The push is now underway to enable assisted suicide for psychiatric patients. the Eating Disorders Diary published an article calling for psychiatrists to be allowed to witness the suicide of patients with anorexia who want to die rather than continue to fight their mental illness.
Think about it. Seriously. Assisted suicide is featured as a “treatment” for serious psychiatric disorders in a respected medical journal. Awful.
First, the authors push the absurdity that assisted suicide isn’t really suicide. From “Terminal anorexia nervosa“:
Terminal AN designation may make it easier for patients to receive palliative care, palliative care, and emotional and practical resources for their loved ones, as well as access to medical assistance in dying (MAID) where needed. is legal. The therapeutic goals in these situations are to alleviate the suffering and to honor the life lived. It should be noted that MAID is offered to people whose death is inevitable within six months of an underlying disease process; it offers patients the choice of How? ‘Or’ What they die, no whether they die. It’s not a way to kill yourself.
Semantics. Death is caused either by the ingestion by the patient of a lethal dose of barbiturates to cause death – suicide – or in other countries, by lethal injection – legalized homicide. It is not dying a natural death.
The idea expressed is that some cases of anorexia are so severe that they should be considered terminal, like cancer. But mental illness is not like some relentless biological disease process. The person with serious mental illness can be kept alive. It could be very difficult. It may even require involuntary hospitalization. With anorexia, if the patient were forced to feed, she would not die. We might not want to do it, but we could. This is not the case for illnesses such as terminal cancer (which should also not be eligible for assisted suicide).
Never mind all that. The authors want patients with “terminal” anorexia to have access to assisted suicide:
Recognizing the considerable controversies surrounding MAID for patients with mental disorders, we also argue that patients with end-stage AN who are severely compromised physiologically and whose suffering at the end of life results from both psychological pain and physical should have access to medical assistance in dying in places where such assistance has been legalized, just like other terminally ill patients.
It’s abandonment, no matter how well intentioned. Sometimes the only thing that stands between a seriously mentally ill patient and death is a dedicated psychiatrist or psychologist.
By the way, allow assisted suicide for “terminal” mental illnesses and it wouldn’t necessarily be psychiatrists prescribing the poison. In theory, any doctor could do it. Cases of deaths by physicians prescribing lethal drugs outside of their specialties in jurisdictions allowing assisted suicide and euthanasia are ubiquitous. For example, in Belgium, a oncologist euthanized a woman who wanted to die because of her relentless depression. The same sort of thing happened in the United States, although it didn’t involve mental illness.
The article presents three serious cases to justify the authorization of assisted suicide. They break your heart. But hard cases make bad law. Allowing assisted suicide for psychiatric illnesses would open the door wide to medicalized murder.
If you doubt me, consider this from the paper:
AN carries the second highest mortality rate in the DSM-5 after opioid use disorder, with an estimated mortality rate of 5 to 16 times that of the general population.
So why not allow an intentional and fatal overdose of opioids as a “treatment” for an opioid use disorder? Once you open the door to one by redefining it as “terminal”, you will no longer be able to prevent others from entering.
When psychiatrists abandon their mentally ill patients – and in fact are allowed to help them commit suicide — who will defend the value and continued importance of their lives? How will these very unfortunate people be kept among us during their darkest days?