[DivideByZero]

Hi

It seems like Montana has made some progress with laws surrounding euthanasia. Other countries are also revisiting these laws. As far as I know most actions of euthanasia are extended to people with terminal illness where the quality of life is in question and palliative care is no longer sufficient to ease a persons suffering.

My question is this: Should some mental illnesses be considered terminal? If there is a very poor psychiatric prognosis and recovery is not believed to be possible and the quality of life is very poor should a human be afforded compassionate euthanasia for a mental illness? Personally, I think if we had this open approach to death then we would have less suicides and failed-suicides because the topic would be completely open and non-taboo. If a person no longer wished to be alive they could could be compassionately euthanized after a comprehensive evaluation.

Thoughts?

[Elysium]

You know, I've often thought about this topic.

Mostly, I would be okay with a form of compassionate euthanasia, but I think it would need to be monitored and used in a case by case situation.

I don't see anything like this being accepted any time soon though by the medical or psychological/psychiatric communities. I think there is still such a strong argument that even though a psych disorder may not be able to be cured, it can be treated and managed and that this should be enough for people to hold on to. I don't necessarily agree with that however because this is more geared towards quantity and not quality. I also think this would not be looked ay seriously because there is such an intense fear of death throughout certain societies. To embrace human euthanasia would mean having to face our darkest fears which are rooted in our environments, our faith/spirituality, our morals and values, and ethics.

I personally feel that life is profoundly beautiful and precious...and believe it or not, this is the reason I would be able to support monitored compassionate euthanasia. Life is beautiful!! Yet life is not JUST a physical/biological experience, it is also spiritual, and for some who have intractable emotional/psychological pain, biological life can come at the high price of one's spirit and soul.

I think right now, society is promoting quantity of life over quality. We can't cure you...so we'll drug you, charge you lots of money for treatment that will merely treat/mask the symptoms of your pain, and you will just have to suffer. It's taken a long time to get where we are in the Medical profession to become comfortable addressing people's wishes related to end of life care based on medical issues, and I don't see them budging on the mental health spectrum any time soon. Before society would do that, it would have to overcome the stigma of mental health...that it's all in our heads and that it's something we could control if we just got our butts out of bed and started thinking happy thoughts.

This is a great question. I look forward to hearing others thoughts on the subject.

[FooZe]

Originally Posted by DivideByZero

Should some mental illnesses be considered terminal? If there is a very poor psychiatric prognosis and recovery is not believed to be possible and the quality of life is very poor should a human be afforded compassionate euthanasia for a mental illness?

I see the equivalent of Catch-22 looming here. If someone is ill enough mentally that they want to die, who's going to rule that despite being obviously dangerous to themselves, they're nevertheless sane enough to make life-or-death choices?

I know -- Let's treat them till they don't want to die any more and then let them choose!

Most states right now allow a person who has been committed to waive a right provided by law. A waiver is the act of intentionally relinquishing or abandoning a known right, claim, or privilege.

To be committed the person must be found to be suffering from a mental illness (there are other grounds too, like alcoholism) and a danger to himself, others and/or property.

So, the committed person is not deemed well enough to decide to leave the institution if his/her doctor disagrees, but is deemed well enough to waive a hearing on his/her involuntary confinement. How truly bizarre and illogical.

If, for the sake of argument, compassionate euthanasia for some mental illnesses is considered appropriate, a guardian or other fiduciary likely would have to begin the process, the mentally ill person deemed to be lacking the capacity to do so. I envision protracted proceedings akin to what goes on in death penalty cases.

[DivideByZero]

Thanks for the responses, good food for thought here. I agree strongly with Elysium's point on "quantity of life over quality", in my experience (I know I know anecdotal) the mental health care process for some illnesses seems to be very much "treat the symptoms" so that the patient is well enough to survive. The quality of life does not seem to be considered.

On the flipside, I can also clearly envision the protracted proceedings and possibility that we should be focusing on better palliative care and not on terminating the patient. Clearly it is not a simple issue, it is one that would need to be carefully evaluated on a case by case basis. I do however believe that there are rational humans (I am going to be egotistic and suggest that I am at least partly rational) that would like to have the choice to end their lives in a safe and comfortable fashion when they choose to die. Nature has no regard for comfort, so in my mind it is up to humanity to provide this comfort.

The alternative is forcing a person into a position where they need to end their own life if they wish to do so (after all treatment avenues have been exhausted), which could have terrible results for the individual choosing to end their life and for their family (since they cannot really speak of such things at the moment without the threat of incarceration). It seems to me that an open dialog on the matter with the possibility that the person can visit a hospital and with the consent of their immediate family go to sleep is far better than the alternative.

[lynn P.]

This is a very difficult and interesting topic. I support euthanasia in some circumstances - to me the term 'terminal' means the person has an illness that's causing unbearable pain and the person will die anyways in a certain period of time - like cancer, ALS etc. I don't support it as much, when someone's in a coma because there are cases, where a person has awakened after 26 yrs and it's revealed the patient was aware of everything. Imagine being immobilized, unable to talk while people are deciding if you should live or die.

I don't think we would get to a point in our lifetime where compassionate euthansia would be allowed for the mentally ill - even though their suffering is very intense - who would be the person who counsels them? What if there is a break through, where they wouldn't suffer anymore. For me the key point in euthanasia is - would this person die from their illness within a short time - like with terminal cancer etc.

Originally Posted by DivideByZero

Hi

It seems like Montana has made some progress with laws surrounding euthanasia. Other countries are also revisiting these laws. As far as I know most actions of euthanasia are extended to people with terminal illness where the quality of life is in question and palliative care is no longer sufficient to ease a persons suffering.

My question is this: Should some mental illnesses be considered terminal? If there is a very poor psychiatric prognosis and recovery is not believed to be possible and the quality of life is very poor should a human be afforded compassionate euthanasia for a mental illness? Personally, I think if we had this open approach to death then we would have less suicides and failed-suicides because the topic would be completely open and non-taboo. If a person no longer wished to be alive they could could be compassionately euthanized after a comprehensive evaluation.

Thoughts?

I agree 100%. (This has always been a question I've carried and I take it Seriously)

Sure there are a lot what 'ifs, buts, etc. BUT

When I was very young I believed that everyone should be given a cyanide pill. That when they thought it was their choice to go - they could.

BUT - we have teenagers who are too young to decide - their future is not defined yet

The pill could be allotted to people once they reach a certain age.

We humbly have our animals put down....

Yet, we are left in the humiliation of our own incontinence.

Also - True mental illness that can only be stabilized, if possible, for so long.. leaving life a continuous rollercoaster, etc.

I BELIEVE we should definitely have a choice..
Of course we could put stipulations: 'A certain amount of time of 'death choice' therapy....'

blah blah.... I want my pill

[FooZe]

Originally Posted by DivideByZero

It seems to me that an open dialog on the matter with the possibility that the person can visit a hospital and with the consent of their immediate family go to sleep is far better than the alternative.

Ideally, yes, but you'd have to watch carefully for the occasional case where a family might want to get rid of a troublesome member -- or even someone who was hogging their inheritance.

[Elysium]

Originally Posted by starlite*111

When I was very young I believed that everyone should be given a cyanide pill. That when they thought it was their choice to go - they could.

blah blah.... I want my pill

LOL Starlite!!!

I love the way you just come on out and tell it!!

I have always held a similar belief. I have visions of finding a nice spot along the shore at sunset. I would have a blanket, my favorite beverage and snack, and I would enjoy the beauty of the Sun's slumber. Then, I would pop my cyanide capsule and enjoy my own slumber.

If you ever meet up with the Cyanide Queen, you let me know where I can find her.

In regards to Euthanasia, I think, as with anything major like this (i.e. end of life care, death penalty...) that there would always be a potential for abuse of the system.

I think there would need to be some sort of evaluation and interview with the respective patient/client and I think it would need to be documented legally, as is a POLST (Physicians Order For Life Sustaining Treatment). A POLST is an outpatient "Do Not Resuscitate" order from a physician which allows medical personal, such as EMS to withhold life saving treatment outside of the hospital setting.

In regards to abuse of the system....I see plenty of cases, in the hospital, where a DNR order, which is a Doctors order, is being interpreted as "Do Not Treat". Countless times I have had a patient circling the drain and needing a higher level of care, like ICU, and have been told "This patient is a DNR, they don't want life sustaining treatment.", which makes my blood boil, as that is abuse of an order. DNR means you do not resuscitate once they have experienced clinical death (no heart beat or breathing), it does not mean you withhold treatment that would prevent them from dying.

So, see...there are still many bugs in the medical arena when it comes to end of life care, and there is still some taboo there too. It took so long to get society to this point of acceptance and not everyone is there yet. It would be a long time coming for a program such as this to be enacted and managed appropriately.

LOL Starlite!!!

I love the way you just come on out and tell it!!

It makes me ill.

I 'Do Not Resuscitation'. I've written on little cards, signed and laminated them, put them in my purse, behind my license.

I've looked at it as you've said 'though the people do not want to be RES., doesn't mean until then, they don't want to have medical treatment.

Sad, so many points to it.

I have told those I know that when I am 'not here' in brain that I want to be put into a nursing home.
Many tell me they won't or describe how cruel I could be treated.

My response "I won't know what's happening anyway".

Either/Or I refuse to hinder my peoples life's while I wait to pass.

My life beginning as it has.... REFUSE to add ANY ugliness to another's life.

Sorry here folks - Things have been tough for us all - And I very much included.

Sincerely Starlite.

[changeisgood]

ABSOLUTELY NOT NO WAY!!!!!!!!!! i was told by many psychiatrists for 15 years i'd never live outside a mental hospital. well i got the chance to be cared for by a kind compassionate man. this was about 25 yrs ago. we married and i learned things. i got a job in a factory. i had problems lots of them. i found a clinic with a kind caring therapist i've seen for 7 years. i now own my home run a small business, drive and contribute to society

[changeisgood]

read my post on this at the bottom.

There is no one answer good enough for this question. For some, it may be a solution.
I was also told I would live in a residential for the rest of my life, when I was 18. I graduated from college, married, had kids , worked full time....IF I had listened and believed those people, where would I be? I intentionally screwed up the one interview with the residential, knowing once I was in there, I would never get out of the system. I can't imagine my life like that.
The many glitches that come with a topic like this make it impossible to give one solid answer. Too many unpredictable events...and people....Too many mistakes....I wish I knew a better way to respond.

[changeisgood]

good for me and you!!!!!!!!!!!

Yes...very good! I thank the "powers that be" every day of my life.

There was a man in the UK who suffocated his daughter she was mentally ill and wanted to die so he helped her, she had been ill for some years and he was arrested and got the minimum sentance from the judge.

I think that was wrong it was murder or at the very very least assisted suicide and he should be punished accordingly.

I feel unless someone has a diagnosis from several Drs that the person is going to die within a short time and in pain then its murder and nothing less.

[VickiesPath]

In all of these cases, you have the "legal" world mixing with the "medical" world. Definitions, definitions, definitions.

Sane.

Of sound mind.

Of mental clarity.

Clear.

Rational.

Judgment.

Sensible.

Mindful.

Reasonable.

Conscious.

Any of these words could be used to legally describe the medical requirements of the patient before a decision for euthanasia or assisted suicide in the conscious state could be granted. They could also be applied when describing the person who has been given medical power of attorney for someone who is incapacitated and a question of euthanasia is being considered. Who makes the final decision? Who is to say that these conditions exist?

It's a minefield. It won't be resolved anytime soon.

[sanityseeker]

An interesting question for sure but just to add a different dimension consider this.... among past generations of tribal peoples whose culture and spiritual beliefs are holistically intertwined with the physical and mental it was common practise for the old people to go off or be left to die a quick and painless death when they believed it was their time to go. They simply willed themselves to die.

In consideration of this I believe that as spiritual beings having a human experience we have the capacity within us to determine or perhaps more accurately align with the limitations or intentions of our human life cycle. If our 'eternalness' refers to our spirit and not our physical than it suggests to me that the physical is an aide or tool or temporary expression or manifestation of our spirit. It further suggests to me that spirit can command a physical response at will. Therefore should a person truly believe their time in the physical is over or no longer serves a purpose then they have the power within by spirit to cease to exist in the physical.

At the risk of really sounding like a wacho here I will suggest that I have personally experienced such power of spirit. I believe I brought on my own near death only to at the very last minute opt to change course and chose or be prompted to chose more physical life instead. I vividally remember a huge casp of breath pulling me back into consciousness after making the determination to will myself to die. Ever since that experience I have abandon any thoughts of medically assisted death. Should I believe my life is no longer worth living I believe I have the power without to will that to happen. If my desire is aligned with my spirit and is of spirit than I will cease to exist physically and move on in spirit.

On a more 'rationale' or rather 'worldly' note.... I also don't think it is fair or reasonable to put the decision of my death onto anyone else but me. My mother died from an over dose of prescriptions drugs. She made her own choice and used her own hand to go to sleep and not wake up again. That was her choice and I understood it even if the loss of her in my life still pains me almost 30 years later. To me the idea of assisted suicide or euthanasia would only be viable if a person deemed to be mentally capable to choice was physically incapable of doing it themselves.

[Perna]

"Most jurisdictions are reluctant to authorise Physician Assisted Suicide (PAS) for patients with severe psychiatric illness in the absence of physical illness. None the less, the Dutch Supreme Court has ruled that PAS may be justifiable in certain cases in which there is unbearable mental suffering in the absence of physical illness. In 1994, the Court indicated that extreme care should be taken if PAS is considered in the absence of physical illness, and that the request should not be granted if the patient has deliberately refused a realistic alternative treatment. The advice of an independent expert is also required.

"In Dutch psychiatric practice only about 2% of requests for PAS are finally granted — compared with 37% of requests granted in Dutch medical practice as a whole (Groenewoud et al, 1997). In The Netherlands, PAS occurs in current psychiatric practice no more than five times per year, and most of these patients have both physical and mental illness. It could be argued that to deny a person PAS on the grounds that the illness is psychiatric rather than physical would be discriminatory. Is this the ‘slippery slope’ that opponents of PAS have always feared? Moreover, in an increasingly consumer-led society, could it become incumbent upon psychiatrists to provide such services?

"Requests for PAS on the basis of psychiatric illness alone stem from the provision of PAS for physical illness and from our growing understanding of the biological basis of certain mental illnesses. However, the similarities between physical and mental illness, though strong, are not complete. There is still a limited understanding of the underlying causes of common mental illnesses, including depression and schizophrenia. In the case of an individual patient, it remains extremely difficult to predict whether therapy will produce an early response, a delayed response or no response (Schoevers et al, 1998). It is impossible to predict which patients will undergo spontaneous remission and when this will happen. These uncertainties are far more pronounced in psychiatric practice than in medical practice, to the extent that it is essentially impossible to describe any psychiatric illness as incurable, with the exception of advanced brain damage as occurs in progressive neurodegenerative disorders such as Alzheimer's disease and Huntington's disease."

From: http://bjp.rcpsych.org/cgi/content/full/181/4/278