Euthanasia: When and If

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thatalex
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Joined: 23 Oct 2023, 21:17

Euthanasia: When and If

Post by thatalex »

So I just saw a Guardian article claiming that euthanasia is allowed for unbearable mental suffering in the Netherlands...

https://www.theguardian.com/society/art ... wtab-en-gb

This disturbs me. Not just because I have a Dutch acquaintance in a very similar situation with some of the same diagnoses, but also because of my own diagnoses.

I just can't figure out what it is about this case that makes trauma and anxiety untreatable (although it sounds like they've tried everything) and unbearable. She is younger than I am and has had way more help in her life.

Not just anecdotally but in my personal life with these diagnoses, it has often been the case that I was not in my right mind, or acting out someone else's agenda and not self-willed. Yes, I've made suicide attempts. I never attempted suicide by doctor... Doctors are held to a higher standard surely?

Mental conditions are real, but being so often poorly understood, how can it be said that there is certainly no prospect of improvement?
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sharoma
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Re: Euthanasia: When and If

Post by sharoma »

I find this extremely disturbing. She isn't even 30 yet. I expect at least half of us have felt suicidal before 20, let alone before 30 (28 was one of the lowest years in my own life). I certainly have not been in my right mind when these thoughts have been in my head. The thought of a doctor validating it and okaying suicide is quite terrifying. The medical system is completely failing her.
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Sycorax
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Re: Euthanasia: When and If

Post by Sycorax »

This is state-sanctioned cleansing of undesirables from society.

Speaking as a healthcare worker, a shit philosopher, and as a mentally-ill woman with multiple attempts on her own life, this is happening because treating mental health conditions takes an *enormous* amount of resources, consistency, and above all time. Governments don't like to pay for these treatments because for them it is purely a matter of cost. If you consider the cost of treatment, and add the fact that she likely does not work (which governments hate)... they're not seeing her as a human; they are looking at her as an expense and assisted suicide is a way to "wrap it up". This is no different to how governments simply ignore the drug crisis and let people die on the streets. Because they know it is cheaper to simply let us die than it is to offer help.

I am all for bodily autonomy. I think there are times where assisted suicide for cognitive issues would be appropriate. If I ever come down with dementia, you're damn right I am checking out before I lose my sense of self.

But this....this is not medically-appropriate. At all. Human beings are not meant to want to die, and if they do, that is a really obvious indicator that *they are not well and not in the right state of mind to make the decisions*. From an ethics standpoint this is absolutely fucking horrendous and wrong.

We have the same issue in Canada. I recall this case being discussed not long ago: https://www.cbc.ca/news/canada/calgary/ ... -1.7154794


I am very close in age to both the Canadian and the Dutch woman we are discussing. I now cannot help but wonder how many men vs women apply for death by assisted suicide for mental health issues.
thatalex
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Re: Euthanasia: When and If

Post by thatalex »

To be fair prison is just as expensive as mental health treatment and politicians have no qualms about mandating that people be sent there, but.... In this instance I would not be surprised if politicians did see the mentally ill - even this apparently bright and strongwilled young woman - as "useless mouths".

Medically, sanity is literally defined in opposition to wanting to die in itself, or to hurt yourself "on principle". I can't get round that factor.

I am wondering now if there is a "suicide lobby" of unethical doctors, just as there is starting to be a "trans lobby" of surgeons who don't bother checking whether the individual in question has true and long-lasting gender dysphoria. And then charge extra to reverse the surgery!

The thing about men vs women touches on a concern I have as well. Is it possible to know - truly know - out of one or two conversations with someone whether their will is truly their own, or if they are being coerced or otherwise manipulated into suicide from individual considerations like profit or because the caregivers resent their role? What if they were being threatened? That doesn't seem to be the case this time, but I know that autistic people tend to be rejection-sensitive and are very vulnerable to manipulation at any level of functioning.
Sycorax
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Re: Euthanasia: When and If

Post by Sycorax »

When we put people in jail, society gets the satisfaction of enacting a punishment or retaliating against a criminal. Western society loves to punish and control. So yes it costs us (dearly and in various ways) to imprison people, but there is a dark satisfaction received from doing so. That's why we do it. If we really cared about helping people, we wouldn't do it in such a damaging and punitive way (prison).

When we try to treat people for mental health, there is no "exchange" or trade off for us putting resources into curing mental health. That's why it's chronically underfunded/understaffed but prisons are not (at least in Canada anyways).

Just for clarity's sake: I don't agree/support the logic I've presented-I'm just saying that's my best assessment of what/why I think is happening.

@Thatalex "sanity is literally defined in opposition to wanting to die in itself, or to hurt yourself "on principle". I can't get round that factor". Yes, a thousand times yes. We shouldn't try to get around it. It's crucial to the whole euthanasia discussion. If people are not in their right mind, they cannot consent to making decisions for themselves. By definition, wanting to die is the most obvious indicator someone lacks mental capacity to make decisions/is not grounded in reality. Anytime I've tried to check out early I was so far removed from myself...all my thoughts and actions were miles and miles beyond reality or rational thinking. I cannot imagine what moral criteria was used to conclude that people who want to die have the capacity to make appropriate decisions for themselves.

I would love to know what medical criteria is used to decide that a mentally-ill person is beyond help. Both of these articles emphasize that it is not easy to get permission for assisted suicide, that there are steps etc etc.. Well, what are the steps? What is the criteria? What is the process people have to go through? How many treatments or assessments do they have to fail? What actually constitutes failing treatment? What kind of doctor or specialist get to decide if a person qualifies, and what are their credentials for doing do?

I have also wondered many times how medically appropriate it is for a doctor to meet a patient 1-2 times and then make decisions about their mental health care. To answer your question, I don't think an accurate diagnosis or assessment of a patient can be obtained from 1-2 visits. Absolutely not. If my therapist needs multiple months before he can come to an idea about what is wrong, then surely a doctor needs the same amount of time.
Sycorax
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Re: Euthanasia: When and If

Post by Sycorax »

I have asked my co-workers about the article and we are currently debating the finer points of this psych journal article:

https://www.cambridge.org/core/journals ... 50ED0E2E02

I would draw your attention to Table 1, which says "decision making capacity should be presumed EXCEPT (emphasis is mine) in young children and patients suffering from psychiatric diseases to the extent and of a type that interferes with capacity".
thatalex
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Joined: 23 Oct 2023, 21:17

Re: Euthanasia: When and If

Post by thatalex »

"One way in which the bar is sometimes set too high for patients who are trying to access assisted suicide is by broadening the scope of decision-making capacity evaluations too far beyond issues of capacity. One example of this is using an inappropriately high standard of ‘stability’ of attitudes, in line with the Swiss Academy of Medical Sciences (SAMS) criteria, which mention that a patient's wish must persist over time.9 In principle, a patient can be competent and still be ambivalent about a wish. This can result in unstable and changing requests over time in a patient with competency. However, unstable attitudes can also be the consequence of fluctuating cognitive and autonomous mental capacities.Reference Trachsel, Hermann and Biller-Andorno10 This shows that it is important to be more specific about decision-making capacity evaluations in patients who are terminally ill and to explain in more detail what should be evaluated. Otherwise, for example, doctors opposed to assisted suicide could insist that a long period of time passes before it can be provided to a terminal patient with early-stage dementia. If the period is too long, the patient will either have already died or will no longer pass a decision-making capacity evaluation at the end of it because their disease will have progressed."

I do not think that a one size fits all policy can account for these disparate examples, but giving doctors broader leeway to make the call risks further abuse of this "right".

"One might never choose assisted suicide for oneself or might think that the practice itself is deeply unethical, but to impose those values on one's patients is deeply unethical and unprofessional."

... You "impose (your) values" by refusing to kill someone?? This doesn't seem coherent.

This is a disturbing article that seems to be telling people to fall in line, despite dodgy "safeguards" :S There ought to be more stipulations; to choose to die is not automatically insane, but what about permanent fixes to temporary problems? Like if a somatic narcissist got flesh-eating bacteria on their face and "chose" to die rather than go round less than perfect, what then? What if it was just acne for an awkward teenager? Do healthy people have the "right to die" too? This is a massive can of worms.
Sycorax
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Re: Euthanasia: When and If

Post by Sycorax »

https://www.parl.ca/Content/Committee/4 ... rp03-e.pdf

Page 13 "distinguishing MAID requests from suicidality"

"Some witnesses told the committee that there is no way to distinguish requests for MAID MD SUMC (Assisted suicide for mental health issues) from suicidality, while others asserted there is a clear distinction between the two".

I had about a dozen of my co-workers and 3 doctors read this document. There is no criteria for distinguishing between suicidality and requests for MAID. There are no guidelines for it, no training, nothing to go off whatsoever. It's just your best guess.

It is totally unethical to offer MAID for mental health when you're not able to determine a reasonable request vs suicidality. We are supposed to do no harm and yet that's exactly what this policy is.

@Alex in Canadian MAID, they don't even have to exhaust all of the treatment options. Basically, I could ask for MAID, refuse all treatment, and they'd give it to me.
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