I don’t get it.
In the moral, ahem, gray area of euthanasia, there are numerous organisations that operate between advocacy and abetment. A problem that psychiatrists often have is the management of suicidal tendencies in patients with mental health vulnerabilities is that they often find support with the euthanasia movements to support their plight. What absolutely has to cease is the practice of conflating suicide with euthanasia. Suicide is a preventable act of ultimate self-destruction. Euthanasia is a merciful termination of a terminal or severely incapacitating physical illness. The latter occurs when a person retains capacity – defined as an unimpaired mind that can reasonably take into account the context and implications of a decision. A person who is depressed, or delirious, or unduly coerced, by all international standards is determined to lack capacity.
This certainly does not mean that deciding to die is in itself a mental illness. Fortunately most psychiatrists do not see a wish to die per se as being a mental illness, provided that there are sufficient insoluble stressors causing the decision. However, increasingly the definition of ‘insoluble stressors’ is stretching the argument for euthanasia beyond the point of rational discourse. In June 2015, a 24 year old Belgian woman known as “Laura” was granted the right to die for longstanding suicidal tendencies only. In July 2015, a Swiss clinic euthanised Gill Pharaoh, a retired palliative care nurse who was afraid of growing old.
I once had a 70 year old patient with recurrent serious depressive episodes leading to suicide attempts. She was a “professional suicider”, in that she belonged to an organisation that clandestinely posted out kits to help one to kill oneself. I saw her after yet another attempt, wherein she drank a large amount of whisky and then attempted to use the kit. She was discovered on the floor a day later with some muscle damage and semi-comatose, but revivable to an almost full level of functioning. She explained to me a few weeks later that she now had a renewed purpose to life – she realised her mistake was attempting to kill herself using the device whilst intoxicated, and that “thousands” of people around the world must be trying to do the same thing and failing. With a renewed mission in life, she decided that she would cease attempting to kill herself and would now play a more active role in the organisation, particularly in online messageboards, so as to assist other people to kill themselves more efficiently and help others to avoid the mistakes she made. It was one of the more confusing risk assessments I’ve ever had to make.
There are reasonable mental health principles that assist us with maintaining and protecting vulnerable patients from poor choices, and these are a world away from the suffering terminally ill patients for which the majority of the saner euthanasia debates run. It is an emotive and difficult issue, and we do not make it any easier by equating all suicide with euthanasia. A world where electronic bullying leading to the death of an 18 year old can be regarded as a necessary occurrence to protect freedom of euthanasia advocacy, is not a world that makes sense.