Euthanasia for Psychiatric reasons is complicated

Dr K Suno Gaind

Dr K Suno Gaind

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

Doctor K Suno Gaind, who is a President of the Canadian Psychiatric Association and an associate professor at the University of Toronto wrote an article that was published in the Globe and Mail on Friday May 27, 2016; where he states that there are no known standards for approving euthanasia for psychiatric reasons.

Dr Gaind questions how euthanasia fits with  - Do No Harm - ethic:

Do no harm. How do we square this guiding tenet with medically assisted death? Which is the greater harm – helping a person to end his life, or allowing continued suffering when he seeks death? 
When it comes to mental illness, it is even more complicated. The 2015 Supreme Court decision emphasized the need to protect the vulnerable from seeking suicide at a time of weakness. Less clear is how we actually do that. 
Mental illness can affect how a person thinks. Depression fuels negative self-thoughts, self-blame, hopelessness and struggling with one’s place in the world. Negative events are dwelt upon and positive ones discounted, with emotional resilience lowered until mundane stresses seem overwhelming. 
This is not to deny the real pain and suffering of mental illness, nor to imply that it invariably compromises clarity of thought. However, in severe cases, teasing apart how illness-based cognitive distortions can influence decision making is a formidable challenge. Heart disease might produce suffering but not necessarily alter thought processes; with depression, people often say they no longer feel or think like themselves. 
This predicament could be moot if suffering continued indefinitely. The value of suicide prevention is not to stay alive with intolerable suffering, but to avoid ending life during a vulnerable period. Unfortunately, cognitive distortions can lead some to decline treatment and seek death, despite the prospect of a healthy future. 

Dr Gaind explains how difficult it is to assess irremediable suffering of psychiatric patients. 

Link to the full article

Woman, in the 20's, who was sexually abused, dies by euthanasia in the Netherlands

Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

The 2015 Netherlands euthanasia report that was recently released states that there were 5561 reported euthanasia deaths in 2015, up from 5306 in 2014, there were 109 reported euthanasia deaths for dementia, up from 81 in 2014, and there were 56 reported euthanasia deaths for psychiatric reasons, up from 41 in 2014.

Shockingly, a woman who died by euthanasia for psychiatric reasons in 2015 was in her 20's and had been sexually abused.

The Daily Mail news reported:

The woman, in her twenties, was given a lethal injection after doctors and psychiatrists decided that her post-traumatic stress disorder and other conditions were incurable. 
It went ahead despite improvements in the woman's psychological condition after 'intensive therapy' two years ago, and even though doctors in the Netherlands accept that a demand for death from a psychiatric patient may be no more than a cry for help. 
The woman, who has not been named, began to suffer from mental disorders 15 years ago following sexual abuse, according to the papers released by the Dutch Euthanasia Commission.

The Daily Mail reported that the Netherlands government released information about the case to prove that the case fulfilled the requirements of the law.

Link to the full article

Parliament Hill - Press conference - May 11, 2016

Presentation by Dr Lise Poirier-Groulx at the Press Conference on May 11, 2016

Dr Lise Poirier-Groulx  with Alex Schadenberg

Dr Lise Poirier-Groulx
with Alex Schadenberg

First, I need to say that I am not an activist; I am not representing any particular group or organization.

I am a concerned physician… Je suis un médecin, troublée, comme bien d’autres, par la tournure des évènements, concernant l’euthanasie et le suicide assisté.

Throughout the history of the civilized world, Physician Assisted Death has always been a forbidden medical act. The foundation of medical ethics is being shaken to its core.

Today, I hope to be a voice for those who’s lives are deemed “lacking in dignity and not worth living”; the sick and dying patients, and those living with disabilities, as well as dementia. The implication of Physician Assisted Death is the unspoken assumption, under the guise of self-determination, that it is better to die than to live with a disability.

Comme médecin de famille et psychothérapeute depuis plus de 30 ans, j’ai eu le privilège, auprès de mes patients, d’être témoin de leurs plus grandes souffrances.

It has been my clinical experience, which is supported by research, that the overwhelming majority of patients do not want to die. They do however want to end their pain; succumbing to despair and hopelessness they may want to end their lives, especially if they are lacking in support.

I remember as naïve medical students, the faith we had in our mentors, who were teaching us the art and science of Medicine, in order to “cure disease, save lives and relieve human suffering”. And that is exactly what we set out to do upon graduation. 

Link to the full article

Assisted suicide makes us complicit in another's death

Andrew Coyne

Andrew Coyne

Andrew Coyne, a former editor of the National Post, published another excellent article, today, in the National Post - Assisted Suicide makes us all complicit in another's death.

Coyne begins by defining assisted suicide:

By now it should be clear what assisted suicide is not about. It is not about the right of mentally competent adults to end their own lives, or to refuse treatment that might save it: that right has long existed, and is not in question. 
Indeed, it is not about mentally competent adults, suffering unendurable pain at the end of their lives, at all. That may be how most people imagine the issue, and may be how it is still justified by those who have not been paying attention. It may even be, for now, the limits set out in Bill C-14, federal legislation authorizing “medical assistance in dying.”

Coyne comments on the political turmoil related to Bill C-14.

But it is equally clear this is just the start. What once was the furthest limits of the imaginable, something permitted in only a few other countries on Earth, is now the baseline. The senators who, armed with a democratic mandate from exactly no one, are vowing to delay or defeat the bill are not doing so because it goes too far: because, say, it does not require the patient’s consent in all cases, but allows another adult to sign on their behalf; or because the 15-day waiting period is optional, at the doctor’s discretion; or because it does not require that death be imminent and inevitable, but only that it be “reasonably foreseeable.” 
No, the reason the bill is under fire is because, in the view of its critics, it does not go nearly far enough: specifically, because it does not allow for the termination of children, the mentally ill and those who book their demise in advance, in fear of finding themselves unable to consent at the time. Even worse, the bill would still require that death be somewhere in the offing, however vaguely: physical or psychological suffering on its own would not be sufficient. This was not a stipulation of last year’s Supreme Court ruling, which has lately become Holy Writ, or at least the parts that do not mention competent adults.

Coyne uncovers that the government intends to expand euthanasia over time.

Link to the full article

Canadian Jewish News: Concerns raised about physician-assisted death

This article was written by Paul Jungen and published in the The Canadian Jewish News on March 10, 2016.

By Paul Jungen

The Supreme Court has spoken, the legislative wing is deliberating, but some in the Jewish community are uncomfortable with the direction the country is going in adopting a policy on physician-assisted suicide.

Discussion on the topic is now so normalized that an acronym has arisen, PAD, referring to it as physician-assisted dying.

As is the case throughout Canada, the Jewish community is not of one mind when it comes to public policy regarding the issue. The Centre for Israel and Jewish Affairs (CIJA) canvassed a broad spectrum of opinion in the Jewish community and presented a series of suggestions to the minister of justice that would regulate how the policy is implemented.

CIJA found support for the initiative on compassionate grounds, along with concerns that safeguards are needed to avoid the proverbial slippery slope that could lead to assisted deaths beyond the narrow bounds contemplated by its advocates.

READ: ORTHODOX DOCTORS WRESTLE WITH ETHICS OF ‘ASSISTED SUICIDE’

But there are voices in the community who are deeply troubled with the idea that physicians – whose mandate is to preserve life and heal the sick – would participate in ending lives. Others worry that once implemented, a policy of assisted dying in a narrow band of circumstances will gradually broaden to include situations not originally contemplated by proponents of the policy, including “informed minors.”

The current situation grew out of a Supreme Court ruling one year ago that struck down, on constitutional grounds, sections of the Criminal Code that made it illegal to help someone commit suicide. The court stated the law would remain in effect for one year before it lapsed. It later extended the deadline to June 2016.

Link to the full article

Vulnerable Persons Standard - protecting people from assisted death

The Council of Canadians with Disabilities and the Canadian Association for Community Living, in conjunction with many groups and advisors, have launched the Vulnerable Persons Standard as a way to protect Canadians who are vulnerable and that they not die an assisted death based on unresolved physical, psychological or social requirements or based on discrimination.

Link to the Vulnerable Persons Standard website.
The Vulnerable Persons Standard

The Vulnerable Persons Standard is a series of evidence-based safeguards intended to protect the lives of Canadians.

These safeguards will help to ensure that Canadians requesting assistance from physicians to end their life can do so without jeopardizing the lives of vulnerable persons who may be subject to coercion and abuse.

We are calling on all members of Parliament to ensure that federal legislation regulating physician-assisted death incorporate these safeguards. 

Why is vulnerability important?

Vulnerable persons who request physician-assisted dying may be motivated by a range of factors unrelated to their medical condition or prognosis. These factors are important and can often be addressed with adequate and appropriate care. As a society, we have both moral and legal obligations to address the needs of vulnerable persons. Access to physician-assisted dying cannot be allowed to diminish or undermine these important obligations.

Unmet needs should not be a cause of death

Extensive research shows that a wide range of factors related to social, financial, psychological and spiritual suffering can lead patients to request physician-assisted death.

The U.S. National Cancer Institute describes such requests as “a sign that unmet needs have built to an intolerable level.”

Link to the full article

Euthanasia for depression to be debated in Canada

By Alex Schadenberg, Executive Director - Euthanasia Prevention Coalition

Tara Brousseau-Snider

Tara Brousseau-Snider

Canada's parliament will soon debate whether to euthanasia should be permitted for psychological suffering. 

The Supreme Court of Canada, on February 6, struck down Canada's assisted suicide lawand used language that permits euthanasia. The Supreme Court did not define the terminology but it stated that an assisted death could be permitted for someone who has irremediable pain caused by physical orpsychological suffering.

CBC Manitoba reported on an unnamed Winnipeg woman who pushing the issue by requesting a euthanasia based on psychological suffering. Tara Brousseau-Snider, executive director of the Mood Disorders Association of Manitoba stated that woman who wants euthanasia said: "If it was in place, they'd apply for it."

Brousseau-Snide told CBC Manitoba that she is concerned about a law permitting euthanasia for depressed people.

Link to the full article