The content on or accessible through Medpedia.com is for informational purposes only. Medpedia is not a substitute for professional advice or expert medical services from a qualified health professional.
Read more
Medpedia Answers
(Other)Medpedia Answers is a platform for asking and answering questions about health and medicine. Read more.
Should Suicide or Assisted Suicide be an Option for the Mentally Ill?
On June 14 2007, I put up a thread on my Bioethics Discussion Blog titled "Should the Mentally Ill Deserve Assisted-Suicide?"
http://bioethicsdiscussion.blogspot.com/2007/06/should-mentally-ill-deserve-assisted.html
To set a discussion of the answer (if there is one) to my Question, I would like to present two responses by visitors to my blog thread. Here is what each wrote and I look forward toward a response by those reading this Medpedia Question. ..Maurice.
Wednesday, February 03, 2010 4:26:00 PM, 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.
Sunday, June 12, 2011 2:48:00 PM, 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
http://bioethicsdiscussion.blogspot.com/2007/06/should-mentally-ill-deserve-assisted.html
To set a discussion of the answer (if there is one) to my Question, I would like to present two responses by visitors to my blog thread. Here is what each wrote and I look forward toward a response by those reading this Medpedia Question. ..Maurice.
Wednesday, February 03, 2010 4:26:00 PM, 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.
Sunday, June 12, 2011 2:48:00 PM, 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
asked Jun 12 at 04:17PM in Other
-
1Votes
answered Jun 13 at 11:53AMMaurice,
The answer is definitely "No." Suicide and Assisted Suicide should never be an option for the mentally ill.
We all go through bouts of mood changes throughout our lives. Sometimes we all become extremely "down" (depressed) and hopeless; then with one lucky break / gesture we are happy again.
Decisions about life / death may change in which mood and the environment the person is in when making that decision. A Bipolar Disorder person may make multiple decisions about that option in a certain period of time.
Not having enough sleep, feeling of tiredness, delusions and hallucinations may affect the person's perspective on life.
Also realize that caregivers / relatives / services / agencies may be able to manipulate the decision to their benefit. There would have to be a lot of safe guards in place in the law for the protection of the mentally ill.
Once you are alive, there is always hope! -
0Votesanswered Jun 13 at 01:25PMWhat about progressive Alzheimer's disease where the patient knows what the downward course is going to be and knows that there is no cure or substantial treatment to prevent the progression?
Doesn't the mental pain of that aware Alzheimer patient meet the physical pain of a progressive and terminal cancer patient where in Oregon and Washington state assisted-suicide is permitted? ..Maurice. -
0Votesanswered Jun 13 at 04:45PMMaurice,
How do you grade mental/emotional pain? What about spiritual pain? When you start to add mental/emotional pain or spiritual pain as a criterion, you start getting into a grey area.
I believe it is best to stick with physical pain as a criterion.
There are some medical practitioners/care givers who believe that alzheimer patients can enjoy or be helped in enjoying their lives, if certain activities and care are given. -
0Votesanswered Jun 13 at 09:46PM"How do you grade mental/emotional pain?" I suppose I can give you the "tongue in cheek" answer: the same way that physical pain is "quantitated" "0 to 10" by the patient. No observer can make the grading of what the patient actually is experiencing. To be frank, to make criteria based on whatever kind of pain one is evaluating is a "grey area". While others determining the level of any pain is one grey area, certainly understanding the degree of suffering from such pain being experienced by the patient is another. Only the patient knows the extent of the pain and suffering. Thus, how the observer can estimate the pain and suffering of a patient or how to determine that a request for suicide by the patient is rational or irrational for this patient is all guess-work in the mind of the beholder. What I am getting at is that, in the end, we just have to listen to the patient. ..Maurice.
-
0Votes
answered Jun 24 at 11:47AMThere is a dilemma between an individual's perception of pain and suffering, choice in whether to bear it or not as the one living with it in one's own body and mind, and the state or society's perception of what is an ethical and just society with some restrictions on free will of such individuals. For me, no answer is right or wrong, but because states have historically used "assisted suicide" or "euthanasia" for malevolent purposes, condoning it in a "just" society is viewed as unimaginable. The sad reality is that many individuals with mental illnesses, and in pain as real as end stage cancer (or both), do take their lives as the suffering is unbearable. Whether or not the state facilitates that is a question of degree or complete denial. States/countries have to think about the benefit to all society of any one individual choice, be it suicide or crime, for example, whereas individuals often only think of his/her own dilemma. That is the problem. -
0Votesanswered Jun 24 at 06:01PMKim, but what would be a rational basis (rationale) for a state or country to set a bar against any patient who has decisional capacity to end their own life without physical harm to others? Would it be that any person who would make such a decision or attempt to carry out such an action is, without further analysis, considered lacking such decisional capacity? What would be a basis for such a judgment? Would it be, even in the absence of any investigation, that the premature loss of even one citizen represents a loss of value to society despite whether or not that person can or is able to contribute to the enrichment of society. Or are such laws purely religious and based on the same "pro-life" rationales as those against abortion? ..Maurice.
-
0Votes
answered Jul 27 at 08:59AMDr. Bernstein has again posed an excellent, yet complex- possibly inscrutable, question.
First- suicide is indisputably an option for all people regardless of physical or mental condition. The mere occurrence of death by an individual's own hand is sufficient proof. Suicide as a recommended therapeutic option is an entirely different question. The fact that suicide is literally always an option for every clinical situation (health care's "nuclear" or last resort option?) may contribute to it's apparent lack of formal discussion in most therapeutic situations.
Assisted suicide is another issue altogether. Dr. Bernstein has a well-thought out analysis above. This largely reduces to two issues: first is assisted suicide permitted for the patient under consideration under applicable laws in the jurisdiction? Second, does the patient have the requisite decisional capacity? If both conditions are met then mentally ill patients are essentially indistinguishable from other patients. The mentally ill may evoke different paternalistic feelings but these fail as meaningful guidance under a strictly rational review.
Pellegrino has many times noted that the patient is the final authority on the value of any therapy to that patient. This was famously demonstrated by Elizabeth Bouvia who essentially redefined "improved" health as dead when she sought assisted suicide. Whether a physician is willing to provide assistance or guidance regarding suicide depends on the physician's individual moral compass tempered by extant statutory, regulatory, and organizational restraints or compulsions. Yet the value of life over death for an objectively competent individual (an adult with defined decisional capacity) is virtually indisputably within the sole purview of the individual.
Bottom line- What Dr. Bernstein said.
Sign-in
to post an answer to this question.
Related Questions
in
Other
- Will you feel actual pain in your breast or breasts if you have cancer?
- As a patient, how to you feel about the physician’s use of intuition, as you define it, and whether you think it is something that doctors should use?
- Can Occipital Neuralgia cause a feeling of vertigo?
- Are physicians to serve as "moral gatekeepers"?
- What should be the ethical or legal intent to turn off or remove a cardiac pacemaker device?
- What could cause a feeling like an insect crawling on the leg?
- What are the ethical implications of egg donation?
- Would someone explain how guanfacine affects norepinephrine production differently than atomoxetine?
- Do health advocacy groups deserve scrutiny?
- Congenital Heart Defects not found until adulthood
- »» See All
The content on or accessible through Medpedia.com is for informational purposes only. Medpedia is not a substitute for professional advice or expert medical services from a qualified health professional.
Read more