“You can’t reason yourself back into cheerfulness any more than you can reason yourself into an extra six inches of height” ~ Stephen Fry
Though euthanasia laws are changing and many now acknowledge there are those in our society that are fighting for a right to die painlessly. This acknowledgment usually only extends to the terminal and those of extreme somatic pain or physical disability. Most are not willing to extend this right to die to those with a different pain, one that can be much more difficult to treat and can be just as crippling to the sufferer, this being psychological pain. To give the right to die to those that are mentally ill is often taboo to agree with. Different conditions of mental illness, soundness of mind, importance of regulation and legalisation’s possible effect on suicide are important things to consider when forming an opinion on this topic.
The Mentally Ill and Soundness of Mind
In many mental illnesses unsoundness of mind can be easily determined due to the nature of the condition these include conditions such as schizophrenia, psychosis, alcohol / drug addiction and bipolar disorder which often cause distortions of reality as well as sudden extreme changes in behaviour and decision making. Conditions that affect mood such as severe cases of chronic depression and anxiety however are not so clean cut, this is especially the case when treatments fail to be effective on the patient. For many patients (up to ⅔) antidepressants can have little effect and for those with treatment the chances of a second episode of major depression can be as high as 80%1. So for those with severe chronic depression that have resisted treatment euthanasia may be considered.
Depression and Decisions
Competence to make an informed and voluntary decision are required for euthanasia2. However as depression effects the mood, individuals are still capable of weighing the pros and cons of medical actions and making informed decisions based on them. If the justifications of maximising autonomy while minimising suffering can be used for ending of physical disability and somatic pain then surely it follows those with long term depression with a sound mind should have the same rights also.
Doctors and Determining Soundness of Mind
Generally people can detect if a person’s thought are irrational or inappropriate and based of this their soundness of mind. If voluntary euthanasia were legal it would be unlikely that psychiatrist would fail to notice that their patients were of unsound mind. The doctor’s decisions would have serious outcomes and be subject to legal scrutiny, therefore knowing what was at stake would focus their attention to avoid mistakes. A referral to a psychiatrist would be essential when considering such a thing as euthanasia. General practitioners would also be able to make the appropriate referral by considering if the wish for death was reasonable based on the patient’s life story, medical history and current life situations while keeping a eye out for other possible mental illnesses3. Finally with no comorbid mental illnesses and a sound mind the current bout of depression would also have to be considered and follow appointments made to re-think such decisions during a temporary remission in their chronic depression4.
Strictly Regulated Euthanasia and Suicide
Those that attempt suicide in most cases suffer from a mental illness3 and these attempts are often a cry for help, however the sad reality is that although many attempts do not intend to be successful 1 in every 25 results in the loss of life with the elderly demographic being 1 in 42. With euthanasia available such individuals may seek euthanasia before attempting the much more traumatic act of suicide. Many of these requests then seen by doctors would therefore be from individuals wishing to end their pain rather than their life. By having tightly regulated euthanasia these individuals may then be identified and given the appropriate mental health treatment needed for recovery.
Euthanasia in Switzerland for the Mentally Ill
The Netherlands, Belgium and Switzerland all allow physician-assisted suicide in nonterminal cases when suffering cannot be alleviated. A ruling by the Court in 2006 opened up possibilities of the right to die to include psychiatric patients as well in Switzerland. This occurred after a case of a manic depressive man who had already attempted suicide twice before and been repeatedly rejected prescriptions for euthanasia drugs. The Swiss decision recognised that mental illness and pain was on the same level as physical ones. Importantly regulation was also mentioned in this decision, stating that it is important to make a distinction between those temporarily impaired and those with severe chronic conditions that had shown to be treatment resistant.
Psychological pain can be just as difficult to live with as somatic pain. With the current state of pharmacological and behavioural treatments available although effective for many there are still a proportion of individuals that do not benefit. In such cases euthanasia may be considered as a possible option to end severe suffering. However it cannot be emphasised enough that this would be a last resort after other avenues of treatment and the appropriate psychiatric assessment for soundness of mind had been done as well as considerations for the future of possible breakthroughs in science and the ramifications of leaving loved ones behind. In saying this access may help those considering suicide a new path to seeking help, help should be considered the number one priority even to those coming specifically for euthanasia. As often those in sickness do not realise that with assistance they can make it through their illness and onto recovery.
“When ‘I’ is replaced with ‘We’, even ‘Illness’ becomes ‘Wellness’.” ~Malcolm X
1. Clinical depression.co.uk. Treating Depression: What Treatment Actually Works? [Internet]. (United Kingdom): Clinical depression.co.uk.; [cited 2015 Apr. 12]. Available from: http://www.clinical-depression.co.uk/dlp/treating-depression/treating-depression-what-treatment-actually-works/
2. Life. Mental Illness and Euthanasia [Internet]. New Zealand: Life. [cited 2015 Apr 12]. Available from: http://www.life.org.nz/euthanasia/abouteuthanasia/abouteuthanasia2/
3. Lost all hope. Suicide statistics [Internet]. Lost all hope; [cited 2015 Apr. 12]. Available from:http://lostallhope.com/suicide-statistics
4. Appeal J. A Suicide Right for the Mentally Ill? A Swiss Case Opens a New Debate [Internet]. (America): Medscape; 2007 [cited 2015 Apr. 12]. Available from: http://www.medscape.com/viewarticle/557817