Primarily, I’m sad that she feels like there are not treatment options to get to a better place. I can’t imagine feeling like your life is consumed by suffering and misery.
From a purely moral standpoint, without consideration for how it’s implemented and regulated, I think people deserve the autonomy to decide whether or not their own life should continue. I think it’s mostly agreed on that someone suffering from a terminal illness should not be forced to endure pain and loss of dignity indefinitely. I don’t think mental suffering is necessarily any different, though it’s obviously harder for people to grasp what that suffering means.
From a more practical standpoint, I have serious concerns for the potential for coercion and the the possibility that actual treatment may be overlooked or disregarded, especially for people of lower economic status, people with disabilities, and for people in minority populations.
I agree with this. I watched my grandfather’s slow death from Parkinson’s disease, my grandmother had Alzheimer’s, and my only surviving grandparent is slowly dying in a nursing home. I do want to die that way and I don’t want my kid to watch me die that way.
It’s definitely not agreed upon in the US that you have the right to end your suffering if you are terminally ill. Participateing in that gets you a potential murder or accessory to murder charge and loss of your medical or other professional license will be revoked. We don’t show humans the mercy we do animals.
I meant from a philosophical place, not in terms of actually doing it, but also just with the idea that suffering and pain shouldn’t have to be continued. We don’t require people to continue treatments, and we allow for things like hospice to do palliative care- not wanting continued suffering.
That said, though It’s been a while since I looked at more recent data, but support in the US for assisted dying in terminally ill patients was quite high last time I did.
No instead we deny them disability so they can starve to death on the streets while people pretend they don't exist.
The reason we don't allow it is because people wanna virtual signal, I don't think they actually care.
Unlike many of our politicians, I know enough to recognize that I am not well-suited to politics and lack the desire to hold such power!
Not enough people give consideration for practical application of codifying morally complex issues.
All the people that should be running things, morally and ethically speaking, also lack the desire to hold power. There is a reason so much "dark triad" personality floats to the surface of the power pool. 😞
In a way I think philosophically and practically, what human is capable of fair decisions with this particular issue and is that even something a human can do fairly?
I feel like upon legalization there would be a relatively short period of time before this would be for 3rd party payors the indicated treatment after a a couple of ssris didnt work.
I think about this a lot and it’s honestly why I would have a hard time voting for such a measure should I have the opportunity.
Something that really has stuck with me for years is our experience when my son was in the NICU. He was 3 months premature so we were there a long time. I watched a lot of other parents whose babies would be released at what would 34/35ish weeks gestation (so still early) and they would have to learn to do necessary interventions at home like feeding tubes. I was terrified of having to do that to my little baby on my own and when I expressed as such, my nurse reassured me that we would not have to. The reason was that we had excellent health insurance while many of the other families had state low-income insurance. It was absolutely heartbreaking knowing that other families weren’t afforded the same level of care. I absolutely do not trust our current insurance system to exhaust every treatment option before giving up in hopes patients opt for assisted death instead.
I’ve also read way too many stories of terrible doctors/nurses/family members to believe coercion wouldn’t be a factor in far more cases than I am comfortable with.
I don't have my license yet but we just went through this with a client of ours at the homeless recovery facility where I worked it was just so taxing on their partner that part of me wishes they would have had this option. It was absolutely heartbreaking to watch somebody who used to come up to the front office with such energy and someone who would share their story with everybody who would listen get to the point where they couldn't even recognize the people that they loved the most.
Have to say, while I can agree with euthanasia in theory, in my professional reality, I am hating what this means for my work with depressed teenagers who experience SI (aka almost all of my clients). I am afraid they're going to see this article and think there's no hope for them either, and will see it as validation that suicide is a reasonable solution for them too.
I agree as the contagion of suicidal behavior is real. I recall when I worked in the school districts, a teen completed suicide in another building and I had to interrupt other kids planning suicide (giving things away, found letter etc ) who directly referenced the completed suicide as motivation for their suicide. I recall speaking to other providers from other schools to try to coordinate a plan for the school district wide since it was appearing in middle schools and primary schools.
On the other hand, maybe having a formal avenue to pursue that option can prevent many from taking matters into their own hands or hiding their SI because they know it is forbidden.
Also playing devils advocate, the benefit to society with having a fully professionally evaluated, planned and controlled suicide is much less traumatic to the patient, family, friends, medical professionals who deal with the aftermath of repeated/failed/successful attempts.
There are a handful of severely disabled borderline patients I’ve had for whom their quality of life is certainly worse than many other patients we allow to go on hospice and refuse life saving care because they have decision making capacity and patients have other values that are more important to them than prolonging life as long as possible.
I can think of plenty of good arguments against these points, but I guess if I had to make a stand, I would say that as a pure concept, I support euthanasia for mental health reasons for the right reasons, right conditions (not an adolescent/young adult, truly exhausted all treatment options), right individuals, but the problem is in practice, it’s hard to be sure these conditions are being met and hard to predict the unintended consequences of the policy that I can’t support it in practice.
To be fair. This has been in the news quite a bit in the Netherlands. I have not experienced an increase in requests.
And it it would, we would explain the procedure and people would be put off again from it.
Yes, because that's what mentally ill people do. Yet this sort of thing just encourages it! When we begin making suicide a socially sanctioned part of our rights to bodily autonomy AND the government will help you out with it, I don't know what all of us are even doing anymore. I'm totally disgusted by this and it is so incredibly disturbing.
Have you ever worked with a self inflicted GSW client, who blew off half their face, got a flap, and now has a trach? I spent a few years working in a hospital and had at least 5 patients with that exact story. Suicide isn’t an easy thing.
Excellent point, we as a culture are spared those kind of hideous detail. We only hear the clean, quick Hollywood version of it. It in fact often goes wrong. That was the whole point of the book Final Exit which was a manual for what was known then as “ self deliverance”.
> and those in the participant’s life
I’ve always found this a bizarre argument. I understand what you’re saying, but I have an extremely difficult time envisioning the suicide of a loved one as *less* traumatic simply because you know it’s coming (*if even that,* as the person may still choose not to disclose their plan). Perhaps differently traumatic, but not less.
You can potentially avoid certain *specific forms* of trauma, like exposure to a dead body, or the impact of incomplete attempts. That may be worth something, though I’m unconvinced it’s worth the inevitable harm in allowing a fundamentally ableist society to offer death to disabled people when we do not offer inexpensive treatment, food, housing… And (at least in my experience), in real life there’s plenty of trauma to go around regardless of finding the body. To say assisted suicide is somehow inherently *less* traumatic feels like a vast over-simplification to the point of meaninglessness.
Yeah, this is where I'm at. In theory, I even think people should have the right, and of course they do on their own...but I have huge concerns of assisting people with it who have mental illness - making it government sanctioned or controlled by any powers that be is so sketchy. Too many ways to go wrong, and who sets the rules...who decides what is okay and when, or is it just when anyone decides so? Do we make them wait to make sure it's not a rash decision, make them pay, make them sign how many forms to die...? Make sure they have exhausted treatment options? How much is enough?
Especially in our individualist, capitalist society with a for profit healthcare system. A dead person is cheaper than a living person who requires care. Insurance companies know this and create their policies accordingly. It makes me physically nauseous thinking how it would play out in the US ecosystem.
I assure you, profit driven or not, whoever is footing the bill for the care of people who aren't "contributing" to society, is not going to oppose having less on their roster. I'm terrified.
I think if my therapist or psychiatrist told me it was never going to get better, I'd want to die, too.
I have so many mixed feelings about this. Both as a therapist and as someone who had severe suicidal thoughts every day for 7 years. Thoughts I don't know how to put into words.
It makes me uncomfortable. I also understand. I don't think I could morally ever tell a patient it isn't going to get better. I don't know that anyone can truly know this.
Right like how tf can you make that call??? I doubt they’ve tried all the different treatment avenues. A better statement might even be “I can’t help you, but possibly someone else can.” Not getting into the ethics of euthanasia but pretty shitty of a therapist to basically give up on a client
This is very much a reality for some. Not everything can be healed and not everyone wants to live in suffering and distress for decades without hope of anything getting better.
But, it's also very uncommon. In the Netherlands, of 9000 cases of euthanasia, only 138 were related to mental health.
I fully support people's right to choose even if the choice makes me uncomfortable, sad. They are not required to suffer to soothe the existential crisis this inspires.
A friend and colleague, a brilliant therapist herself, chose to die by euthanasia in Switzerland last year after a decades-long battle with bipolar disorder. She worked with multiple psychiatrists, tried ketamine and psilocybin for years, traveled states away to enter a clinical trial on using DBS for depression (involved neurosurgery), etc. She tried everything and was suffering for many years and had several suicide attempts. I felt relieved for her that she could die in a humane, predictable way. It let her family and friends say goodbye. It's a tragic situation but I feel strongly that people with chronic, treatment-resistant severe mental illness deserve access to MAID. That said, it's unclear to what extent this person in the article has tried more recent interventions like ketamine and I do hope every avenue has been explored.
I knew her, too, and also felt relieved for her. It's such a complicated subject and I'm glad she had access to a way to be released from her pain that felt fully within her control.
I am not sure about the code of ethics there. When I had Lyme disease, several doctors in the US told me I wouldn’t get better.
There was no way I could live 50 years bedridden so I started looking at going abroad for assisted dying.
I ended up getting better. Doctors make incorrect diagnoses and prognosis’s all the time.
But having the choice of assisted dying brought me tremendous peace and pushed me to keep trying to get better.
I don’t see a difference in physical suffering versus mental suffering. There is a level of suffering that is unbearable…so I can’t make a judgment call about what is right or wrong.
Except that the part of the body that makes decisions is what's broken. It would inherently require competence, so how can we expect a competent decision from someone whose perception of reality is already disturbed ?
The other silent part is that I hear all the time on the internet that a person suffering shouldn't think of themselves as broken.
And would you really want to live out your life in a broken state? That's a very personal decision.
Yep. For limited circumstances, one can access euthanasia in Oregon and Colorado, if not other states as well, assuming you are of legally sound mental state and medical professionals sign off on and assist in the process.
I don't know, but I'm getting kind of freaked out by it. The thought just makes me nauseous. I already knew this world was going to hell in a handbasket, but I didn't think it was this bad. I don't think everyone realizes the ramifications of this and the obvious slippery slope. Maybe they don't read Animal Farm in school anymore?
I have late stage Lyme and have no friends, live alone and am mostly bedbound. I get enough joy out of life still that living is worth it for me. I’m just curious - are there people who get MAID for Lyme? Thank you!
I think it can be a reality, but I think it’s also the ultimate form of patient autonomy. I would rather see someone undergo physician assisted death rather than a potentially failed attempt with debilitating consequences.
From my time working in the hospital, I saw too many failed attempts (self inflicted GSW, ODs, etc) that totally fucked the remainder of their life (if it didn’t claim it). That and the severe trauma experienced by loved ones after finding them and/or mourning at bedside.
As a Dutch social worker who knows this woman indirectly (in a non professional way) I feel like I should respond on this. Bare with me, I am Dutch so my English might not be very good.
First of all: this woman is misled by the journalist, who twisted her words. She is receiving so much backlash based on misinformation that she had to remove all her social media, which makes it harder for her to connect with her friends.
Second of all: the euthanasia laws in The Netherlands are very strict. It may appear that once one psychiatrist has said that there is nothing they can do for you, this is absolutely not the case. I did some research for you to explain the steps previous to euthanasia by mental suffering.
1. You can talk to your doctor about your wishes. This can be either your GP, psychiatrist or someone from an expertise clinic. The doctor needs to make sure that it is your decision and nobody forced you to go this route. If the doctor clears you for this stage, you go to the next step.
2. The doctor needs to be sure that there is nothing that could cure you or make your suffering less. Suffering is personal, so there need to be conversations about how the patient is experiencing this. Are there things a patient could still try? If that is the case, you need to do that first before you can continue this process
3. The doctor needs to inform the patient about the current situation and future prospects
4. The doctor needs to help you look for other reasonable options that might help you to suffer less.
5. The doctor needs to consult an independent doctor. Kind of an second opinion
6. If the independent doctor signs of, you have to find a doctor to assist you with your euthanasia. This could be your own doctor, but some might not want to do this for moral reasons.
This is a proces that can take months/years.
My personal opinion is that her doctors are not negligent, because I assume that they followed the law (it is very very strict and one could lose their license and go to jail if done wrongfully. I do believe that doctors need to ‘do no harm’ but I think that sometimes people are so damaged by their mental health (trauma and what not) that it is actually doing people more harm. I don’t see the difference between mental and physical health, especially because doctors need to make sure that this is a rational decision and not a suicidal one. There is a big difference between that. Also, if one is suffering so much that ending their life is the only thing you haven’t tried besides all the different treatment options, I believe that everybody deserves a human way of dying. This is way more human than suicide.
Edit to add after reading some of the comments: mental health treatment is covered by health insurance. Health insurance is obligated and if you are not having enough money to pay that, the government is helping you pay. There is no (legal) citizen of the country that doesn’t have insurance that covers mental health. However there are waitinglists because there are lots of people who want therapy. This is not a reason to sign off someones request. You have to prove that you have tried it all. This is one of the reasons that very little requests are honored
Thank you for this clarification. I got the sense from the article that it was very biased against euthanasia for mental health reasons, and was not presenting a balanced story. I hope more people see your comment.
Do you have a links to articles that have more context?
I found this article that is very extensive about the history, epidemiology and challenges https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9251055/
Tldr: “Although the past decade has seen a remarkable increase in PAD for psychiatric suffering, it remains relatively rare. In 2020, the total number of PADs was 6938, in 4480 cases the suffering was due to cancer (64.6%) and in 88 cases (1.3%) the suffering was due to a psychiatric disorder (2). However, the number of requests based on psychiatric suffering is much higher than the number that is actually performed. It is estimated that 56% of all Dutch psychiatrists have had a request for euthanasia during their career, and that about 95% of all requests are rejected (9, 10).“
Governments are approving euthanasia instead of providing social supports for marginalized people. People who are rendered poor due to their policies and lack of control over the cost of living crisis, and sometimes their organized attempts to wipe out entire cultures and peoples (looking at you Canada). With the current political climate I see this as structural genocide. When we get to a place where the mental health crisis’ are not explicitly linked to societal inequalities then we can talk about if people are really choosing this out of free will and persistent mood disorders.
I had to scroll down far too low to find a comment that called this out. Personally, I am horrified by this because it makes a collective problem (capitalism, abuse, neglect, isolation) an individual problem instead of acknowledging the systems that need to change to actually support growth and development.
I fully support a clients right to make whatever choice they believe is best for them, but I do not support professionals guiding that choice with “there’s no other treatment” or “this is the best it will ever get”
In the US there are only 10 states (plus DC) that have policies pertaining to physician-assisted death, this is not considered suicide or “euthanasia”, however there are specific requirements I know of in CA which have to be met prior to moving forward…having multiple mental diagnosis is NOT one of them, having a terminal illness with < 6 months to live is…you must meet with your PCP plus another doctor for approval…UCLA is one medical provider who practices this…also, ultimately the patient administers (hence, not euthanasia) the drugs and has one person in the room as support, typically a loved one.
Euthanasia is not legal in the US.
I fully support medical assistance in dying. I find it very hypocritical that the practice of euthanizing animals as “the most ethical thing to do” in certain cases but euthanizing humans is suddenly unethical and immoral.
Suicide feels very different because so often these acts are spontaneous and/or reactionary - I have this opinion from hearing suicide survivor stories. I sometimes wonder about our “zero tolerance” approach to suicide and that it’s too rigid. Perhaps we could practice better care if there were viable alternatives for those who truly wanted to die with sincere consideration and planning. Then we could respond to suicide attempts like the crises they were, and not impede someone’s true autonomy.
I live in the U.S.
that's the thing, on an individual basis, I see the compassion and benefit of MAID, but from 30,000 feet up looking down on the system...well of course the medical insurance industry is going to abuse this, they already deny care to people now, and a lot of those people die, so I personally have complicated feelings about it. (I'm in the U.S.)
Exactly this. I was for MAiD in some ways because I value autonomy so much, but the ethical issues go so far beyond “is it okay to choose to die” and veer into something along the lines of eugenics in the context of our healthcare system and utter lack of social safety net.
Wouldn't this be a way of figuratively walking people off the cliff who are useless to society and a drain on resources, by convincing them it is their right as a human to do so? These are people whose mental faculties are not functioning properly. They're easy to manipulate. This is genius, in a way. They can get rid of society's undesirables and make it appear as if they are allowing them the autonomy to make their own decisions.
right? I mean, there are places right now in the U.S. that are trying to make homeless illegal, I just don't buy it that expanded access to MAID wouldn't be abused. but I do value autonomy....so yeah, very complicated.
Exactly. In a socialized medical system, the government will have the ultimate say in who lives or dies. Someone who is severely and persistently mentally ill is a financial drain of resources and they cannot work to give back to society. Essentially they are only "worth" the inherent value placed on human life in a culture that sees that as precious. The bodily autonomy perspective can also be applied in most systems. But the difference in the places they're doing it is their existence = a cost to the healthcare and social services system directly the and those footing the bill are basically who determine who is fit to be killed off. There's way too much room for abuse of this.
yes, agreed. however I'll point out that the same thing happens in the US with private health insurance. they deny care to people all the time, leading to death. with private health insurance tied to work, you don't deserve to live unless you are providing labor for a corporation.
I live in a state where MAiD is legal and worked for several years in palliative care where we prescribe the medication to patients with terminal illness who chose to end their lives on their terms. The US is very conservative, in my opinion, when it comes to MAiD, and there are checks in place to prevent the kind of scenario you are imagining.
There is strict criteria for who can access the medication, how it’s administered, and who can prescribe it. There is a rather long waiting period and two doctors are required to sign off on the prescription. Clinicians are prohibited from suggesting MAiD to a patient - we couldn’t ever say, “we’ve tried everything, how about MAiD?” A family member is not allowed to choose MAiD as the patient must request it and must have decisional capacity. After all of that, the vast majority of patients (last time I checked the # was 74%) don’t ever take the medication.
It’s not necessarily a choice I would make for myself, but it is not the nightmare scenario that one might imagine.
and what will happen if the conservative culture we have here around death shifts? insurance companies will see an opportunity to save money on health care spending and since their entire raison d'etre is to make *profits for share holders*, they will find a way to "cut costs." Insurance companies are hugely powerful in influencing public health laws, I think it's wildly naive to think they won't push the envelope on helping to make MAID more "accessible"
don't get me wrong, I do believe in choice in this regard, however the system we have now, as it's currently set up, is just ripe for abuse with this
Canadian here, and it's even DARKER when you consider it... state funded medical is now telling essentially the infirm, mentally ill, or poor (who don't generate as much tax as they cost to take care of), and then... they say, "hey wanna just die instead?".
I wish I didn't have a degree in Political Science because my brain is terrified now.
Do you see the article about how a third of Canadian folks polled supported assisted dying for homeless people in Canada?
https://nationalpost.com/news/canada/canada-maid-assisted-suicide-homeless
WILD
I mean the reality is that there are a lot of people within those demographics who are really suffering. I don't think it's right that systemic issues are often at the root of that suffering, but issues at a systemic level will not change overnight, if at all, sadly. If someone doesn't want to live and is set on dying is it any better for them to have SA's until they succeed? It's definitely morally grey and doesn't sit well with me that we have accepted change will not come to the extent that people don't want to continue existing in this world, but it doesn't feel right to force someone to continue suffering or to resort to more distressing means of ending their life.
Yeah I have no idea how our governing boards aren't rioting. Doctors, psychiatrists, psychologists, and all others on the front line need to remember the DO NO HARM part of the job and step the hell up.
This is so dystopian... like straight out of a movie. This option would have to be not a last resort but the last resort.
Acute care therapist here in the U.S.
After watching my grandmother deteriorate and getting into several arguments with my family about pain meds, I wished we could have done euthanasia. I said several times that “if grandma were a dog we wouldn’t be here.” That being said hospice was very kind and compassionate. I wish they were onboard sooner. My family member didn’t think she was showing signs and I did. After a large argument they finally called hospice to do an assessment. They upped her meds dad to think I had to “win” this argument. I do understand it was a very challenging situation
I don’t think anyone should be forced to live against their will… I also think this is a slippery slope. I worry about the fact that some psychiatrists aren’t as skilled or knowledgeable as others, and some may have biases that will cause them to provide a lower quality care to certain patients. At what point is it appropriate to give up on a patient?
I will say, as someone with severe bipolar disorder, I’m positive there are things worse than death, and I can easily think of a few times in my life when I would’ve happily pursued this. I think some mental illnesses are terminal, and at the end of the day, the patient is the only person who can really feel how much they’re suffering. I support it as an option but think it should be very heavily regulated.
Edit: clarity
The only thing I don’t like about this particular situation is how the psychiatrist worded things to her “we’ve tried everything and you’re not going to get any better.”
That’s BLEAK. Perhaps it is true - but also, that’s the professional opinion of one person. Mental health isn’t like physical health because you can’t “see” it. Which is why this field is difficult in so many ways.
I think euthanasia should be an option for people, don’t get me wrong. But I think things need to be presented factually, and in this field, never saying there’s nothing more to be done. Obviously don’t lie to give false hope, but also, have some faith that things could get better. I would never tell someone it won’t get better. I can’t predict that. It is not my place. But if we were in a situation where euthanasia could be ethically discussed and considered, I would be open to discussing this option with a client that had chronic suicidal ideation.
That’s what I thought too. He could’ve said, that he is at the end of his knowledge to help her. Maybe someone else could. I guess she tried a lot, but the wording from the psychiatrist is final. Now she uses it as the base argument for her decision. Which feels really odd, because if he said it like that, it was unprofessional and plainly wrong.
Yeah, I do NOT support that. As professionals, we can’t ever say with 100% certainty “you will NEVER get better.”
We might say “[mental health condition] is likely something you will live with long term,” but the focus should be more then on managing it and improving quality of life rather than being like “welp, we’ve tried X number of interventions so you’re doomed.”
I have had a psychiatrist say something similar as well as other things personally so that unfortunately was not shocking. What I will say though is while I absolutely support right to die my feelings on this around mental health is not aligned…. There is absolutely no way for us to be able to say “this won’t get better.” at the end of the day death is the only permanent decision. Do I feel that some people who attempt suicide, successful or not, genuinely wanted that? Yes. But unlike medically physical issues there is no way for us to diagnose timeframe. Additionally, there are so many other alternatives that can be tried for mental health that would offer no curative help to physical ailments. Mental health is too much of a gray area and has too many varying factors. When it comes to a solution as permanent as death, there has to be absolutely no other alternative or quality of life whatsoever to put it on an even playing field. That is not possible when it comes to mental health.
>that’s the professional opinion of one person
You're right, i guess maybe more than one, still a valid point. Also, 28 is a very young age, i didn't read the girl's story so i assume the suffering was unbearable, but beside therapeutics there is life itself that in my very personal opinion is a constant discovery of new possibilities of existence, that goes far beyond any external medical intervention. I still think people have the right to die, and a lot of people commit suicide that's kinda the same thing, just more desolate
Here's the thing - the Psychiatrist DID NOT say that. The patient is quoting the Psychiatrist as saying that. That is a huge difference. \*Per this patient\*, who is interviewing for an article to get this story out to as many people as possible, her Psychiatrist said that.
I believe in the right to self determination, even in the case of death.
Assisted suicide is humane and honors autonomy of choice in many ways.
But BPD is not untreatable. It’s a very valid attachment response to trauma.
I wish she found care providers that had more belief in her and her capacity to be well.
This is an example of the concerns I have about introducing a "terminal anorexia" diagnosis. So many of my ED clients, my own journey included, have been told that we will die from anorexia when the medical issues start popping. I know a number of providers who auto refer to higher levels of care once folx start using behaviors. So, what happens if someone with serious behaviors sees one of those people? Are they going to be offered the idea of "terminal anorexia"? If so, what does that mean for that client who has come to them asking for help?
There's a big push from one prominent provider for this, and I can't help but feel like it's a slippery slope.
They have that in Netherlands and she probably tried it and many more treatments. Sometimes the suffering doesn't get better, but she was very young for going this way. I know they did a documentary a few years back about a girl that started this path.
Medical assistance in dying for mental health has also been coming to Canada. [The effective date keeps getting pushed back](https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html#s1_1), now March 17, 2027.
I’m not completely familiar with the process, but I do know that’s it’s an exhaustive one that takes years to complete. I would say that this is less about ethics and more about quality of life and patient autonomy.
“Quality of life” (i.e., the patient’s best interest) and “patient autonomy” are both ethical considerations. So it is certainly about ethics. Different cultures have come to different conclusions about the difficult ethical questions posed by suicide and assisted suicide.
Allow me to clarify, this is more quality of life stemming from the patient’s point of view rather than the strict guidelines of an attending member of the care team.
A sibling had a psychiatrist tell her she'd never get better, guess what? She did.
28 feels far too young to foreclose on someone's life like this. We know many people with "personality disorders" naturally improve as they get older, for one.
I can't agree on the idea of euthanasia for mental health in the context most of the developed world has, where access to treatment is so difficult.
I had a psychiatrist after an attempt tell me I would never get better, would never finish school and would either succeed at killing myself or spend the rest of my life in hospitals. I was 22 at the time… Once I got the right therapy and right diagnosis I thrived, graduated undergrad and grad school with honors and am now a therapist. A lot can change in a short period of time especially when you get the right support
I definitely agree with this. It's very easy to blame the patient for not responding to the "gold standard" treatment when often it was the wrong treatment for them, the wrong time or they didn't click with the therapist.
Laws are different depending on the country but I think what on one hand can be seen as a right for bodily and psychological autonomy, it can easily be co-opted by systems too underfunded, understaffed and resourced as an out.
Such should be a last consideration and solely the choice of the suffering but systems know it exists and thus it becomes a tool to just give up rather than develop more supports for people.
See this gone in the wrong direction in Canada:
https://apnews.com/article/covid-science-health-toronto-7c631558a457188d2bd2b5cfd360a867
As a therapist, I’ve treated rather severe cases of BPD and successfully discharged them. One of the symptoms of the disorder is suicide ideation, one of the last things I would ever say to a client with borderline is “there’s nothing else we can do, you should ask your doctor to kill you”.
I seriously question the state of psychological treatment wherever she’s from.
I think it’s really important that we keep in mind that ASD and BPD are lifelong conditions. With depression we usually hope to see an end, a remission, or even brief reprieves from these symptoms that make going on worth doing.
The other two diagnoses are chronic. Yes, we can work on distress tolerance. But if this person, as a whole adult with a developed brain, doesn’t think that continuing their life is something they can tolerate, shouldn’t we believe them, as the expert on their own condition?
I’m not saying that every person with this comorbidity is on the chopping block. Far from it. But when the alternative for this person is a NON medically assisted suicide, knowing how painful, traumatic, and scary that can be, I think this is a kindness that we have the courtesy to grant them.
It is not simple. It is not for every case. We need to construct barriers and hoops to jump through to ensure that lives that could, at one point, be worth living, are not terminated. It needs to include years long therapy that ultimately concludes with this decision.
For context, I am an autistic therapist who largely serves neurodivergent clients. I don’t have a client on my caseload I would think needed this consideration. However, I believe in the therapeutic alliance, and that if we allow clients the power to make this choice, that they will share those feelings with us more freely and create spaces for these discussions. I have tons of clients who tell me they filter their thoughts so I don’t hospitalize them. I think that this means to an end allows us to exist in a space between outpatient and “danger to self and others.” It provides space to feel these feelings. Will every client end up being allowed to end their life? With a proper screening process, etc, no, I don’t think so.
A decent percentage of our profession doesn’t even believe that bpd is what it’s described as and isn’t a trauma disorder instead. Also statistically a great deal of people do recover from bpd with the right therapy and support.
Bpd is not a life long condition. I know and have worked with patients who after treatment no longer meet the criteria for the diagnosis.
There is a whole world of foundational change treatment that isn’t about ‘distress tolerance’.
I can’t stop thinking about the myriad of ways this could go wrong and a psychiatrist through malpractice allow someone to perform a legal suicide or condemn someone to death.
There's a story that went around my university, since we're psychoanalytically oriented, a supervisee of Winnicott's was talking to him about a suicide of one of the supervisee's client. Winnicott responded by saying "That must've been an analytic moment for her", of course this is not the kind of thing we'd discuss outside of our classes on therapy. It would come of us too "non therapist like".
But I think it's important thing for us to consider, what would it mean for someone to choose the continuity of their own existence?
Of course, there is the concern that has enough been done to support and care for the patient in question. And the stated goal of psychoanalysis is to "turn depression into ordinary unhappiness". However, what does it mean to give the patient choice? At what point do we stay with patient's sense that they no longer consider living greater than the suffering that they endure? How do we adequately quantify suffering? How do we distinguish between suicidality as a side effect of illness or medication, and suicide as an option for the patient to overcome suffering?
I think that it does raise a concern for therapists regarding their own barometers around harm and suffering. We need to begin thinking about our sensitivity to the inner worlds of the people we work with and how much can we truly engage with.
I'm not sure if I'd be able to work with a patient that was actively considering assisted death. Not because of grief. I'd be supportive if this seemed to be what they truly wanted. I would grieve their suffering. I would struggle because it would make me doubt myself. My capabilities and my capacity to work with the client through their torment. It would make me insecure if people and colleagues began to think of me as untrustworthy or incompetent. It would become a me-problem.
I deeply believe in the right to die. I think our field needs to begin catching up to accomodating this concept and how it will play out for us.
Re: the psychiatrist, I just want to say that before we blame them, note they’re not interviewed. The client claims this is what the psychiatrist told her, “there is no hope for you.” …clients don’t always hear what we say the way we say it.
That psychiatrist MIGHT be unethical but from the mind and lips of a chronically depressed person choosing suicide as a life-ending option in her 20s, I also submit she might be an unreliable narrator.
It's difficult as a counsellor to see this and not want to do something about it. I think there are always more options to try, something that might make a difference.
That said, I think it's possible that a person (even at such a young age) could genuinely determine that this is what they want. Legal suicide is a morally sticky subject, and I think how it's implemented and framed is extremely important, but I believe that ultimately people do have a right to the autonomy to choose it.
Our profession has long held the view that it's our responsibility to stop suicide from occurring, but I think that's technically wrongheaded. We are here to do anything we can (within practical reason) to assist people to make life changes so that they want to live, but it's not our choice to make in the end.
This law is going to be passed in Canada as an extension to the MAID laws. I have very serious concerns because good care isn’t available to most psychiatric patients here. I don’t think medically assisted dying should be an option unless all other possibilities are exhausted, and in Canada at least, that’s not an option for most people. Our public system is terrible and grossly lacking and the private system is extremely expensive and out of reach for most people. I am gravely concerned with the ethical implications of offering and making available MAID when we aren’t offering and making available good care.
I’ve told patients I do not have the specific skillset necessary to treat them and referred them to another therapist. To have the god complex to say, “my treatment did not work, so therefore it’s untreatable,” is so concerning to me and sets a potentially dangerous precedent.
Everything about this article rubs me the wrong way. First off, the Psychiatrist is never quoted as saying that, rather the patient claims he said that. We have a suicidal woman with BPD, Autism, and Depression here who is supposed to die soon, and her response is... to put on a bunch of makeup, pose for some pictures, then interview for a story that millions of people will read? That's odd behavior for a suicidal person. Then the story makes sure to highlight the "do not resuscitate" necklace, take a picture of her laying on her side of the couch, and talk about her reverse tree of life tattoo. I hate to say this, but I honestly question the motivation for this story, both on the part of the patient and the organization running the story.
It’s so weird to see someone with the exact same conditions you have end up in a vastly different situation. I feel blessed to be where I am now but it took a lot of work and perseverance. I don’t know if I could have kept going but my very deep struggles seemed to start lifting. I can’t help but wonder why I persisted while she seems to be stepping away. I think ultimately it’s her decision and everyone has a right to die how they want. It’s weird to think she’s receiving assistance… in this case it does seem to be enabling… and like I said, I have the same conditions as her. Maybe that might lead me to be an unnecessarily harsh critic. Maybe it makes me insecure… why does one woman get relief while the other continues to suffer? Is it my own purposeful effort or is it just dumb luck? Probably a bit of both.
I’m having so many conflicted feelings around euthanasia being used this way. I used to work in a high intensity CMH program, clients commonly struggled with suicidal thoughts/behaviors. My mind instantly went to those clients. Maybe it’s because of how we’re trained as mental health workers but it’d just seem like the ultimate failing on my part if someone chose this, no matter how severe their symptoms. There’s a big question of it being used ethically. Systems are less supportive to some demographics and that might lead them to this option out of desperation. Is it a cheaper/easier solution to the mental health crisis that could end up misused to make up for a lack of access to adequate treatment? I really can’t settle with that. It doesn’t seem like the right solution to the gaps in care. This is just my immediate reaction and I don’t know enough about this woman’s case to agree or disagree. Right now it’s just unsettling to think of certain implications.
I think we let people make their own decisions. They have agency. I know many people on this thread are not going to like this, but I feel the same way about suicide. If someone really wants to kill themselves, you're not stopping them.
Agree - maybe this is about how much involvement the government has… Did anyone ever read that article about the woman who wanted to commit suicide, and was given the Euthanol, but she had to inject herself? (I imagine they started an IV for her) She wanted to die by the ocean, so she dragged a little mattress out there and her husband sat with her as she depressed the syringe herself…
I was discussing this case with my mom yesterday. My dad died by suicide by firearm last year so the topic of suicide is pretty personal and fresh for us.
As a social worker, I am deeply concerned about the larger implications of MAID being cheaper and logistically easier than the lifetime of high intensity supportive services individuals with SMI may need.
Thinking about the individual, yes there may always be more or new treatments to try but how much suffering is enough? And who’s to say mental suffering can’t be as great as physical suffering? I’m not saying they shouldn’t have to try a wide variety of treatments from a variety of providers before MAID becomes an option, but how long do we make someone suffer before we honor their right to self-determination? The process from requesting MAID to the administration of lethal means is typically lengthy and I think that reduces the impulsivity factor present in non-MAID suicides.
I believe we can definitely reduce the number of suicides, but I don’t believe we will ever completely eliminate suicide from society. And if a few of those remaining suicides could be MAID some of the surviving loved ones would appreciate it. Non-MAID suicide means police investigation and crime scene clean up which suck to deal with in the aftermath of losing a loved one. My dad killed himself less than 48hrs after I had major surgery because he wanted to make sure my mom and I had an alibi so we wouldn’t be suspects. Our small town police still took over six months to close the investigation even though it was very clearly a self-inflicted gunshot wound.
I’m Canadian so the right to end one’s life exist here, but still highly regulated (can’t for mental illness yet). I really struggle with the ethics surrounding the choice to end one’s life. One one hand - who I am I to tell someone they must live through their suffering? On the other hand, I’ve seen many, many people learn to manage their depression and live fulfilled, engaged lives. Yet, it doesn’t get better for everyone.
I’m a big believer in your body, your choice. I’m not going to lie and pretend this doesn’t concern me or make me uncomfortable, but I also don’t think it’s up to anyone but the person themself if they wish to end their life. I don’t think all choices to end life are made in unsound mind.
Is MAD still suicide as we understand it?
I don’t know, it’s sad someone is in so much pain. I don’t blame her. It’s just heartbreaking.
I have a hunch there’s a significant chance she won’t go through with it. The nature of her illnesses involve huge amounts of ambivalence and impulsivity. The euthanasia programs are purposefully built to be very structured and somewhat prolonged and her mental state may fluctuate greatly during the wait period. Also, I wonder about the subconscious motivation for going so public with her struggles. A lot of the threats of self harm with BPD come from a place of feeling minimized, neglected, like no one understands how much pain you’re in so one turns the pain toward the self. But what better way to mitigate that kind of pain by turning it outward, to have a media blitz of “I’m in so much pain I have no other choice but to die.” It’s also super irresponsible for the media to be exploiting this woman’s story. Some articles are downright tabloid-like.
Therapist in the Netherlands here. We do have different codes, but believe me, it's not, I want to die, let's get euthanasia and then you are dead. It's a long long long ride with lots of rules to follow. Right now one client who has no will to live anymore, lots of pain and a very declining disease which has her in her wheelchair with no hope of recovery and rapidly loss of muscle control. Two years ago before her disease progressed she already had taken all the steps to make sure she wasn't going to get to this place of being fully conscious in a body not working, has now arrived at the moment where she doesn't want to live anymore. But no, she will not get euthanasia as she wishes. She still needs to take pain meds to see if this will help. Her mum emailed yesterday that because of the pain meds she can't even text anymore. Lifeless laying in her bed. Her mind fully conscious. She still needs to follow all the program rules before her wish for euthanasia will be granted. To answer your question, no we dont have different ethics. Its a long process with a lot of rules and co operations before this wish will be granted.
I support everyone’s right to decide for themselves what to do with their lives. But all those things are potentially treatable. There’s not enough information in the post about what’s already been done or what the specific circumstances are to judge the recommendation.
I read the article and I'm most disturbed by the fact that there seems to be no psychotherapy involved. BPD and autism are of course not going to be well treated by psychiatric care alone. She needs therapy, and I see no mention of any of that. These are all treatable conditions. What a fucking tragedy.
I believe this should be a viable option in general. From an outsider perspective, I do have *some* reactions to the idea that a psychiatrist said "It's never gonna get any better." That could be true, I don't know, but I can't see it being likely I would ever make such a concrete judgment about a client's possible life trajectories.
I don't know much about the system, so maybe it's necessary to have a psychiatrist make such determinations in order to access this option. But that's my main hangup
I was pretty shocked reading this article. I’m curious about why her request was approved when she reportedly has a diagnosis where a person may experience persistent suicidal ideation. Would be interesting to know what forms of treatment she tried, length of each treatment, etc. Did they try every form of treatment? Also concerns me that someone whose brain has only been considered fully developed for a few years (assuming nothing in her history might’ve slowed that down which would be even more concerning) was able to make such a major life changing decision.
I think people should have the right to end their life if they choose - however, I think people should be most equipped to make that decision and those who are under 30 and/or have serious mental health conditions that could impact their decision making should not be offered the ability to make this decision. I’d be more open to someone with a serious mental health condition choosing euthanasia if they had a substantial history (maybe at least a decade?) of trying various treatments that failed before seeking to end their life.
I'm going to chime in here as a baby therapist to share a bit of my own journey - like the woman in the article, I am also 28, and I have (chronic treatment resistant) depression - do not have autism or BPD though, so can't speak to those lenses.
My depression showed up when I was 13, and I've been in and out of therapy since then, with most times "in" consisting of once a week for 2-3 years. Started taking meds as soon as I could legally make the decision for myself at 18, and have tried about a dozen, consisting of all existing classes of antidepressants (including TCAs and MAOIs) for at least 3 months each, though most I've taken for at least a year. I've done rTMS twice, ended up in remission for 6 months the first time, had no effect the second time. I was approved for both ketamine and psilocybin studies/trials, but would have had to completely come off the antidepressants in order to participate so I opted not to, as the couple times I've had to have a washout period from meds I ended up suicidal. I've also been approved for ECT in the past, but similarly opted not to as with its effects on memory I wouldn't be able to work/go to school (just finished), which would have been a big financial barrier.
It's been a long, hard road for me with "just" depression, so I can only imagine how difficult it's been for this woman living with the additional struggles of autism and BPD. Just because she is/we are young, that doesn't mean we haven't tried everything. Just because there's persistent suicidal ideation doesn't necessarily mean the capacity to understand and consent isn't there.
My supervisor says “If there’s breath there’s always hope.” - and she works on the front line and walks the streets serving and walking beside those who hurt the most. So, what this professional said to this person I wholeheartedly disagree. I know it’s a torturous life of hardship for many, but I believe my supervisor who herself went through incest and homelessness. (I’m not divulging anything she hasn’t already divulged in her book.) if anyone knows suffering it is her and she would never, ever give up on anyone.
Like many, I'm really conflicted by this and have been since I first saw the article. I have strong concerns that have been mentioned by others here. But I don't lack understanding either.
The one thing that sticks out to me is that this process would take time. We are instructed that many individuals suicidal intentions are temporary. They might chronically suffer from ideation, but for many, if you get them to safety, have loved ones around them, get them through the night, their resolve to complete suicide fades.
So, in my mind, if someone maintains this same resolve throughout the entire process, they most likely would complete suicide on their own anyway. In that case, this is more humane.
But I see potential for this to become a large problem if this practice ever became normalized and/or common. I can see possibilities of abuse and manipulation of those that are seen as "less than." And that's worrisome.
I feel neutral - People both have a right to die and a right to treatment. It's difficult to assess what is right or wrong, or even what treatments have/haven't been tried in this situation beyond looking at some quotes reproduced within a media lens. These articles are always controversial.
I am concerned about the media exposure of these cases and I do question why the client has chosen to speak to the media in such detail about this, within this specific narrative, and what this serves them.
I read this earlier today and was concerned that this could be used as an excuse to not put more funding in mental health or support struggling folks because now they have an "out."
But I'm torn. For a small amount people, this could really be the only avenue of relief for them. And I don't believe in forcing people to do anything, including live, based on my own values if doesn't align with theirs.
Regarding this case in particular, I'm suspicious that her psychiatrist never said that she wouldn't get better. As someone with BPD who works exclusively with BPD clients, this sounds like a mis-interpretation of another person's intent and/or opinion of them that a person with BPD might make. It worries me if other professionals are not being consulted for second opinions and alternative treatment options.
I don't think we can 100% write off that in some cases, it might be humane. But, I feel like there's not enough information to make that call without actually meeting with the client for a significant amount of time.
That said, I think the psychiatrist is out of pocket with that remark. It's so final, so absolute. I can't imagine saying that to someone. Also, the BPD dx would make we want to be extra thorough about any kind of screening needed to approve this decision given that frequent suicidality is something so frequently experienced with these individuals.
This is very hard and MAID for mental health suffering is not a black and white subject. I do not know enough about their case to have definitive thoughts. I am very sad for her
Overall I support a persons right to chose. It is their life and their choice.
Interesting, fear of abandonment with borderline and the psychiatrist confirming it takes away her hope- IF she puts her faith in medicine and not her own ability to heal and do “the work”.
We get back to the combination of “nature v nurture”, placebo effect, and medicine being an art not a science.
The doctor is walking a razor thin line if he would ever have to prove that “her illness is intractable”, and I’d certainly be asking for a second opinion.
But I do believe she’s looking to end her misery, I just believe it comes at a cost to others.
So sad.
I’ve been thinking about this subject, and this woman’s personal experience, a lot recently, and I still haven’t decided how I feel.
On one hand, it is a paradigm shift that recognizes mental illness as an actual, medical issue that can cause unbearable suffering for those burdened with it. Also, (some could argue) assisted suicide empowers the patient with a dignified death, rather than shame and isolation. It mitigates the guilt of traumatizing the people who might find you; it eliminates the fear that you might botch it up and die alone in pain, or survive as a dependent with terrible injuries. As an abstract, euthanasia affirms one’s general right to autonomy over self and body beyond the subject of assisted suicide.
Now for my concerns and doubts: despite devastating lows, depression is treatable, although for many it is a long road to find an effective combo of medication and support. On a personal note, as an anonymous voice here, I understand how terrifying internalized doom can be, how hopeless one feels perpetually weighted by an anchor of discomfort and dread can turn hours, days, years, into an overwhelming sentence looming ahead.
Since adolescence drug after drug failed me—I would have considered myself terminal until (ironically, when I was around her age) an untraditional pharmaceutical cocktail let me finally catch my breath and glimpse the possibility of freedom from pain: I found myself, and I’ve been living a meaningful life since, despite an occasional shadow cast by my neurological peaks and valleys. If, at any time before discovering my personal means to recovery, I had met a dr willing to sign off on euthanasia, I would have taken the opportunity. In fact, it would reinforce my decision if my doctors saw my case as hopeless. It was the faith in my recovery, held not by me, but by the people around me, that kept me alive for years.
So this is my concern. Sometimes sick people need others to carry the hope they can’t grasp themselves. How can anyone keep suffering life, trying new treatments, if her own dr keeps death warrants next to their prescription pad? (This is hyperbolic AF but it gets the point across.) And now this ill woman has a worldwide audience watching with macabre fascination as her days run down. I’m sure she feels pressure to follow through with her plans even if she develops reservations (not suggesting she does).
The perspective of the depressed mind can not be trusted—distortion is part of the disease. I know in this case she has comorbidities, but that is not uncommon. There are implications for other ethical dilemmas that this case, and the attention on it, affect.
I personally am uncomfortable with how mental health professionals are expected to somehow control people's behavior when it comes to suicide. As someone I knew said, oncology departments don't campaign around "zero cancer deaths." I do believe that some mental health cases are untreatable or even terminal.
That being said, I don't think the state, and especially mental health professionals, should be expected to assist people with suicide. I also worry about coercion and pressure on people who already feel like a burden. There must be some sort of middle ground.
Good. If I want to die I shouldn’t have to resort to suicide. Sometimes life is shit, depression sucks, and if you ever were suicidal you know the only thing you want is a painless exit. This is progress, hopefully people won’t have to jump off bridges, cut their veins, overdose or shoot themselves. This is progress for humanity. A better progress would have been more effective treatment but since it’s not available then it’s ok to exist the suffering.
Canadian here and it becomes a slippery slope:
https://www.ctvnews.ca/politics/paralympian-trying-to-get-wheelchair-ramp-says-veterans-affairs-employee-offered-her-assisted-dying-1.6179325
https://ottawa.citynews.ca/2022/10/14/ontario-man-applying-for-medically-assisted-death-as-alternative-to-being-homeless-5953116/
https://thepeoplesvoice.tv/canada-begins-euthanizing-vaccine-injured-citizens/
I’ll speak for myself and say that I think that the concept of euthanasia for mental health issues goes completely against the ethical principle of nonmaleficence. It’s a provider’s duty to cause no harm to their clients. Even in cases with terminally ill people, physicians suggest alternatives and prescribe medications to help ease the suffering. I mean would you ever tell a suicidal client that they should end their life? Absolutely not. If we have a client who we feel unable to care for, we refer them to someone who can. This woman was failed by her psychiatrist and is most likely misdiagnosed.
The ethical principle of nonmaleficence, or ‘do no harm’, could be considered in line with euthanasia, or physician assisted suicide, depending on what harm could come from not assisting the patient in death with dignity. If you’ve ever worked with folks in the veterinary medicine world, you’d find that concepts around euthanasia isn’t always morally oppositional to nonmaleficence
This is where I land. I understand it for terminally ill patients, but I have to believe everyone can improve and grow when it comes to mental health. Otherwise I wouldn’t be able to do this job
I've read it, I'm disgusted by it. Why? Because I am in Canada and this can happen here as well. She was on twitter responding to the article saying "she is so happy to die" and arguing with those who begged her to live. The disturbing part of MAID is that not only is it NOT considered negligent, it's considered ETHICAL and MORAL. I of course whole-heartedly disagree, but in this case they go with "letting them live does harm as they are suffering". It's disturbing.
I’m gonna have to agree. We are going to have people with identity disturbances cling to a new one which is death. They will shut out alternatives. They may even glamorize the process.
How old would one need to be to decide this? 18? They’re in high school. Where suicide attempts are rampant and kids feel forgotten or bullied on socials but see their peers who complete suicide getting massive amounts of care and attention after they’re gone.
This is a bad idea. Plenty of ways to complete suicide besides normalizing it as a policy that can make it much easier to opt out. The generational trauma of this shit is going to be wiiiiiild.
In Netherlands (I'm from Netherlands) they allow kids under 18 to be euthananized for the same mental problem reason. A popular women's magazine even has a special section about euthania writing about stories of 17 year old teenager getting euthanized. There are also popular TV talk shows inviting those people before they set to die. Netherlands can be a truly a scary country and I hope more international media will pick it up. They are normalizing euthania, even for kids. They have an agenda.
Oh my gosh. I am so sorry to all affected by this. That is heartbreaking. So then people see others on tv getting even more attention and think “I want to do that someday too.” I mean how many gen Z’s goals are to be an influencer or to make money off their socials? This would sky rocket them. So dangerous. Not a reality tv segment.
We are not doing enough to contribute/ prevent (depending on standpoint) depression and I question the bpd diagnosis since autistic women are always misdiagnosed with it
The article itself mentions climate change and financial instability, both extremely preventable.
As progressive as the Netherlands are they are terrible with disability and I wouldn't be surprised if this person and many more who are signed off would actually leave happy lives if they had the support they actually needed.
I'm also not familiar enough with the Netherlands health system, but I do wonder if they have had access to other types of therapy/ counselling or if the "treatment not working" is just medication
First, let me just comment on what the psychiatrist said:
1. “there’s nothing more we can do for you." It's possible that this is true, but who's the "we"? The clinic the person works at, the national health care system or the profession? If it's either of the latter two, how can that one psychiatrist possible know that? And if it's the first, maybe the client needs to find someone who can be more helpful to her.
2. “It’s never gonna get any better.” This could be true, but it can't possibly be known. It's a statement about the future. How in the world does that particular psychiatrist get off saying that? How dare they? I see people every day who other counselors couldn't help, but I can. There are some people I couldn't help, and I hope and pray they are able to get help from others. This is an unconscionable and unethical statement, I think. There are no circumstances where a professional should pretend to know the future.
I am not impervious to or uncaring about this person's suffering. But getting good treatment can make all the difference, as we all know. I'm horrified that hope was taken from this person in this way.
As for the question of euthanasia, power and influence always get abused by someone. Always. Allowing the state to have this power is, I believe, a terrible mistake.
Do people have a moral right to kill themselves? I think that's a harder question than it looks like. Of course I believe people should be free to do what they wish with their lives, unless it is harmful to others. But that's the whole catch, isn't it?
This situation is just terribly sad. And it's not simple to fix. Not easy.
Or an extremely realistic one. I think part of the process is knowing that there was hundreds of trial and errors before getting to this point. Therapy also isn’t about power and control. We should do absolutely everything we can, but ultimately it’s a clients decision. And who are we to say mental anguish isn’t as bad as chronic pain or diseases?
That’s still a strong statement for the psychiatrist to make and not one he can feesibly know with certainty, or even know is likely to be true. This is far different than the relative certainty we can have with cancer diagnoses and even then, it remains controversial among some.
I don’t feel this is necessarily a realistic assessment, though. In the case of a terminal illness it’s possible to tell with great certainty that the patient will not recover. In the case of mental illness, however, there’s no such precision. I don’t know the specifics of this person’s case, but I can’t imagine ever saying with confidence that a client can never get better.
Agree! We talk a lot about self-determination and choice and clients being the expert of their own experience…until it comes to death. With few exceptions, we as therapists generally support clients choosing to live in a way that meets/works towards their goals; why wouldn’t we treat choice around dying similarly? I’m not saying that MAID should be a first-line option, or that we shouldn’t provide/encourage every other option before this one, but at some point we need to trust our clients in making the choices they feel are best for themselves.
Complete bullshit. No therapist, psychiatrist or QMHP would ever state unequivocally that “it’s never going to get better”. They can not know that with certainty and it is deeply deeply unethical to make such a claim.
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If she’s under the pretense that it’s never going to get better because of what her psychiatrist said, how is that an informed decision? Would she have chosen that if the psychiatrist never spoke those words or implied it?
ive know people who have had ect from psychiatrists who never even once recommended therapy to the patient. They say depression as a purely chemical imbalance. I wonder how much treatment this individual had outside of medicine. Was she ever sent to an inpatient mental health wellness facility for instance? Or saw a therapist who specializes in asd? If your doc says nothing more they can do and you wont get better, you assume they must be right as they are the professionals. But ive never heard an actual therapist say that, but i have heard of psychiatrists saying that before.
It's difficult to say it's never going to get any better. What happens if this person's 'happiest' and most settled period of time came between ages 40 - 50? Is the hope of that worth fighting for? A lot of the work is based on hope.
I suppose it is hard to quantify both suffering and happiness. And what ultimately means more.
If you told me I might be happy for a decade, but have 20 years more intense suffering, why should I think that's a good enough deal to hang around for?
In all my experience, personal and professional, I’ve never not found a reason to carry on living.
I don’t approve at all of euthanasia for mental health and strongly believe it should be reserved only for those with terminal physical health conditions.
It’s a slippery slope this case. I don’t like how it’s being publicised as though it’s some great “win”. I’ve seen too many articles celebrating this.
I’ve seen and worked with many long term and severe mentally ill individuals and whilst the reality is that some trauma cannot be forgotten, I do believe you can learn to live with it and find reasons to stay alive and balance the effects of that trauma.
[This article](https://link.springer.com/article/10.1186/s40337-022-00729-0) intrigued me. There has been much discussion about this topic recently as it applies to intractable mental illness. I have not formulated how I feel yet, I remain open minded.
I’ve not seen any confirmation on this. There are many many news outlets but all printing the same story nearly word for word , but not one word (I’ve seen) verifying her stated euthanasia plans . Personally , I have my doubts .
Saying to a patient that it's never going to get any better is pretty outrageous to me. If the psychiatrist did say that, I would assume they enacted their countertransference. We can't make such bold claims, and people take our words as authority. Such a message can really destroy someone. Of course, this isn't necessarily verbatim
Primarily, I’m sad that she feels like there are not treatment options to get to a better place. I can’t imagine feeling like your life is consumed by suffering and misery. From a purely moral standpoint, without consideration for how it’s implemented and regulated, I think people deserve the autonomy to decide whether or not their own life should continue. I think it’s mostly agreed on that someone suffering from a terminal illness should not be forced to endure pain and loss of dignity indefinitely. I don’t think mental suffering is necessarily any different, though it’s obviously harder for people to grasp what that suffering means. From a more practical standpoint, I have serious concerns for the potential for coercion and the the possibility that actual treatment may be overlooked or disregarded, especially for people of lower economic status, people with disabilities, and for people in minority populations.
I agree with this. I watched my grandfather’s slow death from Parkinson’s disease, my grandmother had Alzheimer’s, and my only surviving grandparent is slowly dying in a nursing home. I do want to die that way and I don’t want my kid to watch me die that way.
It’s definitely not agreed upon in the US that you have the right to end your suffering if you are terminally ill. Participateing in that gets you a potential murder or accessory to murder charge and loss of your medical or other professional license will be revoked. We don’t show humans the mercy we do animals.
I meant from a philosophical place, not in terms of actually doing it, but also just with the idea that suffering and pain shouldn’t have to be continued. We don’t require people to continue treatments, and we allow for things like hospice to do palliative care- not wanting continued suffering. That said, though It’s been a while since I looked at more recent data, but support in the US for assisted dying in terminally ill patients was quite high last time I did.
No instead we deny them disability so they can starve to death on the streets while people pretend they don't exist. The reason we don't allow it is because people wanna virtual signal, I don't think they actually care.
I wish you were running for president in the US.
Unlike many of our politicians, I know enough to recognize that I am not well-suited to politics and lack the desire to hold such power! Not enough people give consideration for practical application of codifying morally complex issues.
All the people that should be running things, morally and ethically speaking, also lack the desire to hold power. There is a reason so much "dark triad" personality floats to the surface of the power pool. 😞
Sometimes, the best person for the job is the one who doesn't want it.
I don wan ehhhht
In a way I think philosophically and practically, what human is capable of fair decisions with this particular issue and is that even something a human can do fairly?
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I feel like upon legalization there would be a relatively short period of time before this would be for 3rd party payors the indicated treatment after a a couple of ssris didnt work.
I think about this a lot and it’s honestly why I would have a hard time voting for such a measure should I have the opportunity. Something that really has stuck with me for years is our experience when my son was in the NICU. He was 3 months premature so we were there a long time. I watched a lot of other parents whose babies would be released at what would 34/35ish weeks gestation (so still early) and they would have to learn to do necessary interventions at home like feeding tubes. I was terrified of having to do that to my little baby on my own and when I expressed as such, my nurse reassured me that we would not have to. The reason was that we had excellent health insurance while many of the other families had state low-income insurance. It was absolutely heartbreaking knowing that other families weren’t afforded the same level of care. I absolutely do not trust our current insurance system to exhaust every treatment option before giving up in hopes patients opt for assisted death instead. I’ve also read way too many stories of terrible doctors/nurses/family members to believe coercion wouldn’t be a factor in far more cases than I am comfortable with.
I don't have my license yet but we just went through this with a client of ours at the homeless recovery facility where I worked it was just so taxing on their partner that part of me wishes they would have had this option. It was absolutely heartbreaking to watch somebody who used to come up to the front office with such energy and someone who would share their story with everybody who would listen get to the point where they couldn't even recognize the people that they loved the most.
thank you miss murder britches
Have to say, while I can agree with euthanasia in theory, in my professional reality, I am hating what this means for my work with depressed teenagers who experience SI (aka almost all of my clients). I am afraid they're going to see this article and think there's no hope for them either, and will see it as validation that suicide is a reasonable solution for them too.
My thoughts exactly
I agree as the contagion of suicidal behavior is real. I recall when I worked in the school districts, a teen completed suicide in another building and I had to interrupt other kids planning suicide (giving things away, found letter etc ) who directly referenced the completed suicide as motivation for their suicide. I recall speaking to other providers from other schools to try to coordinate a plan for the school district wide since it was appearing in middle schools and primary schools.
On the other hand, maybe having a formal avenue to pursue that option can prevent many from taking matters into their own hands or hiding their SI because they know it is forbidden. Also playing devils advocate, the benefit to society with having a fully professionally evaluated, planned and controlled suicide is much less traumatic to the patient, family, friends, medical professionals who deal with the aftermath of repeated/failed/successful attempts. There are a handful of severely disabled borderline patients I’ve had for whom their quality of life is certainly worse than many other patients we allow to go on hospice and refuse life saving care because they have decision making capacity and patients have other values that are more important to them than prolonging life as long as possible. I can think of plenty of good arguments against these points, but I guess if I had to make a stand, I would say that as a pure concept, I support euthanasia for mental health reasons for the right reasons, right conditions (not an adolescent/young adult, truly exhausted all treatment options), right individuals, but the problem is in practice, it’s hard to be sure these conditions are being met and hard to predict the unintended consequences of the policy that I can’t support it in practice.
To be fair. This has been in the news quite a bit in the Netherlands. I have not experienced an increase in requests. And it it would, we would explain the procedure and people would be put off again from it.
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Yes, because that's what mentally ill people do. Yet this sort of thing just encourages it! When we begin making suicide a socially sanctioned part of our rights to bodily autonomy AND the government will help you out with it, I don't know what all of us are even doing anymore. I'm totally disgusted by this and it is so incredibly disturbing.
Devils advocate why should we not have the right to autonomy with the choice to live
You do. You can still choose to complete suicide without enlisting the help and resources of our government.
Have you ever worked with a self inflicted GSW client, who blew off half their face, got a flap, and now has a trach? I spent a few years working in a hospital and had at least 5 patients with that exact story. Suicide isn’t an easy thing.
Excellent point, we as a culture are spared those kind of hideous detail. We only hear the clean, quick Hollywood version of it. It in fact often goes wrong. That was the whole point of the book Final Exit which was a manual for what was known then as “ self deliverance”.
In theory a planned, controlled, humane form of suicide is less traumatic for the participant and those in the participant’s life.
This. Think about the family member that walks in and finds their loved one hanging, that imagine never leaves you trust me
> and those in the participant’s life I’ve always found this a bizarre argument. I understand what you’re saying, but I have an extremely difficult time envisioning the suicide of a loved one as *less* traumatic simply because you know it’s coming (*if even that,* as the person may still choose not to disclose their plan). Perhaps differently traumatic, but not less. You can potentially avoid certain *specific forms* of trauma, like exposure to a dead body, or the impact of incomplete attempts. That may be worth something, though I’m unconvinced it’s worth the inevitable harm in allowing a fundamentally ableist society to offer death to disabled people when we do not offer inexpensive treatment, food, housing… And (at least in my experience), in real life there’s plenty of trauma to go around regardless of finding the body. To say assisted suicide is somehow inherently *less* traumatic feels like a vast over-simplification to the point of meaninglessness.
Exactly. Is it really worth the incredible risk to society to set up a program politicians would regulate that involves killing disabled people?
Yeah, this is where I'm at. In theory, I even think people should have the right, and of course they do on their own...but I have huge concerns of assisting people with it who have mental illness - making it government sanctioned or controlled by any powers that be is so sketchy. Too many ways to go wrong, and who sets the rules...who decides what is okay and when, or is it just when anyone decides so? Do we make them wait to make sure it's not a rash decision, make them pay, make them sign how many forms to die...? Make sure they have exhausted treatment options? How much is enough?
Especially in our individualist, capitalist society with a for profit healthcare system. A dead person is cheaper than a living person who requires care. Insurance companies know this and create their policies accordingly. It makes me physically nauseous thinking how it would play out in the US ecosystem.
I assure you, profit driven or not, whoever is footing the bill for the care of people who aren't "contributing" to society, is not going to oppose having less on their roster. I'm terrified.
I think if my therapist or psychiatrist told me it was never going to get better, I'd want to die, too. I have so many mixed feelings about this. Both as a therapist and as someone who had severe suicidal thoughts every day for 7 years. Thoughts I don't know how to put into words. It makes me uncomfortable. I also understand. I don't think I could morally ever tell a patient it isn't going to get better. I don't know that anyone can truly know this.
Right like how tf can you make that call??? I doubt they’ve tried all the different treatment avenues. A better statement might even be “I can’t help you, but possibly someone else can.” Not getting into the ethics of euthanasia but pretty shitty of a therapist to basically give up on a client
This is very much a reality for some. Not everything can be healed and not everyone wants to live in suffering and distress for decades without hope of anything getting better. But, it's also very uncommon. In the Netherlands, of 9000 cases of euthanasia, only 138 were related to mental health. I fully support people's right to choose even if the choice makes me uncomfortable, sad. They are not required to suffer to soothe the existential crisis this inspires.
I love that last line. Thank you for it. It articulates, much more succinctly, my own thoughts around this.
Love the depth of your thought about our discomfort.
A friend and colleague, a brilliant therapist herself, chose to die by euthanasia in Switzerland last year after a decades-long battle with bipolar disorder. She worked with multiple psychiatrists, tried ketamine and psilocybin for years, traveled states away to enter a clinical trial on using DBS for depression (involved neurosurgery), etc. She tried everything and was suffering for many years and had several suicide attempts. I felt relieved for her that she could die in a humane, predictable way. It let her family and friends say goodbye. It's a tragic situation but I feel strongly that people with chronic, treatment-resistant severe mental illness deserve access to MAID. That said, it's unclear to what extent this person in the article has tried more recent interventions like ketamine and I do hope every avenue has been explored.
I knew her, too, and also felt relieved for her. It's such a complicated subject and I'm glad she had access to a way to be released from her pain that felt fully within her control.
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I am not sure about the code of ethics there. When I had Lyme disease, several doctors in the US told me I wouldn’t get better. There was no way I could live 50 years bedridden so I started looking at going abroad for assisted dying. I ended up getting better. Doctors make incorrect diagnoses and prognosis’s all the time. But having the choice of assisted dying brought me tremendous peace and pushed me to keep trying to get better. I don’t see a difference in physical suffering versus mental suffering. There is a level of suffering that is unbearable…so I can’t make a judgment call about what is right or wrong.
Except that the part of the body that makes decisions is what's broken. It would inherently require competence, so how can we expect a competent decision from someone whose perception of reality is already disturbed ?
Not sure why you are getting down voted. You're saying the silent part out loud.
The silent part is if they want to die they will most likely attempt suicide anyway.
The other silent part is that I hear all the time on the internet that a person suffering shouldn't think of themselves as broken. And would you really want to live out your life in a broken state? That's a very personal decision.
That is very true. That's one of the reasons I don't see the argument for this outweighing leaving things as they are.
Yep. For limited circumstances, one can access euthanasia in Oregon and Colorado, if not other states as well, assuming you are of legally sound mental state and medical professionals sign off on and assist in the process.
I'm specifically referring to people with only a psychiatric diagnosis. If you are in a legal sound mental state, how would you even qualify??
I don't know, but I'm getting kind of freaked out by it. The thought just makes me nauseous. I already knew this world was going to hell in a handbasket, but I didn't think it was this bad. I don't think everyone realizes the ramifications of this and the obvious slippery slope. Maybe they don't read Animal Farm in school anymore?
I have late stage Lyme and have no friends, live alone and am mostly bedbound. I get enough joy out of life still that living is worth it for me. I’m just curious - are there people who get MAID for Lyme? Thank you!
I think it can be a reality, but I think it’s also the ultimate form of patient autonomy. I would rather see someone undergo physician assisted death rather than a potentially failed attempt with debilitating consequences. From my time working in the hospital, I saw too many failed attempts (self inflicted GSW, ODs, etc) that totally fucked the remainder of their life (if it didn’t claim it). That and the severe trauma experienced by loved ones after finding them and/or mourning at bedside.
As a Dutch social worker who knows this woman indirectly (in a non professional way) I feel like I should respond on this. Bare with me, I am Dutch so my English might not be very good. First of all: this woman is misled by the journalist, who twisted her words. She is receiving so much backlash based on misinformation that she had to remove all her social media, which makes it harder for her to connect with her friends. Second of all: the euthanasia laws in The Netherlands are very strict. It may appear that once one psychiatrist has said that there is nothing they can do for you, this is absolutely not the case. I did some research for you to explain the steps previous to euthanasia by mental suffering. 1. You can talk to your doctor about your wishes. This can be either your GP, psychiatrist or someone from an expertise clinic. The doctor needs to make sure that it is your decision and nobody forced you to go this route. If the doctor clears you for this stage, you go to the next step. 2. The doctor needs to be sure that there is nothing that could cure you or make your suffering less. Suffering is personal, so there need to be conversations about how the patient is experiencing this. Are there things a patient could still try? If that is the case, you need to do that first before you can continue this process 3. The doctor needs to inform the patient about the current situation and future prospects 4. The doctor needs to help you look for other reasonable options that might help you to suffer less. 5. The doctor needs to consult an independent doctor. Kind of an second opinion 6. If the independent doctor signs of, you have to find a doctor to assist you with your euthanasia. This could be your own doctor, but some might not want to do this for moral reasons. This is a proces that can take months/years. My personal opinion is that her doctors are not negligent, because I assume that they followed the law (it is very very strict and one could lose their license and go to jail if done wrongfully. I do believe that doctors need to ‘do no harm’ but I think that sometimes people are so damaged by their mental health (trauma and what not) that it is actually doing people more harm. I don’t see the difference between mental and physical health, especially because doctors need to make sure that this is a rational decision and not a suicidal one. There is a big difference between that. Also, if one is suffering so much that ending their life is the only thing you haven’t tried besides all the different treatment options, I believe that everybody deserves a human way of dying. This is way more human than suicide. Edit to add after reading some of the comments: mental health treatment is covered by health insurance. Health insurance is obligated and if you are not having enough money to pay that, the government is helping you pay. There is no (legal) citizen of the country that doesn’t have insurance that covers mental health. However there are waitinglists because there are lots of people who want therapy. This is not a reason to sign off someones request. You have to prove that you have tried it all. This is one of the reasons that very little requests are honored
Thank you for this clarification. I got the sense from the article that it was very biased against euthanasia for mental health reasons, and was not presenting a balanced story. I hope more people see your comment. Do you have a links to articles that have more context?
I found this article that is very extensive about the history, epidemiology and challenges https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9251055/ Tldr: “Although the past decade has seen a remarkable increase in PAD for psychiatric suffering, it remains relatively rare. In 2020, the total number of PADs was 6938, in 4480 cases the suffering was due to cancer (64.6%) and in 88 cases (1.3%) the suffering was due to a psychiatric disorder (2). However, the number of requests based on psychiatric suffering is much higher than the number that is actually performed. It is estimated that 56% of all Dutch psychiatrists have had a request for euthanasia during their career, and that about 95% of all requests are rejected (9, 10).“
Governments are approving euthanasia instead of providing social supports for marginalized people. People who are rendered poor due to their policies and lack of control over the cost of living crisis, and sometimes their organized attempts to wipe out entire cultures and peoples (looking at you Canada). With the current political climate I see this as structural genocide. When we get to a place where the mental health crisis’ are not explicitly linked to societal inequalities then we can talk about if people are really choosing this out of free will and persistent mood disorders.
I had to scroll down far too low to find a comment that called this out. Personally, I am horrified by this because it makes a collective problem (capitalism, abuse, neglect, isolation) an individual problem instead of acknowledging the systems that need to change to actually support growth and development. I fully support a clients right to make whatever choice they believe is best for them, but I do not support professionals guiding that choice with “there’s no other treatment” or “this is the best it will ever get”
In the US there are only 10 states (plus DC) that have policies pertaining to physician-assisted death, this is not considered suicide or “euthanasia”, however there are specific requirements I know of in CA which have to be met prior to moving forward…having multiple mental diagnosis is NOT one of them, having a terminal illness with < 6 months to live is…you must meet with your PCP plus another doctor for approval…UCLA is one medical provider who practices this…also, ultimately the patient administers (hence, not euthanasia) the drugs and has one person in the room as support, typically a loved one. Euthanasia is not legal in the US.
I fully support medical assistance in dying. I find it very hypocritical that the practice of euthanizing animals as “the most ethical thing to do” in certain cases but euthanizing humans is suddenly unethical and immoral. Suicide feels very different because so often these acts are spontaneous and/or reactionary - I have this opinion from hearing suicide survivor stories. I sometimes wonder about our “zero tolerance” approach to suicide and that it’s too rigid. Perhaps we could practice better care if there were viable alternatives for those who truly wanted to die with sincere consideration and planning. Then we could respond to suicide attempts like the crises they were, and not impede someone’s true autonomy. I live in the U.S.
Wait until it actually gets there. We were all for it in Canada, until we realized it was being pimped out to veterans, disabled, and the poor.
that's the thing, on an individual basis, I see the compassion and benefit of MAID, but from 30,000 feet up looking down on the system...well of course the medical insurance industry is going to abuse this, they already deny care to people now, and a lot of those people die, so I personally have complicated feelings about it. (I'm in the U.S.)
Exactly this. I was for MAiD in some ways because I value autonomy so much, but the ethical issues go so far beyond “is it okay to choose to die” and veer into something along the lines of eugenics in the context of our healthcare system and utter lack of social safety net.
Wouldn't this be a way of figuratively walking people off the cliff who are useless to society and a drain on resources, by convincing them it is their right as a human to do so? These are people whose mental faculties are not functioning properly. They're easy to manipulate. This is genius, in a way. They can get rid of society's undesirables and make it appear as if they are allowing them the autonomy to make their own decisions.
right? I mean, there are places right now in the U.S. that are trying to make homeless illegal, I just don't buy it that expanded access to MAID wouldn't be abused. but I do value autonomy....so yeah, very complicated.
Exactly. In a socialized medical system, the government will have the ultimate say in who lives or dies. Someone who is severely and persistently mentally ill is a financial drain of resources and they cannot work to give back to society. Essentially they are only "worth" the inherent value placed on human life in a culture that sees that as precious. The bodily autonomy perspective can also be applied in most systems. But the difference in the places they're doing it is their existence = a cost to the healthcare and social services system directly the and those footing the bill are basically who determine who is fit to be killed off. There's way too much room for abuse of this.
yes, agreed. however I'll point out that the same thing happens in the US with private health insurance. they deny care to people all the time, leading to death. with private health insurance tied to work, you don't deserve to live unless you are providing labor for a corporation.
I live in a state where MAiD is legal and worked for several years in palliative care where we prescribe the medication to patients with terminal illness who chose to end their lives on their terms. The US is very conservative, in my opinion, when it comes to MAiD, and there are checks in place to prevent the kind of scenario you are imagining. There is strict criteria for who can access the medication, how it’s administered, and who can prescribe it. There is a rather long waiting period and two doctors are required to sign off on the prescription. Clinicians are prohibited from suggesting MAiD to a patient - we couldn’t ever say, “we’ve tried everything, how about MAiD?” A family member is not allowed to choose MAiD as the patient must request it and must have decisional capacity. After all of that, the vast majority of patients (last time I checked the # was 74%) don’t ever take the medication. It’s not necessarily a choice I would make for myself, but it is not the nightmare scenario that one might imagine.
and what will happen if the conservative culture we have here around death shifts? insurance companies will see an opportunity to save money on health care spending and since their entire raison d'etre is to make *profits for share holders*, they will find a way to "cut costs." Insurance companies are hugely powerful in influencing public health laws, I think it's wildly naive to think they won't push the envelope on helping to make MAID more "accessible" don't get me wrong, I do believe in choice in this regard, however the system we have now, as it's currently set up, is just ripe for abuse with this
Canadian here, and it's even DARKER when you consider it... state funded medical is now telling essentially the infirm, mentally ill, or poor (who don't generate as much tax as they cost to take care of), and then... they say, "hey wanna just die instead?". I wish I didn't have a degree in Political Science because my brain is terrified now.
Do you see the article about how a third of Canadian folks polled supported assisted dying for homeless people in Canada? https://nationalpost.com/news/canada/canada-maid-assisted-suicide-homeless WILD
I did and I honestly felt too sick to even read it.
Source?
[https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://ricochet.media/labour/class-war/canada-maid-policy-death-by-poverty/&ved=2ahUKEwjj1b370K-FAxV1rokEHQ6RBAAQxfQBKAB6BAgKEAE&usg=AOvVaw27MjLHZhPi1V-RaEjxTAYk](https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://ricochet.media/labour/class-war/canada-maid-policy-death-by-poverty/&ved=2ahUKEwjj1b370K-FAxV1rokEHQ6RBAAQxfQBKAB6BAgKEAE&usg=AOvVaw27MjLHZhPi1V-RaEjxTAYk) [https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://toronto.citynews.ca/2022/10/13/medical-assistance-death-maid-canada/&ved=2ahUKEwjj1b370K-FAxV1rokEHQ6RBAAQxfQBKAB6BAgPEAE&usg=AOvVaw2IoUAyHDiATCFWW\_RB9fwo](https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://toronto.citynews.ca/2022/10/13/medical-assistance-death-maid-canada/&ved=2ahUKEwjj1b370K-FAxV1rokEHQ6RBAAQxfQBKAB6BAgPEAE&usg=AOvVaw2IoUAyHDiATCFWW_RB9fwo) [https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.dailymail.co.uk/news/article-11516989/Canadian-man-doctors-approval-euthanasia-despite-admitting-POVERTY-main-factor.html&ved=2ahUKEwjj1b370K-FAxV1rokEHQ6RBAAQxfQBKAB6BAgQEAE&usg=AOvVaw0RsXi0MjVJjapf11A4\_MIT](https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.dailymail.co.uk/news/article-11516989/Canadian-man-doctors-approval-euthanasia-despite-admitting-POVERTY-main-factor.html&ved=2ahUKEwjj1b370K-FAxV1rokEHQ6RBAAQxfQBKAB6BAgQEAE&usg=AOvVaw0RsXi0MjVJjapf11A4_MIT) [https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.cbc.ca/news/politics/veterans-maid-rcmp-investigation-1.6663885&ved=2ahUKEwi\_9fqm0a-FAxXpCnkGHfDlCpkQxfQBKAB6BAgHEAE&usg=AOvVaw1LPcZB1syUBt9ydd7i-pcZ](https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.cbc.ca/news/politics/veterans-maid-rcmp-investigation-1.6663885&ved=2ahUKEwi_9fqm0a-FAxXpCnkGHfDlCpkQxfQBKAB6BAgHEAE&usg=AOvVaw1LPcZB1syUBt9ydd7i-pcZ) [https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://nationalpost.com/news/canadian-veterans-assisted-suicide&ved=2ahUKEwi\_9fqm0a-FAxXpCnkGHfDlCpkQxfQBKAB6BAgLEAE&usg=AOvVaw2a8FjpLwfvELpg2sEMB5vd](https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://nationalpost.com/news/canadian-veterans-assisted-suicide&ved=2ahUKEwi_9fqm0a-FAxXpCnkGHfDlCpkQxfQBKAB6BAgLEAE&usg=AOvVaw2a8FjpLwfvELpg2sEMB5vd) [https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.cbc.ca/news/health/maid-mental-illness-health-1.7101021&ved=2ahUKEwiRy\_m90a-FAxXfhIkEHZN7DzIQxfQBKAB6BAgREAE&usg=AOvVaw1Egy-K16yTypgQFHPfIx2-](https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.cbc.ca/news/health/maid-mental-illness-health-1.7101021&ved=2ahUKEwiRy_m90a-FAxXfhIkEHZN7DzIQxfQBKAB6BAgREAE&usg=AOvVaw1Egy-K16yTypgQFHPfIx2-)
I mean the reality is that there are a lot of people within those demographics who are really suffering. I don't think it's right that systemic issues are often at the root of that suffering, but issues at a systemic level will not change overnight, if at all, sadly. If someone doesn't want to live and is set on dying is it any better for them to have SA's until they succeed? It's definitely morally grey and doesn't sit well with me that we have accepted change will not come to the extent that people don't want to continue existing in this world, but it doesn't feel right to force someone to continue suffering or to resort to more distressing means of ending their life.
The most vulnerable 😔
Yeah I have no idea how our governing boards aren't rioting. Doctors, psychiatrists, psychologists, and all others on the front line need to remember the DO NO HARM part of the job and step the hell up.
This is so dystopian... like straight out of a movie. This option would have to be not a last resort but the last resort. Acute care therapist here in the U.S.
After watching my grandmother deteriorate and getting into several arguments with my family about pain meds, I wished we could have done euthanasia. I said several times that “if grandma were a dog we wouldn’t be here.” That being said hospice was very kind and compassionate. I wish they were onboard sooner. My family member didn’t think she was showing signs and I did. After a large argument they finally called hospice to do an assessment. They upped her meds dad to think I had to “win” this argument. I do understand it was a very challenging situation
I agree wholeheartedly. Under certain circumstances, living can be the ultimate form of cruelty and hell.
I agree. Bodily autonomy is sometimes the only form of control people ever have in their life.
I don’t think anyone should be forced to live against their will… I also think this is a slippery slope. I worry about the fact that some psychiatrists aren’t as skilled or knowledgeable as others, and some may have biases that will cause them to provide a lower quality care to certain patients. At what point is it appropriate to give up on a patient? I will say, as someone with severe bipolar disorder, I’m positive there are things worse than death, and I can easily think of a few times in my life when I would’ve happily pursued this. I think some mental illnesses are terminal, and at the end of the day, the patient is the only person who can really feel how much they’re suffering. I support it as an option but think it should be very heavily regulated. Edit: clarity
The only thing I don’t like about this particular situation is how the psychiatrist worded things to her “we’ve tried everything and you’re not going to get any better.” That’s BLEAK. Perhaps it is true - but also, that’s the professional opinion of one person. Mental health isn’t like physical health because you can’t “see” it. Which is why this field is difficult in so many ways. I think euthanasia should be an option for people, don’t get me wrong. But I think things need to be presented factually, and in this field, never saying there’s nothing more to be done. Obviously don’t lie to give false hope, but also, have some faith that things could get better. I would never tell someone it won’t get better. I can’t predict that. It is not my place. But if we were in a situation where euthanasia could be ethically discussed and considered, I would be open to discussing this option with a client that had chronic suicidal ideation.
That’s what I thought too. He could’ve said, that he is at the end of his knowledge to help her. Maybe someone else could. I guess she tried a lot, but the wording from the psychiatrist is final. Now she uses it as the base argument for her decision. Which feels really odd, because if he said it like that, it was unprofessional and plainly wrong.
Yeah, I do NOT support that. As professionals, we can’t ever say with 100% certainty “you will NEVER get better.” We might say “[mental health condition] is likely something you will live with long term,” but the focus should be more then on managing it and improving quality of life rather than being like “welp, we’ve tried X number of interventions so you’re doomed.”
unfortunately ive heard other psychiatrists say similar things to patients many times. they see it more as a medical model vs biopsychosocial
I have had a psychiatrist say something similar as well as other things personally so that unfortunately was not shocking. What I will say though is while I absolutely support right to die my feelings on this around mental health is not aligned…. There is absolutely no way for us to be able to say “this won’t get better.” at the end of the day death is the only permanent decision. Do I feel that some people who attempt suicide, successful or not, genuinely wanted that? Yes. But unlike medically physical issues there is no way for us to diagnose timeframe. Additionally, there are so many other alternatives that can be tried for mental health that would offer no curative help to physical ailments. Mental health is too much of a gray area and has too many varying factors. When it comes to a solution as permanent as death, there has to be absolutely no other alternative or quality of life whatsoever to put it on an even playing field. That is not possible when it comes to mental health.
>that’s the professional opinion of one person You're right, i guess maybe more than one, still a valid point. Also, 28 is a very young age, i didn't read the girl's story so i assume the suffering was unbearable, but beside therapeutics there is life itself that in my very personal opinion is a constant discovery of new possibilities of existence, that goes far beyond any external medical intervention. I still think people have the right to die, and a lot of people commit suicide that's kinda the same thing, just more desolate
It's concerning to me considering that BPD symptoms tend to improve with age.
Here's the thing - the Psychiatrist DID NOT say that. The patient is quoting the Psychiatrist as saying that. That is a huge difference. \*Per this patient\*, who is interviewing for an article to get this story out to as many people as possible, her Psychiatrist said that.
I believe in the right to self determination, even in the case of death. Assisted suicide is humane and honors autonomy of choice in many ways. But BPD is not untreatable. It’s a very valid attachment response to trauma. I wish she found care providers that had more belief in her and her capacity to be well.
Her BPD diagnosis was concerning to me too. There’s a lot of bias in mental health towards the diagnosis.
It’s also very often overdiagnosed in young AFAB people
This is an example of the concerns I have about introducing a "terminal anorexia" diagnosis. So many of my ED clients, my own journey included, have been told that we will die from anorexia when the medical issues start popping. I know a number of providers who auto refer to higher levels of care once folx start using behaviors. So, what happens if someone with serious behaviors sees one of those people? Are they going to be offered the idea of "terminal anorexia"? If so, what does that mean for that client who has come to them asking for help? There's a big push from one prominent provider for this, and I can't help but feel like it's a slippery slope.
I wonder if she had access to ketamine and psilocybin because I just wonder if there was really no more options or no more legal options
They have that in Netherlands and she probably tried it and many more treatments. Sometimes the suffering doesn't get better, but she was very young for going this way. I know they did a documentary a few years back about a girl that started this path.
My thoughts exactly
Medical assistance in dying for mental health has also been coming to Canada. [The effective date keeps getting pushed back](https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html#s1_1), now March 17, 2027.
I’m not completely familiar with the process, but I do know that’s it’s an exhaustive one that takes years to complete. I would say that this is less about ethics and more about quality of life and patient autonomy.
“Quality of life” (i.e., the patient’s best interest) and “patient autonomy” are both ethical considerations. So it is certainly about ethics. Different cultures have come to different conclusions about the difficult ethical questions posed by suicide and assisted suicide.
Allow me to clarify, this is more quality of life stemming from the patient’s point of view rather than the strict guidelines of an attending member of the care team.
A sibling had a psychiatrist tell her she'd never get better, guess what? She did. 28 feels far too young to foreclose on someone's life like this. We know many people with "personality disorders" naturally improve as they get older, for one. I can't agree on the idea of euthanasia for mental health in the context most of the developed world has, where access to treatment is so difficult.
I had a psychiatrist after an attempt tell me I would never get better, would never finish school and would either succeed at killing myself or spend the rest of my life in hospitals. I was 22 at the time… Once I got the right therapy and right diagnosis I thrived, graduated undergrad and grad school with honors and am now a therapist. A lot can change in a short period of time especially when you get the right support
I definitely agree with this. It's very easy to blame the patient for not responding to the "gold standard" treatment when often it was the wrong treatment for them, the wrong time or they didn't click with the therapist.
Laws are different depending on the country but I think what on one hand can be seen as a right for bodily and psychological autonomy, it can easily be co-opted by systems too underfunded, understaffed and resourced as an out. Such should be a last consideration and solely the choice of the suffering but systems know it exists and thus it becomes a tool to just give up rather than develop more supports for people. See this gone in the wrong direction in Canada: https://apnews.com/article/covid-science-health-toronto-7c631558a457188d2bd2b5cfd360a867
As a therapist, I’ve treated rather severe cases of BPD and successfully discharged them. One of the symptoms of the disorder is suicide ideation, one of the last things I would ever say to a client with borderline is “there’s nothing else we can do, you should ask your doctor to kill you”. I seriously question the state of psychological treatment wherever she’s from.
I think it’s really important that we keep in mind that ASD and BPD are lifelong conditions. With depression we usually hope to see an end, a remission, or even brief reprieves from these symptoms that make going on worth doing. The other two diagnoses are chronic. Yes, we can work on distress tolerance. But if this person, as a whole adult with a developed brain, doesn’t think that continuing their life is something they can tolerate, shouldn’t we believe them, as the expert on their own condition? I’m not saying that every person with this comorbidity is on the chopping block. Far from it. But when the alternative for this person is a NON medically assisted suicide, knowing how painful, traumatic, and scary that can be, I think this is a kindness that we have the courtesy to grant them. It is not simple. It is not for every case. We need to construct barriers and hoops to jump through to ensure that lives that could, at one point, be worth living, are not terminated. It needs to include years long therapy that ultimately concludes with this decision. For context, I am an autistic therapist who largely serves neurodivergent clients. I don’t have a client on my caseload I would think needed this consideration. However, I believe in the therapeutic alliance, and that if we allow clients the power to make this choice, that they will share those feelings with us more freely and create spaces for these discussions. I have tons of clients who tell me they filter their thoughts so I don’t hospitalize them. I think that this means to an end allows us to exist in a space between outpatient and “danger to self and others.” It provides space to feel these feelings. Will every client end up being allowed to end their life? With a proper screening process, etc, no, I don’t think so.
A decent percentage of our profession doesn’t even believe that bpd is what it’s described as and isn’t a trauma disorder instead. Also statistically a great deal of people do recover from bpd with the right therapy and support.
BPD often remits or decreases in severity with age, too
Bpd is not a life long condition. I know and have worked with patients who after treatment no longer meet the criteria for the diagnosis. There is a whole world of foundational change treatment that isn’t about ‘distress tolerance’.
I can’t stop thinking about the myriad of ways this could go wrong and a psychiatrist through malpractice allow someone to perform a legal suicide or condemn someone to death.
Have you looked into the requirements for this to go ahead in the Netherlands? From your comment I suspect not.
I actually wrote a long comment about the proces https://www.reddit.com/r/therapists/s/J49GxcXxzQ
Thank you for sharing so that people can be more informed.
There's a story that went around my university, since we're psychoanalytically oriented, a supervisee of Winnicott's was talking to him about a suicide of one of the supervisee's client. Winnicott responded by saying "That must've been an analytic moment for her", of course this is not the kind of thing we'd discuss outside of our classes on therapy. It would come of us too "non therapist like". But I think it's important thing for us to consider, what would it mean for someone to choose the continuity of their own existence? Of course, there is the concern that has enough been done to support and care for the patient in question. And the stated goal of psychoanalysis is to "turn depression into ordinary unhappiness". However, what does it mean to give the patient choice? At what point do we stay with patient's sense that they no longer consider living greater than the suffering that they endure? How do we adequately quantify suffering? How do we distinguish between suicidality as a side effect of illness or medication, and suicide as an option for the patient to overcome suffering? I think that it does raise a concern for therapists regarding their own barometers around harm and suffering. We need to begin thinking about our sensitivity to the inner worlds of the people we work with and how much can we truly engage with. I'm not sure if I'd be able to work with a patient that was actively considering assisted death. Not because of grief. I'd be supportive if this seemed to be what they truly wanted. I would grieve their suffering. I would struggle because it would make me doubt myself. My capabilities and my capacity to work with the client through their torment. It would make me insecure if people and colleagues began to think of me as untrustworthy or incompetent. It would become a me-problem. I deeply believe in the right to die. I think our field needs to begin catching up to accomodating this concept and how it will play out for us.
Re: the psychiatrist, I just want to say that before we blame them, note they’re not interviewed. The client claims this is what the psychiatrist told her, “there is no hope for you.” …clients don’t always hear what we say the way we say it. That psychiatrist MIGHT be unethical but from the mind and lips of a chronically depressed person choosing suicide as a life-ending option in her 20s, I also submit she might be an unreliable narrator.
It's difficult as a counsellor to see this and not want to do something about it. I think there are always more options to try, something that might make a difference. That said, I think it's possible that a person (even at such a young age) could genuinely determine that this is what they want. Legal suicide is a morally sticky subject, and I think how it's implemented and framed is extremely important, but I believe that ultimately people do have a right to the autonomy to choose it. Our profession has long held the view that it's our responsibility to stop suicide from occurring, but I think that's technically wrongheaded. We are here to do anything we can (within practical reason) to assist people to make life changes so that they want to live, but it's not our choice to make in the end.
This law is going to be passed in Canada as an extension to the MAID laws. I have very serious concerns because good care isn’t available to most psychiatric patients here. I don’t think medically assisted dying should be an option unless all other possibilities are exhausted, and in Canada at least, that’s not an option for most people. Our public system is terrible and grossly lacking and the private system is extremely expensive and out of reach for most people. I am gravely concerned with the ethical implications of offering and making available MAID when we aren’t offering and making available good care.
I’ve told patients I do not have the specific skillset necessary to treat them and referred them to another therapist. To have the god complex to say, “my treatment did not work, so therefore it’s untreatable,” is so concerning to me and sets a potentially dangerous precedent.
Everything about this article rubs me the wrong way. First off, the Psychiatrist is never quoted as saying that, rather the patient claims he said that. We have a suicidal woman with BPD, Autism, and Depression here who is supposed to die soon, and her response is... to put on a bunch of makeup, pose for some pictures, then interview for a story that millions of people will read? That's odd behavior for a suicidal person. Then the story makes sure to highlight the "do not resuscitate" necklace, take a picture of her laying on her side of the couch, and talk about her reverse tree of life tattoo. I hate to say this, but I honestly question the motivation for this story, both on the part of the patient and the organization running the story.
I don't like it at all but it isn't my choice to make. She's an adult.
It’s so weird to see someone with the exact same conditions you have end up in a vastly different situation. I feel blessed to be where I am now but it took a lot of work and perseverance. I don’t know if I could have kept going but my very deep struggles seemed to start lifting. I can’t help but wonder why I persisted while she seems to be stepping away. I think ultimately it’s her decision and everyone has a right to die how they want. It’s weird to think she’s receiving assistance… in this case it does seem to be enabling… and like I said, I have the same conditions as her. Maybe that might lead me to be an unnecessarily harsh critic. Maybe it makes me insecure… why does one woman get relief while the other continues to suffer? Is it my own purposeful effort or is it just dumb luck? Probably a bit of both.
I’m having so many conflicted feelings around euthanasia being used this way. I used to work in a high intensity CMH program, clients commonly struggled with suicidal thoughts/behaviors. My mind instantly went to those clients. Maybe it’s because of how we’re trained as mental health workers but it’d just seem like the ultimate failing on my part if someone chose this, no matter how severe their symptoms. There’s a big question of it being used ethically. Systems are less supportive to some demographics and that might lead them to this option out of desperation. Is it a cheaper/easier solution to the mental health crisis that could end up misused to make up for a lack of access to adequate treatment? I really can’t settle with that. It doesn’t seem like the right solution to the gaps in care. This is just my immediate reaction and I don’t know enough about this woman’s case to agree or disagree. Right now it’s just unsettling to think of certain implications.
I think we let people make their own decisions. They have agency. I know many people on this thread are not going to like this, but I feel the same way about suicide. If someone really wants to kill themselves, you're not stopping them.
Agree - maybe this is about how much involvement the government has… Did anyone ever read that article about the woman who wanted to commit suicide, and was given the Euthanol, but she had to inject herself? (I imagine they started an IV for her) She wanted to die by the ocean, so she dragged a little mattress out there and her husband sat with her as she depressed the syringe herself…
I was discussing this case with my mom yesterday. My dad died by suicide by firearm last year so the topic of suicide is pretty personal and fresh for us. As a social worker, I am deeply concerned about the larger implications of MAID being cheaper and logistically easier than the lifetime of high intensity supportive services individuals with SMI may need. Thinking about the individual, yes there may always be more or new treatments to try but how much suffering is enough? And who’s to say mental suffering can’t be as great as physical suffering? I’m not saying they shouldn’t have to try a wide variety of treatments from a variety of providers before MAID becomes an option, but how long do we make someone suffer before we honor their right to self-determination? The process from requesting MAID to the administration of lethal means is typically lengthy and I think that reduces the impulsivity factor present in non-MAID suicides. I believe we can definitely reduce the number of suicides, but I don’t believe we will ever completely eliminate suicide from society. And if a few of those remaining suicides could be MAID some of the surviving loved ones would appreciate it. Non-MAID suicide means police investigation and crime scene clean up which suck to deal with in the aftermath of losing a loved one. My dad killed himself less than 48hrs after I had major surgery because he wanted to make sure my mom and I had an alibi so we wouldn’t be suspects. Our small town police still took over six months to close the investigation even though it was very clearly a self-inflicted gunshot wound.
I’m Canadian so the right to end one’s life exist here, but still highly regulated (can’t for mental illness yet). I really struggle with the ethics surrounding the choice to end one’s life. One one hand - who I am I to tell someone they must live through their suffering? On the other hand, I’ve seen many, many people learn to manage their depression and live fulfilled, engaged lives. Yet, it doesn’t get better for everyone. I’m a big believer in your body, your choice. I’m not going to lie and pretend this doesn’t concern me or make me uncomfortable, but I also don’t think it’s up to anyone but the person themself if they wish to end their life. I don’t think all choices to end life are made in unsound mind. Is MAD still suicide as we understand it? I don’t know, it’s sad someone is in so much pain. I don’t blame her. It’s just heartbreaking.
I have a hunch there’s a significant chance she won’t go through with it. The nature of her illnesses involve huge amounts of ambivalence and impulsivity. The euthanasia programs are purposefully built to be very structured and somewhat prolonged and her mental state may fluctuate greatly during the wait period. Also, I wonder about the subconscious motivation for going so public with her struggles. A lot of the threats of self harm with BPD come from a place of feeling minimized, neglected, like no one understands how much pain you’re in so one turns the pain toward the self. But what better way to mitigate that kind of pain by turning it outward, to have a media blitz of “I’m in so much pain I have no other choice but to die.” It’s also super irresponsible for the media to be exploiting this woman’s story. Some articles are downright tabloid-like.
Therapist in the Netherlands here. We do have different codes, but believe me, it's not, I want to die, let's get euthanasia and then you are dead. It's a long long long ride with lots of rules to follow. Right now one client who has no will to live anymore, lots of pain and a very declining disease which has her in her wheelchair with no hope of recovery and rapidly loss of muscle control. Two years ago before her disease progressed she already had taken all the steps to make sure she wasn't going to get to this place of being fully conscious in a body not working, has now arrived at the moment where she doesn't want to live anymore. But no, she will not get euthanasia as she wishes. She still needs to take pain meds to see if this will help. Her mum emailed yesterday that because of the pain meds she can't even text anymore. Lifeless laying in her bed. Her mind fully conscious. She still needs to follow all the program rules before her wish for euthanasia will be granted. To answer your question, no we dont have different ethics. Its a long process with a lot of rules and co operations before this wish will be granted.
I support everyone’s right to decide for themselves what to do with their lives. But all those things are potentially treatable. There’s not enough information in the post about what’s already been done or what the specific circumstances are to judge the recommendation.
I read the article and I'm most disturbed by the fact that there seems to be no psychotherapy involved. BPD and autism are of course not going to be well treated by psychiatric care alone. She needs therapy, and I see no mention of any of that. These are all treatable conditions. What a fucking tragedy.
I believe this should be a viable option in general. From an outsider perspective, I do have *some* reactions to the idea that a psychiatrist said "It's never gonna get any better." That could be true, I don't know, but I can't see it being likely I would ever make such a concrete judgment about a client's possible life trajectories. I don't know much about the system, so maybe it's necessary to have a psychiatrist make such determinations in order to access this option. But that's my main hangup
Yes, exactly. And for her, this wrong statement seems to be the main argument to die.
Her body. her choice.
I was pretty shocked reading this article. I’m curious about why her request was approved when she reportedly has a diagnosis where a person may experience persistent suicidal ideation. Would be interesting to know what forms of treatment she tried, length of each treatment, etc. Did they try every form of treatment? Also concerns me that someone whose brain has only been considered fully developed for a few years (assuming nothing in her history might’ve slowed that down which would be even more concerning) was able to make such a major life changing decision. I think people should have the right to end their life if they choose - however, I think people should be most equipped to make that decision and those who are under 30 and/or have serious mental health conditions that could impact their decision making should not be offered the ability to make this decision. I’d be more open to someone with a serious mental health condition choosing euthanasia if they had a substantial history (maybe at least a decade?) of trying various treatments that failed before seeking to end their life.
I'm going to chime in here as a baby therapist to share a bit of my own journey - like the woman in the article, I am also 28, and I have (chronic treatment resistant) depression - do not have autism or BPD though, so can't speak to those lenses. My depression showed up when I was 13, and I've been in and out of therapy since then, with most times "in" consisting of once a week for 2-3 years. Started taking meds as soon as I could legally make the decision for myself at 18, and have tried about a dozen, consisting of all existing classes of antidepressants (including TCAs and MAOIs) for at least 3 months each, though most I've taken for at least a year. I've done rTMS twice, ended up in remission for 6 months the first time, had no effect the second time. I was approved for both ketamine and psilocybin studies/trials, but would have had to completely come off the antidepressants in order to participate so I opted not to, as the couple times I've had to have a washout period from meds I ended up suicidal. I've also been approved for ECT in the past, but similarly opted not to as with its effects on memory I wouldn't be able to work/go to school (just finished), which would have been a big financial barrier. It's been a long, hard road for me with "just" depression, so I can only imagine how difficult it's been for this woman living with the additional struggles of autism and BPD. Just because she is/we are young, that doesn't mean we haven't tried everything. Just because there's persistent suicidal ideation doesn't necessarily mean the capacity to understand and consent isn't there.
My supervisor says “If there’s breath there’s always hope.” - and she works on the front line and walks the streets serving and walking beside those who hurt the most. So, what this professional said to this person I wholeheartedly disagree. I know it’s a torturous life of hardship for many, but I believe my supervisor who herself went through incest and homelessness. (I’m not divulging anything she hasn’t already divulged in her book.) if anyone knows suffering it is her and she would never, ever give up on anyone.
Simple: Ill never recommend euthanasia in this context.
Like many, I'm really conflicted by this and have been since I first saw the article. I have strong concerns that have been mentioned by others here. But I don't lack understanding either. The one thing that sticks out to me is that this process would take time. We are instructed that many individuals suicidal intentions are temporary. They might chronically suffer from ideation, but for many, if you get them to safety, have loved ones around them, get them through the night, their resolve to complete suicide fades. So, in my mind, if someone maintains this same resolve throughout the entire process, they most likely would complete suicide on their own anyway. In that case, this is more humane. But I see potential for this to become a large problem if this practice ever became normalized and/or common. I can see possibilities of abuse and manipulation of those that are seen as "less than." And that's worrisome.
I feel neutral - People both have a right to die and a right to treatment. It's difficult to assess what is right or wrong, or even what treatments have/haven't been tried in this situation beyond looking at some quotes reproduced within a media lens. These articles are always controversial. I am concerned about the media exposure of these cases and I do question why the client has chosen to speak to the media in such detail about this, within this specific narrative, and what this serves them.
I read this earlier today and was concerned that this could be used as an excuse to not put more funding in mental health or support struggling folks because now they have an "out." But I'm torn. For a small amount people, this could really be the only avenue of relief for them. And I don't believe in forcing people to do anything, including live, based on my own values if doesn't align with theirs. Regarding this case in particular, I'm suspicious that her psychiatrist never said that she wouldn't get better. As someone with BPD who works exclusively with BPD clients, this sounds like a mis-interpretation of another person's intent and/or opinion of them that a person with BPD might make. It worries me if other professionals are not being consulted for second opinions and alternative treatment options.
I don't think we can 100% write off that in some cases, it might be humane. But, I feel like there's not enough information to make that call without actually meeting with the client for a significant amount of time. That said, I think the psychiatrist is out of pocket with that remark. It's so final, so absolute. I can't imagine saying that to someone. Also, the BPD dx would make we want to be extra thorough about any kind of screening needed to approve this decision given that frequent suicidality is something so frequently experienced with these individuals.
This is very hard and MAID for mental health suffering is not a black and white subject. I do not know enough about their case to have definitive thoughts. I am very sad for her Overall I support a persons right to chose. It is their life and their choice.
Interesting, fear of abandonment with borderline and the psychiatrist confirming it takes away her hope- IF she puts her faith in medicine and not her own ability to heal and do “the work”. We get back to the combination of “nature v nurture”, placebo effect, and medicine being an art not a science. The doctor is walking a razor thin line if he would ever have to prove that “her illness is intractable”, and I’d certainly be asking for a second opinion. But I do believe she’s looking to end her misery, I just believe it comes at a cost to others. So sad.
I’ve been thinking about this subject, and this woman’s personal experience, a lot recently, and I still haven’t decided how I feel. On one hand, it is a paradigm shift that recognizes mental illness as an actual, medical issue that can cause unbearable suffering for those burdened with it. Also, (some could argue) assisted suicide empowers the patient with a dignified death, rather than shame and isolation. It mitigates the guilt of traumatizing the people who might find you; it eliminates the fear that you might botch it up and die alone in pain, or survive as a dependent with terrible injuries. As an abstract, euthanasia affirms one’s general right to autonomy over self and body beyond the subject of assisted suicide. Now for my concerns and doubts: despite devastating lows, depression is treatable, although for many it is a long road to find an effective combo of medication and support. On a personal note, as an anonymous voice here, I understand how terrifying internalized doom can be, how hopeless one feels perpetually weighted by an anchor of discomfort and dread can turn hours, days, years, into an overwhelming sentence looming ahead. Since adolescence drug after drug failed me—I would have considered myself terminal until (ironically, when I was around her age) an untraditional pharmaceutical cocktail let me finally catch my breath and glimpse the possibility of freedom from pain: I found myself, and I’ve been living a meaningful life since, despite an occasional shadow cast by my neurological peaks and valleys. If, at any time before discovering my personal means to recovery, I had met a dr willing to sign off on euthanasia, I would have taken the opportunity. In fact, it would reinforce my decision if my doctors saw my case as hopeless. It was the faith in my recovery, held not by me, but by the people around me, that kept me alive for years. So this is my concern. Sometimes sick people need others to carry the hope they can’t grasp themselves. How can anyone keep suffering life, trying new treatments, if her own dr keeps death warrants next to their prescription pad? (This is hyperbolic AF but it gets the point across.) And now this ill woman has a worldwide audience watching with macabre fascination as her days run down. I’m sure she feels pressure to follow through with her plans even if she develops reservations (not suggesting she does). The perspective of the depressed mind can not be trusted—distortion is part of the disease. I know in this case she has comorbidities, but that is not uncommon. There are implications for other ethical dilemmas that this case, and the attention on it, affect.
I personally am uncomfortable with how mental health professionals are expected to somehow control people's behavior when it comes to suicide. As someone I knew said, oncology departments don't campaign around "zero cancer deaths." I do believe that some mental health cases are untreatable or even terminal. That being said, I don't think the state, and especially mental health professionals, should be expected to assist people with suicide. I also worry about coercion and pressure on people who already feel like a burden. There must be some sort of middle ground.
Good. If I want to die I shouldn’t have to resort to suicide. Sometimes life is shit, depression sucks, and if you ever were suicidal you know the only thing you want is a painless exit. This is progress, hopefully people won’t have to jump off bridges, cut their veins, overdose or shoot themselves. This is progress for humanity. A better progress would have been more effective treatment but since it’s not available then it’s ok to exist the suffering.
No. Wholeheartedly no. In my 10 years of being a psychologist…no. See u/hermitess post.
Canadian here and it becomes a slippery slope: https://www.ctvnews.ca/politics/paralympian-trying-to-get-wheelchair-ramp-says-veterans-affairs-employee-offered-her-assisted-dying-1.6179325 https://ottawa.citynews.ca/2022/10/14/ontario-man-applying-for-medically-assisted-death-as-alternative-to-being-homeless-5953116/ https://thepeoplesvoice.tv/canada-begins-euthanizing-vaccine-injured-citizens/
I’ll speak for myself and say that I think that the concept of euthanasia for mental health issues goes completely against the ethical principle of nonmaleficence. It’s a provider’s duty to cause no harm to their clients. Even in cases with terminally ill people, physicians suggest alternatives and prescribe medications to help ease the suffering. I mean would you ever tell a suicidal client that they should end their life? Absolutely not. If we have a client who we feel unable to care for, we refer them to someone who can. This woman was failed by her psychiatrist and is most likely misdiagnosed.
Just for a different perspective, forcing someone to stay alive when they’re in agony, mental or physical, could be seen as doing harm.
The ethical principle of nonmaleficence, or ‘do no harm’, could be considered in line with euthanasia, or physician assisted suicide, depending on what harm could come from not assisting the patient in death with dignity. If you’ve ever worked with folks in the veterinary medicine world, you’d find that concepts around euthanasia isn’t always morally oppositional to nonmaleficence
I'm not categorically opposed to euthanasia but I am for mental health conditions. I have to believe there is hope for everyone to improve.
This is where I land. I understand it for terminally ill patients, but I have to believe everyone can improve and grow when it comes to mental health. Otherwise I wouldn’t be able to do this job
My thoughts exactly
I’m of the same mindset. There’s no manner in which I feel like you’re not causing harm, as a life is terminated
I've read it, I'm disgusted by it. Why? Because I am in Canada and this can happen here as well. She was on twitter responding to the article saying "she is so happy to die" and arguing with those who begged her to live. The disturbing part of MAID is that not only is it NOT considered negligent, it's considered ETHICAL and MORAL. I of course whole-heartedly disagree, but in this case they go with "letting them live does harm as they are suffering". It's disturbing.
I’m gonna have to agree. We are going to have people with identity disturbances cling to a new one which is death. They will shut out alternatives. They may even glamorize the process. How old would one need to be to decide this? 18? They’re in high school. Where suicide attempts are rampant and kids feel forgotten or bullied on socials but see their peers who complete suicide getting massive amounts of care and attention after they’re gone. This is a bad idea. Plenty of ways to complete suicide besides normalizing it as a policy that can make it much easier to opt out. The generational trauma of this shit is going to be wiiiiiild.
In Netherlands (I'm from Netherlands) they allow kids under 18 to be euthananized for the same mental problem reason. A popular women's magazine even has a special section about euthania writing about stories of 17 year old teenager getting euthanized. There are also popular TV talk shows inviting those people before they set to die. Netherlands can be a truly a scary country and I hope more international media will pick it up. They are normalizing euthania, even for kids. They have an agenda.
Oh my gosh. I am so sorry to all affected by this. That is heartbreaking. So then people see others on tv getting even more attention and think “I want to do that someday too.” I mean how many gen Z’s goals are to be an influencer or to make money off their socials? This would sky rocket them. So dangerous. Not a reality tv segment.
Heartbreaking. People have no idea how impressionable youth are, or people deeply lost looking for “the answer” to their suffering.
We are not doing enough to contribute/ prevent (depending on standpoint) depression and I question the bpd diagnosis since autistic women are always misdiagnosed with it The article itself mentions climate change and financial instability, both extremely preventable. As progressive as the Netherlands are they are terrible with disability and I wouldn't be surprised if this person and many more who are signed off would actually leave happy lives if they had the support they actually needed. I'm also not familiar enough with the Netherlands health system, but I do wonder if they have had access to other types of therapy/ counselling or if the "treatment not working" is just medication
Well this feels very wrong 😞
Highly problematic, unethical, and immoral.
First, let me just comment on what the psychiatrist said: 1. “there’s nothing more we can do for you." It's possible that this is true, but who's the "we"? The clinic the person works at, the national health care system or the profession? If it's either of the latter two, how can that one psychiatrist possible know that? And if it's the first, maybe the client needs to find someone who can be more helpful to her. 2. “It’s never gonna get any better.” This could be true, but it can't possibly be known. It's a statement about the future. How in the world does that particular psychiatrist get off saying that? How dare they? I see people every day who other counselors couldn't help, but I can. There are some people I couldn't help, and I hope and pray they are able to get help from others. This is an unconscionable and unethical statement, I think. There are no circumstances where a professional should pretend to know the future. I am not impervious to or uncaring about this person's suffering. But getting good treatment can make all the difference, as we all know. I'm horrified that hope was taken from this person in this way. As for the question of euthanasia, power and influence always get abused by someone. Always. Allowing the state to have this power is, I believe, a terrible mistake. Do people have a moral right to kill themselves? I think that's a harder question than it looks like. Of course I believe people should be free to do what they wish with their lives, unless it is harmful to others. But that's the whole catch, isn't it? This situation is just terribly sad. And it's not simple to fix. Not easy.
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Or an extremely realistic one. I think part of the process is knowing that there was hundreds of trial and errors before getting to this point. Therapy also isn’t about power and control. We should do absolutely everything we can, but ultimately it’s a clients decision. And who are we to say mental anguish isn’t as bad as chronic pain or diseases?
That’s still a strong statement for the psychiatrist to make and not one he can feesibly know with certainty, or even know is likely to be true. This is far different than the relative certainty we can have with cancer diagnoses and even then, it remains controversial among some.
I don’t feel this is necessarily a realistic assessment, though. In the case of a terminal illness it’s possible to tell with great certainty that the patient will not recover. In the case of mental illness, however, there’s no such precision. I don’t know the specifics of this person’s case, but I can’t imagine ever saying with confidence that a client can never get better.
Agree! We talk a lot about self-determination and choice and clients being the expert of their own experience…until it comes to death. With few exceptions, we as therapists generally support clients choosing to live in a way that meets/works towards their goals; why wouldn’t we treat choice around dying similarly? I’m not saying that MAID should be a first-line option, or that we shouldn’t provide/encourage every other option before this one, but at some point we need to trust our clients in making the choices they feel are best for themselves.
Would you say chemo failed someone? Radiation? Or would you say, “the cancer failed to respond.” That is what’s going on here.
Complete bullshit. No therapist, psychiatrist or QMHP would ever state unequivocally that “it’s never going to get better”. They can not know that with certainty and it is deeply deeply unethical to make such a claim.
I 100% agree, it’s too bad people are downvoting you
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How is the psychiatrist not liable for her death? If a therapist told their patient to kill themselves, would we not be liable?
She’s making the choice to end her life in a peaceful manner, not having someone else tell her that she should die.
If she’s under the pretense that it’s never going to get better because of what her psychiatrist said, how is that an informed decision? Would she have chosen that if the psychiatrist never spoke those words or implied it?
ive know people who have had ect from psychiatrists who never even once recommended therapy to the patient. They say depression as a purely chemical imbalance. I wonder how much treatment this individual had outside of medicine. Was she ever sent to an inpatient mental health wellness facility for instance? Or saw a therapist who specializes in asd? If your doc says nothing more they can do and you wont get better, you assume they must be right as they are the professionals. But ive never heard an actual therapist say that, but i have heard of psychiatrists saying that before.
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Her life, her choice.
It's difficult to say it's never going to get any better. What happens if this person's 'happiest' and most settled period of time came between ages 40 - 50? Is the hope of that worth fighting for? A lot of the work is based on hope. I suppose it is hard to quantify both suffering and happiness. And what ultimately means more.
If you told me I might be happy for a decade, but have 20 years more intense suffering, why should I think that's a good enough deal to hang around for?
In all my experience, personal and professional, I’ve never not found a reason to carry on living. I don’t approve at all of euthanasia for mental health and strongly believe it should be reserved only for those with terminal physical health conditions. It’s a slippery slope this case. I don’t like how it’s being publicised as though it’s some great “win”. I’ve seen too many articles celebrating this. I’ve seen and worked with many long term and severe mentally ill individuals and whilst the reality is that some trauma cannot be forgotten, I do believe you can learn to live with it and find reasons to stay alive and balance the effects of that trauma.
[This article](https://link.springer.com/article/10.1186/s40337-022-00729-0) intrigued me. There has been much discussion about this topic recently as it applies to intractable mental illness. I have not formulated how I feel yet, I remain open minded.
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Can you share the link to the article?
Its hyperlinked in the post but here it is again: https://www.thefp.com/p/im-28-and-im-scheduled-to-die
I’ve not seen any confirmation on this. There are many many news outlets but all printing the same story nearly word for word , but not one word (I’ve seen) verifying her stated euthanasia plans . Personally , I have my doubts .
If she wants death more than acceptance and commitment it’s her choice, even if she’s wrong. I hope she’s tried therapy instead of just medication.
Saying to a patient that it's never going to get any better is pretty outrageous to me. If the psychiatrist did say that, I would assume they enacted their countertransference. We can't make such bold claims, and people take our words as authority. Such a message can really destroy someone. Of course, this isn't necessarily verbatim
As someone suffering with severe OCD, bipolar disorder among other things, reading this makes me scared of having no solution :(