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Key points
- Should assisted dying be an option for the psychic pain of mental illness?
- Assisted dying should not be only for physical pain due to disease.
- Newspaper articles consider physician-assisted dying for SPMI.
Present-day laws regarding physician-assisted death are guided by physical illness. But should seriously and persistently mentally ill patients (SPMI) be afforded the same opportunities?
Physician-assisted death requires patients to satisfy three criteria:
- terminal physical illness with a prognosis of having six months or less to live
- competence and intact judgment
- voluntariness
A presumption is that persons with SPMI characteristically lack competence and intact judgment.
To argue that access to assisted dying should be allowed only when physical pain leads to unbearable suffering would refuse this option for persons with mental disorders.
Beliefs that follow SPMI patients encounter serious questions about a patient's decision-making capacity.
Decision-making capacity is the ability of an individual to make independent resolutions, in this case, between life and death. To argue that access to assisted dying should be allowed only when physical pain leads to unbearable suffering would discriminate unfairly against patients with SPMI.
Dr. Eric Cassell, of Cornell University, has stated, “Suffering is experienced by persons, not merely by bodies…“Personal suffering is not just physical in nature but includes psychological, existential beliefs, and spirituality. Emotional and existential anguish may also be caused by a mental disorder.”
Some patients experience intractable depressions, that are resistant to evidence-based treatment such as different medication combinations, EMDR, and treatment modalities such as cognitive behavioral therapy, electroconvulsive therapy, or the newer treatment of ketamine infusion. They may spend their lives struggling with simple tasks such as rising each morning, caring for themselves, isolation, and an inability to develop meaningful relationships and work. Their lives are filled with hopelessness, sadness, and desperation They may consider the quality of their lives as abysmal causing intolerable suffering with no hope of successful recovery.
Individuals who suffer from schizophrenia may experience internal voices that they battle daily; being followed by the F.B.I. or hearing a television speaking directly to them. Side effects of medication can be numbing or sedating. They may develop the wish for death rather than living in their own version of hell that has been consistently unremitting.
Anorexia is also a form of mental illness that can be fatal. Those with this disorder may develop cachexia, which is a condition that leads to extreme weight loss, referred to as wasting syndrome.
Two recent poignant articles have addressed this disorder.
A February 24, 2014, a Washington Post article asserted that half of anorexics and bulimics who receive treatment will not recover. Many will experience multiple relapses or develop chronic diseases and die. Treatment has dismal recovery rates.
A January 3, 2024, a New York Times Magazine article chronicles the journey of a 30-year-old woman who could not conquer her illness. After years of treatment, she stated, “I can’t imagine continuing.”
Dr. Joel Yager, at the University of Colorado Hospital, surmises that psychiatrists are reluctant to believe that some of their patients just can’t get better.
The question remains, should physician-assisted dying be a viable option for the psychic pain of mental illness or reserved solely for physiological disease that will result in a death in six months?
