Bioethics Discussion Blog: Should The Mentally Ill Deserve Assisted Suicide?

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Sunday, June 24, 2007

Should The Mentally Ill Deserve Assisted Suicide?

Although physician assisted suicide is legal, with restrictions, in but one U.S. state, Oregon, it is practiced in other countries. One such country is Switzerland, which allowed assisted suicide since 1918 and not requiring physician involvement and not requiring the patient to be a resident. A recent decision by the Swiss Federal Supreme Court now permits assisted suicide, under guidelines, to be available to psychiatric patients and others with mental illnesses. The issue of whether the mentally ill should have suicide rights is discussed as an Essay in the May-June 2007 issue of the "Hastings Center Report" titled "A Suicide Right for the Mentally Ill?" by Jacob M. Appel. (The link will lead you to the full text article after a free sign-in.) Read the article and then return and write about the issue. ..Maurice.

19 Comments:

At Monday, June 25, 2007 8:14:00 PM, Blogger Maurice Bernstein, M.D. said...

For those visitors who would like to read a current news story from the hfxnews from Halifax N.S. (Canada) about a Canadian woman suffering but not terminal from multiple sclerosis who went to Switzerland to obtain physician-assisted suicide, go to this link. The woman was said to be suffering for years with "excruciating pain" and was wheel chair bound. The issue here as with the patients with severe mental illness is whether the patients are truely untreatable with any mode of therapy to either relieve pain or improve the mental illness. Could there still have been a physician's therapeutic approach other than provide relief by aiding the patient into an act of suicide? ..Maurice

 
At Wednesday, July 04, 2007 6:59:00 AM, Anonymous moof said...

Assisted suicide, for anyone, is a difficult subject. I sincerely believe that there's almost always a way to improve the quality of a person's life, whether they're suffering from physical pain - or from emotional or mental pain.

Assisted suicide seems to be a way of telling people that we just don't care enough to help them. What a sad, lonely way to die.

I feel that the energies applied to legalizing assisted suicide for any reason would be a lot more useful if they were instead applied toward helping these people deal with the difficulties that make them want to consider suicide to begin with.

 
At Wednesday, July 04, 2007 6:10:00 PM, Blogger Maurice Bernstein, M.D. said...

It seems that the topic of suicide and the mentally ill has recently been of interest in the bioethics literature. In the current June 2007 issue of the American Journal of Bioethics (AJOB), there is a target article followed by a bunch of open peer commentaries on the subject of whether there is a "moral duty" for the "soon-to-be demented" persons to commit suicide. The target article was written by Dennis R. Cooley who makes the follow proposition in the Abstract to the article:


It has been argued that, on Kantian grounds, pedophiles, rapists and murderers are morally obligated to take their own lives prior to committing a violent action that will end their moral agency. That is, to avoid destroying the agent's moral life by performing a morally suicidal action, the agent, while he still is a moral agent, should end his body's life. Although the cases of dementia and the morally reprehensible are vastly different, this Kantian interpretation might be useful in the debate on the permissibility of suicide for those facing dementia's effects. If moral agents have a duty to act as moral agents, then those who will lose their moral identity as moral agents have an obligation to themselves to end their physical lives prior to losing their dignity as persons.


To me, a non-philosopher, the argument offered and the support by Kant is rather obtuse but after reading the commentaries to this article it would appear that neither persons nor their physicians can really determine the point when the person can be classified as "soon-to-be" demented with Alzheimer's Disease. Also when does a person with a dementia fully lose their dignity as persons--that is become moral "non-persons". One recognizes Alzheimer patients with significant congnitive loss still appearing to enjoy life and those around them as persons. And what will the suicide accomplish except to follow a philosophical idea. Is this the way our society wants to cut down on the burden including the expense of caring for the disabled? Does any of this make sense? ..Maurice.

 
At Monday, February 02, 2009 9:02:00 AM, Blogger MSK said...

I am living with someone with Dementia (mother-in-law) and experiencing first hand the burdens it puts on the family and how it hurts everyone's quality of life. I don't want to wind up like this and importantly, I certainly don't want my children to bear the same burden and remember me this way.

It strikes me that we are kind to our pets when they reach a debilitated state yet we put humans thought an awful "experience" at end of life.

 
At Saturday, June 27, 2009 12:23:00 PM, Anonymous Anonymous said...

Mental illness can be just as terminal and painful as physical illness. Is there no room to debate the right to die of those who suffer such terminal in inexplicable ways?

 
At Saturday, September 19, 2009 3:04:00 PM, Anonymous Anonymous said...

Let us allow adults to decide the time of their death. Surely this is better than being tortured by psychiatrists. I buried a man who was destroyed by major tranquilizers and antidepressants. When one of your friends walks in front of a train that is not something to forget.

 
At Saturday, September 19, 2009 5:15:00 PM, Blogger Maurice Bernstein, M.D. said...

This says something about our current psychiatric management and value when it turns out that death is the most efficacious tranquilizer. ..Maurice.

 
At Wednesday, February 03, 2010 4:26:00 PM, Anonymous Anonymous said...

I am 26 years old and I wish that it is socially acceptable to deliver myself. There is a huge difference between feeling suicidal and feeling depressed. Feeling suicidal stems from unbearable life conditions and a very strong feeling of dread. It is a culmination of years of depression and unsolvable events that renders the person in pain and in suffering. When a person goes through a long period of learned helplessness and hopelessness, such as one realizing that one has no options, there isn't much the person or the medical community can do to alleviate the suffering. This is a terminal illness. A point of no return.

 
At Sunday, June 12, 2011 2:48:00 PM, Anonymous Marianne said...

I agree that for an adult suffering longterm mental illness it can be just as painful as a terminal illness,not only for them but for their families.Given the choice being in this situation myself i would definitely choose an assisted suicide.At present this is not possible although a few years ago it was with Dignitas.The only other rational option is to find an understanding compassionate person in Estonia willing to assist-not actually commit the act.If i could find such a person i would be so grateful.If such a genuine person is reading this please reply.Thank you

 
At Monday, November 14, 2011 12:27:00 AM, Blogger Christoph said...

I think anyone should be allowed to perform suicide at any time for any reason.

 
At Sunday, January 15, 2012 6:13:00 AM, Anonymous Anonymous said...

I've suffered from mental illness since I was nine. I have been diagnosed with bipolar, depression, ADD, GAD and addiction. The list of medications, ECT treatments, hospitalisations, medications, psychiatrists and therapists are numerous. I've attempted holistic approaches, all to no avail. I am now 40, and the battle continues. I can generally keep myself together for no longer than a month before an event triggers a lengthy phase of unmanageability. Do I blame the system? Is it my fault? No. Simply my brain does not function in a stable fashion. Soon I'll be on the streets. Once I was a film director (creativity was my gift but continuous mental breakdowns unfortunately prevented progress). Assisted suicide would be a safe and dignified manner in which to depart. The fear of my family receiving a call that their son was found with a bullet in his head keeps me alive, and so I remain in limbo. Often those who have never suffered treatment-resistant disorders assume that there is always a cure or solution, my experience is evidence that sadly the difficulties of life are not always fixable. Euthanasia for severe mental illness has the potential to relieve the burden to society and prevent further deterioration to the sufferer.
Adam

 
At Sunday, January 15, 2012 9:18:00 AM, Blogger Maurice Bernstein, M.D. said...

To those of us who are both healthy and caregivers to others find that suicide either non-assisted or assisted for those suffering patients may represent a failure on our part and that is why we reject that ultimate treatment.

By the way, since I started this thread, in the United States, the state of Washington has joined Oregon permitting legal assisted-suicide under specified regulations. ..Maurice.

 
At Wednesday, June 27, 2012 3:07:00 AM, Anonymous Anonymous said...

I take great exception to the use of he word "deserve" in this context. What exactly do you mean by "deserve"???

Maybe the non-mentally ill "deserve" a painful death for judging.
And from a medical professional, no less. No wonder there is no hope for humanity.

 
At Wednesday, June 27, 2012 7:59:00 AM, Blogger Maurice Bernstein, M.D. said...

Anonymous, "deserve" is used in the sense being "worthy" or "should be considered as worthy" to be offered assisted suicide as an alternate treatment or management of their condition. I was simply asking a question to my blog visitors and not making a statement of my own view as a physician. My view as stated in my last commentary goes along with the majority of physicians that assisted suicide by the medical profession is professionally wrong and should not be offered or carried out. ..Maurice.

 
At Saturday, May 11, 2013 12:03:00 PM, Blogger Tweet Tweet said...

Wow! I am 40 years old. I didn't even know I was "mentally ill" until I was in my early 30s. I was simply depressed ten years ago when I approached the Mental Health Community for help with depression without suicidal ANYTHING. Three years ago they diagnosed me with Borderline Personality Disorder (Mental Illness DX with the Highest Suicide Completion Rate 10%) after 5+ years of daily suicidal ideation, 9 hospitalizations, electro-convulsive therapy, countless medications/PHARMA-POISONS (Lithium, Seroquel and others that did not help me mentally but did cause great harm to my physical quality of life), and years of individual and group therapy.
I have a bachelors and a masters degree. For 3/4 of my life I fought the good fight. I tried so hard. I didn't choose to "give up," I exhausted myself and lost hope in the process. I have three teen-aged children who all refuse to speak to me because in the later part of the 14 years I was raising them on my own, I wanted to be dead and after a time I could no longer keep it to myself.
I never used drugs or alcohol though I was investigated by DHS for it and for child abuse when my middle daughter went to school on a Monday with a weekend injury to her face. I was investigated by DHS on 4 occasions during the 14 years I raised my children alone with never a finding because I was never guilty of an accusation.
So now, not only have I wanted to be dead for the greater part of the last 10 years, my children for whom I stayed alive, and tried so hard, will have nothing to do with me because I'm SUICIDAL. My own children BLAME ME (with the help of others) for wanting relief from the excruciating mental agony I experience on a daily basis. I wish for death but I'm paralyzed by fear to do anything about it myself. I fear pain, suffering, and failure which will only ensure further pain and humiliation. I cannot work. Since January of this year I have began getting $1,350.00 a month from a combination of Social Security Disability and VA Disability. Still it is not enough for me to live without the stress of figuring out how to pay my bills. Right now I am homeless. It's ironic. Even if I qualified for assisted suicide ANYWHERE... I could not afford to get it. I hope one day I will take the risk of doing it on my own and that I will be lucky enough to be successful. My aunt jumped off the Coronado Bay Bridge in the late 70s/early 80s and completed suicide after numerous previous attempts. I am not my Aunt Nancy but I feel I understand her better than anyone else in the family 30+ years after her death. I wish I had not tried so hard all my life. My ambition, belief in societies lies (you can accomplish anything you set your mind to [not so conveniently omitting ...as long as you're not mentally ill...], and goal oriented style is probably the reason my mental illness went undetected, and thereby untreated, most of my life. One thing I can promise anyone. NO PERSON OR ANIMAL DESERVES TO SUFFER ON A DAILY BASIS AS I DO.

 
At Wednesday, November 13, 2013 5:50:00 PM, Anonymous Anonymous said...

I suffer from bipolar II with mixed states, which has the highest suicide rate of any mental illness. For the suffering individual, suicide is just a matter of weather or not your suffering out weights your coping mechanisms. The sad part is that years of no relief, the coping mechanisms erode away. At that point it doesn't matter if suicide is dignified, honorable, or socially acceptable is beside the point. The ethics of suicide is for those who are not suicidal.
ananymous

 
At Thursday, November 14, 2013 10:43:00 AM, Blogger Maurice Bernstein, M.D. said...

Anonymous from yesterday: "The ethics of suicide is for those who are not suicidal." How true! In fact, this statement may be applied to other disabilities. ..Maurice.

 
At Tuesday, July 07, 2015 3:55:00 PM, Anonymous Matthew Cortez said...

I am a bipolar II male with three suicide attempts that were NOT for attention. My condition has effected the lives of my family, friends and employers. I have black outs with no memory of some events. This occurs when I am under tremendous stress. In manic states, my behavior is alarmingly erratic and has put me in a state of financial disaster. My down cycles last much longer than my manic.

I feel that I have become a burden to my partner who feels obligated not to "abandon" me yet I cause him much stress.

I'm highly functional but only in between episodes. I feel that I should have the right to end my life in peace legally. My suffering and hopelessness and desire to end my life leaves someone like me to my own devices. The methods I choose to continue this quest will only cause pain and shock to those who are left behind "blindsided" by my death it I succeed.

I feel it is inhumane that I sit and contemplate methods that are the least painful and gruesome. A bridge jump is my latest contemplation but I know this would be an awful death. Why should I have to suffer?

I have been a primary caregiver to my grandmother, father and mother. At the end, hospice issues you an "e-kit." Basically this kit contains everything to end your loved ones suffering. I never abused these "kits" while caring for my family members. I administered as instructed.

How unfair that we are not allowed to get our affairs in order, make peace with our loved ones and YES, finally choose to leave not as a body to be identified in God know what condition, but in a peaceful passing.

 
At Sunday, May 15, 2016 5:09:00 PM, Anonymous Anonymous said...

I have spent many years trying to understand others in order to know if what I feel is comparable.
I became fixated on suicide at the age of eight. I started to ask if mental illness could ever be so insufferable that one might consider it cruel to let one continue to go on.
My boundary is the guilt. If one fails at suicide, they can be put in a room as a prisoner for observation. They can be given pills and injections and become drug-addled hospital zombies. In places like these, one is dissuaded from contact with others.
Most often, a warm embrace would go miles in place of cold professionalism.
I have quit seeking help.
I have borderline personality disorder. I wasn't diagnosed until my thirties, and am raising two children.
I don't think any amount of money will ever solve the dilemma of provider+experience+rapport.
In hospital, I'm not allowed to have any part of my self.
Suicide is very personal. For some reason we are left contemplating how the easing of insurmountable pain will upset everyone else.
I feel compelled to teach my children. I don't think I would have have kids if I had known how very isolated I would end up. My family is rife with mental illness. It took me until now to realize what it was that kept them from acting like family.
Suicide closes all doors of possibility in life. For some, this is the answer to the question nobody can answer. The solution to the problem everyone insists is all in one's head.

 

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