer with mental illness.

Udo Schuklenk who holds the Ontario Research Chair in Bioethics at Queen’s University in Kingston, Ontario and who chaired the Royal Society of Canada International Expert Panel on End-of-Life Decision-Making, also wrote supporting assisted suicide in the Globe. He went through all the arguments used by the opponents and disproved them.

The point of view of a practicing psychiatrist in Dr David Laing Dawson is the following:

I think assisted suicide for refractory mental illness presents three very difficult issues to consider.

Most chronic and debilitating physical illnesses have been so well studied, researched and documented we, or experts in each field, know with a degree of certainty the inevitable course of the illness and whether or not all known effective treatments have been utilized.

For e.g. we know where ALS leads; we know there are no effective treatments beyond the palliative; we know and can see objectively, the suffering entailed in the progression of this disease.

But for bipolar disorder or schizophrenia, for example, the patterns of symptoms and the course of the illness, and the responsiveness to treatment, are almost as variable as the number of people with these illnesses. How do we ensure, when the request for Assisted Death is made, that the course of the illness from this point is predictable and that all known treatments have been tried and failed? And if resources are available to make such a determination and/or to carry out another new treatment plan?

The second problem is making a determination that the request for assisted death is not, in itself, a symptom of the illness. Or of a co-morbid untreated severe depression.

The third problem lies in the transactional nature of the request. That is, for all of us at times, and for some people with certain personality disorders all the time, any such demand or request or statement is driven by transactional needs, such as the need, at this moment in time, to be able to assume or fight for power/control in the current relationship.

A highly contentious topic and I would love to hear what readers of this blog have to say on the issue. Feel free to wade into the debate.