This article is spot on. Someone very close to me went through the MAiD process. Not only did I have to say goodbye too early, my family member refused to allow me to be physically present at her last moment.
I understand now that if she saw me she would not have gone through with it.
Let me repeat that
if she saw me she wouldn’t have gone through with it.
"This is not just a philosophical shift but an existential collapse of the psychiatric profession." - is this in fact not an existential collapse of the western culture where individuation and responsibility are being replaced through social engineering with a collective identity and socially acceptable persona the very antithesis of individuation.
Eugenics, once a discussion point of a select few now has become far more pervasive and accepted rhetoric, without actual cognizance of its full and true import and consequence for humanity as a whole. Empathy as a term is bandied about quite casually, yet used out of context, by whichever party wishes to appear to promote psuedocare more.
The points you raise are highly relevant because once we venture onto these slippery slopes how long before your right to life and it's sanctity are removed altogether and the decision ensconced in a third party at their discretion for the greater good. As councilors to those in need, is it not, in fact, your duty to maintain objectivity and present all sides and options available to the client who, if in a state of distress and angst cannot see the full picture and thus assist clear and rational thinking when theirs is impaired. I would concur that your duty would not be to simply ratify or support either deluded personal thoughts or group/social pressures. However, each must make their own decisions, something I'm sorry to say, is becoming an seemingly unpopular norm in this modern culture of collective hive mentality.
I support your work and endeavour to spark debate and allow individuals to reassess their stance in a world being engineered to wipe out individual thought and being, if not humanity itself
I think you have a valid perspective, however this doesn’t really shake my support for the least intense version of MAiD (those with terminal illnesses). For example, this makes me think of my grandmother, her dementia had progressed, her breast cancer had spread, she was in agonizing pain unless she was kept on strong pain medications. Seeing her life, and how she was dragged along for too long has honestly filled me with fear. The idea that someone might do that to me, trap me in my body and let me rot in agony rather than allowing me to pass on my own terms genuinely gave me nightmares for weeks. I think there’s absolutely room for compassion, people shouldn’t be forced to suffer an agonizing death for the moral comfort of strangers, when instead they can choose their own time surrounded by friends and loved ones. I agree though that the idea of people with mental health disorders like depression doing this is categorically wrong and I think that isn’t a contradiction. I understand your philosophical point, but philosophy has to go hand in hand with the lived reality of someone. I would gladly support rolling back certain expansions, and codifying into law that it cannot be used for psychiatric disorders, but I don’t think we should throw the baby out with the bath water. There is a reason these provisions passed in the first place, and I think it was because of stories like my grandmothers. No one wants that for themselves or their loved ones.
I've seen what death with *true* dignity looks like. It's hit close to home for me. It's not MAiD. You're entitled to your own opinion, of course. That these provisions passed for a reason is self-evident. That doesn't mean that the reasoning behind it is sound.
IF we’re allowing maid for mental health, we need to be pulling out ALL the stops. Heroic psychedelic doses, for one.
I support it if you are terminal. I would like to think I’d shoot myself if I got terminal cancer, and if I get to be demented please for the love of God take me for one last walk in my beloved forest and leave me there for the local wildlife.
"For years, our role was to guard the flicker of hope, to widen the patient’s perspective beyond the walls their illness had built. If we begin telling some patients their suffering is too great to bear, what message does that send to the others who are still trying?"
Suffering has meaning. It is part of the human condition and we all touch upon it during our lives. We have purpose during times of trials and can exit the other side as a light for others. If this is short circuited by inserting suicide, then the light of hope disappears. I fear this will create a juggernaut of death that will pull far too many people into its grasp, including unwillingly.
I am not a trained mental health professional, but I am a Medical Aid in Dying (MAID) advocate in the United States. I also do not care for the term "death with dignity." I feel dignity is inherent to the person, however they die. I was a caregiver for both of my parents, and while neither died using MAID, both died with dignity, with their pain controlled and at home per their wishes.
As folks comment, it's essential to understand the distinctions between Medical Aid in Dying in the United States versus other countries that utilize euthanasia and have very liberal criteria. In the United States, a person must be a mentally capable, terminally ill (<6 mos life expectancy) adult. A multi-step eligibility process and other safeguards and protections exist for patients and healthcare providers.
Both United States national advocacy groups (Compassion and Choices and Death with Dignity National Center) oppose MAID for mental health conditions. If you are interested in hearing the perspective of U.S. psychiatrists on MAID for terminally ill people, I would suggest Dr. Timothy Quill or Dr. Ronald Pies.
It has been a privilege to talk with patients and families within the U.S. system who have been comforted by access to MAID. Many have faced years of surgery, chemo, radiation, immunotherapy, and clinical trials, and all they ask for is the peace and comfort of a planned death in the face of a disease that is killing them.
The role of a psychiatrist who participates in the MAID or similar program is similar to a military physician, which I was. In both instances, their perceived duty is no longer to help patients get well but to fulfill the mission, i.e. return the soldier to active duty ASAP or to fulfill the dictates of the state. As a physician, unless you are seriously character disordered, this situation likely results in your cognitive dissonance and moral injury. The fact that psychiatrists are willing to act as enforcers of a MAID program reflects our profession's loss of a core of transcendent Hippocratic and ethical values.
My biggest concern is the pre-teens who are committing suicide because of social bullying. I read recently of an eight-year-old who took her own life. It's heartbreaking.
I read an article about a woman in France who was depressed and decided on euthanasia. The day before it was to happen, she changed her mind. She was told "nope, too late" and they went ahead.
Psychiatrists need to help people understand that depression is anger turned inward. Once they deal with the anger, the depression subsides.
Thank you for spelling this out in this way. As soon as I heard about MAiD, it immediately felt so off in my body. I think there are major implications for humanity spiritually as well. I actually met a man a couple years ago who came up to me in a coffee shop when I was having a really hard day. He had noticed me from the restaurant over and said he could feel my pain. He took some poignant photos of me and wanted to share them. His visit turned my whole day around. During our conversation he shared with me that a few years back he had been going through a very dark time and had decided to end his life. He went to a busy street and as a truck was coming by he went to step in front of it, but just as he was going to he saw the drivers face. The terror in his eyes and in a split second he realized he could not do that to this man. He realized he would leave this man with unimaginable pain and stepped back. Now he showed up to me as an angel. As someone who has become acquainted with his sensitivity and has moved through the darkness. Our connection to others is often the very thing that can pull us out of our self-focused internal state of doom like you said.
Making it easy to die is incredibly dangerous on so many levels.
Wow. Wonderful insights. As I've learned in recent years, from people like Fr. Seraphim Rose, and Swiss philosopher Max Picard, the west's fundamental problems began in the 11th century between East and West. The Orthodoxy chose the church fathers and their creeds for their authority. The west chose rationality, reason, independent thought and pursuits. The west wound up with the so-called Enlightenment, Renaissance, Reformation, industrialization, and ultimately nihilism. That's where we are today, Hannah. A fully nihilistic, me me me culture, pragmatic to the point of replacing ourselves with chimerical creatures made of who knows what. We have outsourced to the extent of no longer having souls, no longer answering to God, our Creator. This will not end well. There is no possibility of reformating our lives and civilization, as the foundations are just plain gone. Thank you for this writing. If only people still read books, philosophy, literature. They won't, of course. Images lie, but they're titillating and always promise more of same.
I've had a problem with the "death" with dignity crowd for a long time, mostly because of the inherent contradictions in their policy proposals. There's nothing "private" about needing someone else's help to die, nor is there anything "dignified," as I understand the concept, about having to agitate for policy changes in order to make assisted suicide legal.
Very well said Hannah and what a difficult issue. Very good point that if you "give up" on a client and they later change their mind that impacts the continued therapeutic relationship....um yeah. The other thing I think about is karma. Some very wise folks tell us that if you suicide you are simply avoiding your own karma and it will chase you after death. Does assisted suicide doom those making that choice to a continued working out of their karma post death?
I’m a psychiatrist who trained 20 years ago. I can’t believe how far we have strayed from our oaths. Between murdering young people with autism and borderline personality disorder and performing sex changes on the exact same population of patients (coincidence?) we can hardly complain when people mistrust us.
It may be that their suffering is to great to bear. In that moment. That’s why there should be support to help them through.
If they break their leg, there is support of a cast and a crutch. Not an option of in this moment you are suffering, hop in the pod. No, the fact you don’t want to wait the time to heal is not a justification to use the pod.
Your motherhood does not in any way diminish your education. Nor should education invalidate motherhood. Same for fathers.
Diminishing the elderly for their age and current lack of productivity has always been a concern. But the have earned the right to enjoy their age. Why should they be coerced into anything else.
I realise there may be permanent injury of a significant degree, or rapidly degenerative that may give legitimate reason to using the pod, but great care should still be made.
I have particular concern for prisoners. Where states don’t make genuine effort to facilitate reintegration into community, and recidivism rates grow, people may become despondent to the point of wanting to use the pod to break the cycle. What if it is made available in prisons? No death penalty per se, but a death sentence all the same…. What do prison psychologists/0psychiatrists do?
This is a horrific situation I think. I believe mental health specialists should fight for life. When well the patient can give consideration on what to do in future.
"Once a society offers assisted suicide as a dignified option for some, the mere existence of that “choice” exerts pressure on others. It quietly redefines which lives are worth living and which are not. What begins as autonomy for one becomes coercion for another."
Once death as a medical intervention is let out of the box, its logic is inexorable: either death should be available to anyone at their request for any reason (maximizing autonomy) or death should be available even to those who cannot consent (maximizing relief of suffering). Any safeguards fall as people just beyond the boundary clamor for access. Indeed, safeguards are styled as impeding access, rather than doing what they're designed to do.
We see this tension in assisted suicide and euthanasia (ASE) for mental illness. Either we deny people with mental illnesses ASE and create a double standard, essentially claiming their suffering doesn't rise to the level of other forms of suffering that do warrant ASE, or we offer it and run into the dilemmas you describe. Our patients are caught in the throes of this dilemma.
Medical assistance for suicide is predicated on the idea that there are levels of pain that no human should be expected to endure, and offering suicide assistance for mental suffering supposedly acknowledges mental suffering as equal to physical pain.
In the US, treatment for physical pain has for years been increasingly difficult to access. Between 2011 and 2016, the amount of opioids prescribed in the US dropped 40%. Each year since, the FDA & DEA have ordered reductions in amounts of opioids legally manufactured for the US market. Opioids are not only effective and reliable, they are the only treatment for pain that is reliable and effective. Claims that prescribed opioids contributed to deaths attributed to opioids were supported with flawed data that counted deaths of users of illicit fentanyl as "prescription drug deaths" on the basis that there was such a thing as prescription fentanyl. Also, according NIH, the CDC's overestimates of opioid deaths of 20,000-30,000/year align with the amounts by which CDC was claiming that opioid deaths were increasing.
The US now has opioid-free emergency rooms, opioid-free surgery and even opioid-free pain clinics.
I think it is very important to take into account the war on physical pain care that has been underway in the US for years. The implications for caring for people sufering emotional and/or mental turmoil are truly frightening.
This article is spot on. Someone very close to me went through the MAiD process. Not only did I have to say goodbye too early, my family member refused to allow me to be physically present at her last moment.
I understand now that if she saw me she would not have gone through with it.
Let me repeat that
if she saw me she wouldn’t have gone through with it.
Now let that settle in.
"This is not just a philosophical shift but an existential collapse of the psychiatric profession." - is this in fact not an existential collapse of the western culture where individuation and responsibility are being replaced through social engineering with a collective identity and socially acceptable persona the very antithesis of individuation.
Eugenics, once a discussion point of a select few now has become far more pervasive and accepted rhetoric, without actual cognizance of its full and true import and consequence for humanity as a whole. Empathy as a term is bandied about quite casually, yet used out of context, by whichever party wishes to appear to promote psuedocare more.
The points you raise are highly relevant because once we venture onto these slippery slopes how long before your right to life and it's sanctity are removed altogether and the decision ensconced in a third party at their discretion for the greater good. As councilors to those in need, is it not, in fact, your duty to maintain objectivity and present all sides and options available to the client who, if in a state of distress and angst cannot see the full picture and thus assist clear and rational thinking when theirs is impaired. I would concur that your duty would not be to simply ratify or support either deluded personal thoughts or group/social pressures. However, each must make their own decisions, something I'm sorry to say, is becoming an seemingly unpopular norm in this modern culture of collective hive mentality.
I support your work and endeavour to spark debate and allow individuals to reassess their stance in a world being engineered to wipe out individual thought and being, if not humanity itself
I think you have a valid perspective, however this doesn’t really shake my support for the least intense version of MAiD (those with terminal illnesses). For example, this makes me think of my grandmother, her dementia had progressed, her breast cancer had spread, she was in agonizing pain unless she was kept on strong pain medications. Seeing her life, and how she was dragged along for too long has honestly filled me with fear. The idea that someone might do that to me, trap me in my body and let me rot in agony rather than allowing me to pass on my own terms genuinely gave me nightmares for weeks. I think there’s absolutely room for compassion, people shouldn’t be forced to suffer an agonizing death for the moral comfort of strangers, when instead they can choose their own time surrounded by friends and loved ones. I agree though that the idea of people with mental health disorders like depression doing this is categorically wrong and I think that isn’t a contradiction. I understand your philosophical point, but philosophy has to go hand in hand with the lived reality of someone. I would gladly support rolling back certain expansions, and codifying into law that it cannot be used for psychiatric disorders, but I don’t think we should throw the baby out with the bath water. There is a reason these provisions passed in the first place, and I think it was because of stories like my grandmothers. No one wants that for themselves or their loved ones.
I've seen what death with *true* dignity looks like. It's hit close to home for me. It's not MAiD. You're entitled to your own opinion, of course. That these provisions passed for a reason is self-evident. That doesn't mean that the reasoning behind it is sound.
IF we’re allowing maid for mental health, we need to be pulling out ALL the stops. Heroic psychedelic doses, for one.
I support it if you are terminal. I would like to think I’d shoot myself if I got terminal cancer, and if I get to be demented please for the love of God take me for one last walk in my beloved forest and leave me there for the local wildlife.
"For years, our role was to guard the flicker of hope, to widen the patient’s perspective beyond the walls their illness had built. If we begin telling some patients their suffering is too great to bear, what message does that send to the others who are still trying?"
Suffering has meaning. It is part of the human condition and we all touch upon it during our lives. We have purpose during times of trials and can exit the other side as a light for others. If this is short circuited by inserting suicide, then the light of hope disappears. I fear this will create a juggernaut of death that will pull far too many people into its grasp, including unwillingly.
I am not a trained mental health professional, but I am a Medical Aid in Dying (MAID) advocate in the United States. I also do not care for the term "death with dignity." I feel dignity is inherent to the person, however they die. I was a caregiver for both of my parents, and while neither died using MAID, both died with dignity, with their pain controlled and at home per their wishes.
As folks comment, it's essential to understand the distinctions between Medical Aid in Dying in the United States versus other countries that utilize euthanasia and have very liberal criteria. In the United States, a person must be a mentally capable, terminally ill (<6 mos life expectancy) adult. A multi-step eligibility process and other safeguards and protections exist for patients and healthcare providers.
Both United States national advocacy groups (Compassion and Choices and Death with Dignity National Center) oppose MAID for mental health conditions. If you are interested in hearing the perspective of U.S. psychiatrists on MAID for terminally ill people, I would suggest Dr. Timothy Quill or Dr. Ronald Pies.
It has been a privilege to talk with patients and families within the U.S. system who have been comforted by access to MAID. Many have faced years of surgery, chemo, radiation, immunotherapy, and clinical trials, and all they ask for is the peace and comfort of a planned death in the face of a disease that is killing them.
The role of a psychiatrist who participates in the MAID or similar program is similar to a military physician, which I was. In both instances, their perceived duty is no longer to help patients get well but to fulfill the mission, i.e. return the soldier to active duty ASAP or to fulfill the dictates of the state. As a physician, unless you are seriously character disordered, this situation likely results in your cognitive dissonance and moral injury. The fact that psychiatrists are willing to act as enforcers of a MAID program reflects our profession's loss of a core of transcendent Hippocratic and ethical values.
Correct. See my comment below. There is a reason that “do no harm” endured through the ages. We have moved too far from the ancient wisdom.
My biggest concern is the pre-teens who are committing suicide because of social bullying. I read recently of an eight-year-old who took her own life. It's heartbreaking.
I read an article about a woman in France who was depressed and decided on euthanasia. The day before it was to happen, she changed her mind. She was told "nope, too late" and they went ahead.
Psychiatrists need to help people understand that depression is anger turned inward. Once they deal with the anger, the depression subsides.
“Nope, too late”??? So… a death against her wishes, by an authority. An execution?
That’s what it seemed to me to be. I was horrified.
Thank you for spelling this out in this way. As soon as I heard about MAiD, it immediately felt so off in my body. I think there are major implications for humanity spiritually as well. I actually met a man a couple years ago who came up to me in a coffee shop when I was having a really hard day. He had noticed me from the restaurant over and said he could feel my pain. He took some poignant photos of me and wanted to share them. His visit turned my whole day around. During our conversation he shared with me that a few years back he had been going through a very dark time and had decided to end his life. He went to a busy street and as a truck was coming by he went to step in front of it, but just as he was going to he saw the drivers face. The terror in his eyes and in a split second he realized he could not do that to this man. He realized he would leave this man with unimaginable pain and stepped back. Now he showed up to me as an angel. As someone who has become acquainted with his sensitivity and has moved through the darkness. Our connection to others is often the very thing that can pull us out of our self-focused internal state of doom like you said.
Making it easy to die is incredibly dangerous on so many levels.
Wow. Wonderful insights. As I've learned in recent years, from people like Fr. Seraphim Rose, and Swiss philosopher Max Picard, the west's fundamental problems began in the 11th century between East and West. The Orthodoxy chose the church fathers and their creeds for their authority. The west chose rationality, reason, independent thought and pursuits. The west wound up with the so-called Enlightenment, Renaissance, Reformation, industrialization, and ultimately nihilism. That's where we are today, Hannah. A fully nihilistic, me me me culture, pragmatic to the point of replacing ourselves with chimerical creatures made of who knows what. We have outsourced to the extent of no longer having souls, no longer answering to God, our Creator. This will not end well. There is no possibility of reformating our lives and civilization, as the foundations are just plain gone. Thank you for this writing. If only people still read books, philosophy, literature. They won't, of course. Images lie, but they're titillating and always promise more of same.
I've had a problem with the "death" with dignity crowd for a long time, mostly because of the inherent contradictions in their policy proposals. There's nothing "private" about needing someone else's help to die, nor is there anything "dignified," as I understand the concept, about having to agitate for policy changes in order to make assisted suicide legal.
Very well said Hannah and what a difficult issue. Very good point that if you "give up" on a client and they later change their mind that impacts the continued therapeutic relationship....um yeah. The other thing I think about is karma. Some very wise folks tell us that if you suicide you are simply avoiding your own karma and it will chase you after death. Does assisted suicide doom those making that choice to a continued working out of their karma post death?
I’m a psychiatrist who trained 20 years ago. I can’t believe how far we have strayed from our oaths. Between murdering young people with autism and borderline personality disorder and performing sex changes on the exact same population of patients (coincidence?) we can hardly complain when people mistrust us.
The Oath is passe along with Belief in an Almighty GOD whose pronouns are I AM and I LOVE YOU.
Not to quibble but I believe Canada reported 5% of total deaths were due to MAiD, not 5% of its population. That’s a key distinction.
Thank you for directing my attention to this, quite right, that was a mistake. I have corrected it.
yes I was going to point to this.
It may be that their suffering is to great to bear. In that moment. That’s why there should be support to help them through.
If they break their leg, there is support of a cast and a crutch. Not an option of in this moment you are suffering, hop in the pod. No, the fact you don’t want to wait the time to heal is not a justification to use the pod.
Your motherhood does not in any way diminish your education. Nor should education invalidate motherhood. Same for fathers.
Diminishing the elderly for their age and current lack of productivity has always been a concern. But the have earned the right to enjoy their age. Why should they be coerced into anything else.
I realise there may be permanent injury of a significant degree, or rapidly degenerative that may give legitimate reason to using the pod, but great care should still be made.
I have particular concern for prisoners. Where states don’t make genuine effort to facilitate reintegration into community, and recidivism rates grow, people may become despondent to the point of wanting to use the pod to break the cycle. What if it is made available in prisons? No death penalty per se, but a death sentence all the same…. What do prison psychologists/0psychiatrists do?
This is a horrific situation I think. I believe mental health specialists should fight for life. When well the patient can give consideration on what to do in future.
"Once a society offers assisted suicide as a dignified option for some, the mere existence of that “choice” exerts pressure on others. It quietly redefines which lives are worth living and which are not. What begins as autonomy for one becomes coercion for another."
The philosopher David Velleman raised this concern in the early 1990s and no one has offered a rebuttal since: https://academic.oup.com/jmp/article-abstract/17/6/665/914272?redirectedFrom=fulltext
Once death as a medical intervention is let out of the box, its logic is inexorable: either death should be available to anyone at their request for any reason (maximizing autonomy) or death should be available even to those who cannot consent (maximizing relief of suffering). Any safeguards fall as people just beyond the boundary clamor for access. Indeed, safeguards are styled as impeding access, rather than doing what they're designed to do.
We see this tension in assisted suicide and euthanasia (ASE) for mental illness. Either we deny people with mental illnesses ASE and create a double standard, essentially claiming their suffering doesn't rise to the level of other forms of suffering that do warrant ASE, or we offer it and run into the dilemmas you describe. Our patients are caught in the throes of this dilemma.
Medical assistance for suicide is predicated on the idea that there are levels of pain that no human should be expected to endure, and offering suicide assistance for mental suffering supposedly acknowledges mental suffering as equal to physical pain.
In the US, treatment for physical pain has for years been increasingly difficult to access. Between 2011 and 2016, the amount of opioids prescribed in the US dropped 40%. Each year since, the FDA & DEA have ordered reductions in amounts of opioids legally manufactured for the US market. Opioids are not only effective and reliable, they are the only treatment for pain that is reliable and effective. Claims that prescribed opioids contributed to deaths attributed to opioids were supported with flawed data that counted deaths of users of illicit fentanyl as "prescription drug deaths" on the basis that there was such a thing as prescription fentanyl. Also, according NIH, the CDC's overestimates of opioid deaths of 20,000-30,000/year align with the amounts by which CDC was claiming that opioid deaths were increasing.
The US now has opioid-free emergency rooms, opioid-free surgery and even opioid-free pain clinics.
I think it is very important to take into account the war on physical pain care that has been underway in the US for years. The implications for caring for people sufering emotional and/or mental turmoil are truly frightening.