Monday, October 27, 2008

Dying of hopelessness

Leonard Stern, the Ottawa Citizen's editorial pages editor has written a thought provoking article on the connection of depression to the request for euthanasia or assisted suicide.

Stern begins his article by referring to the fact that the State of Oregon legalized assisted suicide several years ago.

He then states:
For many people, the merits of assisted suicide are self-evident. Who doesn't believe in personal autonomy and the end of suffering? The case for assisted suicide seems all the stronger because those who oppose it tend to invoke religious arguments. Church teachings about the sanctity of life don't resonate very well in public policy debates.

There is, however, a non-religious case to be made against assisted suicide, and it gets stronger the closer one looks at the Oregon experiment, as a team of Oregon psychiatrists recently did. Beginning in 2006, the psychiatrists started interviewing patients who wanted to make use of the assisted suicide legislation. They discovered that one in four patients had undiagnosed clinical depression.

Stern then explains how assisted suicide creates an inequality for people with disabilities. He states:
In most places, people who express a desire to die are evaluated for depression, and receive treatment for it. In places where assisted suicide is practised, such patients might instead receive a fatal dose of barbiturates. The researchers discovered that in 2007, not one "of the people who died by lethal ingestion in Oregon had been evaluated by a psychiatrist or a psychologist."

This secular case against assisted suicide is that assisted suicide discriminates against the sick and disabled. If an able-bodied woman tells her family that she's suicidal, they will surely intervene with psychiatric help. But if a wheelchair-bound woman with Lou Gehrig's disease tells her family the same thing, they might assume, based on social prejudices about disabilities, that the request was a sensible one.

Stern then introduces the case of Daniel James:
Medical ethicists are currently agonizing over the case of Daniel James, a British man who last month killed himself at a Swiss clinic that offers assisted suicide. The case is unsettling for two reasons. First, Mr. James was not suffering a terminal disease. Second, he was 23. The popular image of people who avail themselves of assisted suicide is of very ill senior citizens at the end of life. That was not Mr. James.

Daniel James was a gregarious, burly athlete who last year suffered a terrible injury during a rugby game and was paralyzed from the chest down. Although he could breathe without a ventilator, he couldn't move his limbs. After the accident he tried to kill himself several times but, owing to his disability, was unable to do so. Finally, his parents took him to the clinic in Switzerland. They were with him in the room when the overdose was administered.

By all accounts, Daniel's parents are decent people who were motivated by love. In a statement, his mother talked about how her son had finally been freed from the "prison" he felt his body had become. "What right does any human being have to tell any other that they have to live such a life, filled with terror, discomfort and indignity?" she wrote.

This is heartwrenching. And yet we have to wonder: Daniel said he wanted to die, this is true, but was he instead crying for help, as is the case with so many people -- able-bodied or not -- whose anguish is so great that life seems pointless?

With his injury, Daniel suffered an unspeakable loss -- the loss of the man he once was, and the loss of the man he had planned to be. Because it happened only a year ago, Daniel would still have been in the most intense throes of shock, fear and disorientation that accompany catastrophic misfortune.

Stern then questions whether James was actually depressed:
I'm no expert on the psychology of bereavement, but I suspect that most anyone who suffers a loss of this enormity -- be it the loss of physical independence, the loss of a child, indeed the loss of your future as you envisioned it -- would in the aftermath question the value of living. But experience shows that with time and support, people -- at least some people -- find a way to endure and rebuild.

In her public statement, Daniel's mother acknowledged that "not everyone in Dan's situation would find it as unbearable as Dan." Why is it that Daniel found his situation hopeless and another person with a similar disability might not? One reason might be that Daniel was suffering from profound depression, as would be expected so soon after the accident.

There is a cultural assumption that severe disability is worse than death, and so to Daniel's parents it was completely normal that their 23-year-old son wanted to die. Perhaps they were right. Maybe for Daniel, disability really would have been worse than death. But he should have been given a chance to discover otherwise.

Link to the Ottawa Citizen article:
http://www.canada.com/ottawacitizen/columnists/story.html?id=98cd7c37-2daf-462a-9698-01a775b4a10b

Link to my blog comment on the Ganzini study on depression and assisted suicide in Oregon:
http://alexschadenberg.blogspot.com/2008/10/depression-and-physician-assisted.html

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