Tag Archives: The Globe and Mail

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.

The Red Herring of Anti-Stigma

By Marvin Ross

Anti-stigma red herring Image by PublicDomainPictures from Pixabay

Many of us have spoken up against the very popular mental illness anti-stigma strategies that have proliferated over the past few years. The problem has never been stigma but the lack of resources needed to properly treat serious mental illness. Queen’s University psychiatrist, Dr Julio Arboleda-Florez once stated that

“helping persons with mental illness to limit the possibilities that they may become violent, via proper and timely treatment and management of their symptoms and preventing social situations that might lead to contextual violence, could be the single most important way to combat the stigma that affects all those with mental illness.”

Sadly, we are not capable of doing that because we just do not have the psychiatric resources as a recent analysis by the Globe and Mail just revealed. Our resources are strained but thanks to anti-stigma policies and work-place wellness initiatives that reduce stigma, more people are seeking help.

Journalist, Erin Anderrson reports that half of Canadians have too few local psychiatrists or none at all. The result is chocked emergency rooms, long wait lists to see psychiatrists, frustrated families and stressed out doctors. Most of the psychiatrists are located in the large urban areas like Toronto and Vancouver and many of them not only do not take on new patients but have few patients on their roster.

Dr Paul Kurdyak of the Centre for Addiction and Mental Health (CAMH) in Toronto pointed out that some get too much care when they may not need it and those who do need it get too little. He co-authored a study in Toronto and Ottawa that found that 40% of full time doctors saw less than 100 patients a year and 10% saw less than 40. Those patients are in high income areas and have usually never been hospitalized. A 2019 paper found that about one in three psychiatrists only see less than two new out patients a month. And those patients tend to be wealthier and healthier than those seen by busy psychiatrists.

The bottom line as those of us on the front lines as family and advocates know, is that the seriously ill are pretty much abandoned, left to fend for themselves, are cared for by families, wind up homeless or in jail.

Instead of campaigns focusing on anti-stigma, concerned citizens (and corporate citizens) should be lobbying to encourage more medical students to go into psychiatry. Bell Let’s Talk could spend their efforts on setting up scholarships for med students to study psychiatry rather than their Let’s Talk program.

Bell and others could invest in financing hospital beds and units for those with serious psychiatric illnesses. Encouraging people to get help when there is no help available and both cruel and stupid.

What about housing for those with serious mental illness? Let’s say they are lucky enough to get treatment in hospital and are stabilized. Where do they go to live after? Not all have parents who can help and parents get burned out.

How do they pay for housing when they can’t work and disability payments are so low? Increases in disability allowances and guaranteed minimum incomes are needed but, in Ontario anyway, the minimum income project was cancelled and we can expect the right wing Ford government to soon begin attacking disability payments. The disabled in Ontario have still not recovered from the hatchet job done by the last time we had a right wing government in the early 1990s.

It’s time to throw anti-stigma out and move on to more lucrative strategies to improve the lot of those among us with serious mental illnesses.