Friday, May 22, 2020

Do you have a story about euthanasia or assisted suicide?

We need stories to effectively oppose euthanasia and assisted suicide and convince politicians that legalizing or expanding MAiD legislation is bad public policy.

The Euthanasia Prevention Coalition is seeking stories that can be shared with others and decision makers.

The story of Alan Nichols is important when speaking about how our current law is not protecting depressed people or why we should not extend MAiD to people with Mental illness.

Alan Nichols (62) was not sick or dying yet he died by euthanasia on July 26 at Chilliwack General Hospital in BC. His family is shocked that he was approved for and died by euthanasia. They were powerless to stop it.

Alan struggled with chronic depression. He often isolated himself, refusing to take medication or see a doctor. He needed support and encouragement during difficult times, not euthanasia.

Alan's story has been seen Canada-wide through CTV News coverage and social media (Link to Alan's story). His story is helping Canadians understand the consequences of legalized euthanasia.

Was Alan pressured or influenced to choose euthanasia?
Was Alan of sound mind to provide informed consent?
Was Alan offered any caring supports?

What could have been done to protect him?

Do you have a story to tell?

Canada's euthanasia law has opened the door wider to the abuse of people living with vulnerable conditions. The Euthanasia Prevention Coalition is sharing real life stories to show what is happening.

Your voice has the power to influence people, inspire action and affect decisions.

Sharing your experience can help you find closure and justice and honour the memory of a loved one lost to assisted death.

We believe in caring not killing.

If you have a story, email or call EPC at: 1-877-439-3348. 

We will not publicize your story without consent.

EPC is distributing the flyer at the top for $30 for 100 flyers or $50 for 200 flyers (tax and shipping included).

No free choice: Remember four suicides.

This article was published by Toujours Vivant - Not Dead Yet on May 22, 2020.

By Amy Hasbrouck

In the year before euthanasia came into effect in Québec, between April, 2014 and March of 2015, four Québecers with disabilities ended their lives because they didn’t have the supports they needed to remain independent. Despite efforts by advocates, conditions in the province have worsened since then.
  • In April of 2014, Mario Beaudoin and his wife were found dead in their home following what was believed to be a suicide pact. Mr. Beaudoin had been injured in a car accident 16 months earlier, and had been unable to get home modifications, medical equipment and personal assistance services they needed. 
  • In September, three months after Québec’s National Assembly adopted the province’s euthanasia law, Yvan Tremblay killed himself because he was being forced to move out of his apartment due to new security regulations imposed by the government. Management claimed that it would be impossible to evacuate Mr. Tremblay in case of fire, so he would have to move to a smaller apartment without a kitchen. 
  • Two days later, on September 16, Pierre Mayence died of starvation at the nursing home where he lived, after a court ruled that the staff could not force-feed him. 
  • Finally, in March of 2015, Gabriel Bouchard died, also of starvation, because he could not get the supports he needed to remain in his own apartment. (You can watch our Interview with him on our website.)
What has changed since 2015?

In Québec, from December of 2015 to April of 2019, 2,909 people were euthanized, and 2,947 people received continuous palliative sedation, for a total death toll of 5,856.

Neither Québec nor the Federal government has released reports from the monitoring system for medical aid in dying (MAiD). However in introducing bill C-7, the Department of Justice mentioned that more than 13,000 euthanasia had been performed since June of 2016.

As of May 20, 3,718 people had died of COVID-19 in Québec, most of whom were residents of long-term care institutions. Deaths by COVID-19 in Canada totalled 6,030.

What hasn’t changed in the last five years?

  • Public policy still favours warehousing disabled people in institutions, rather than giving them the choice to control their lives by employing their own personal support workers. 
  • The public, including progressives, continue to believe in the myth that assisted suicide and euthanasia (AS & E) is a free choice. 
  • Disability groups remain timid about opposing AS & E.
While we’ve focused on events in Québec, the same problems apply in the rest of Canada. People talk about the health care workers who are the “front-line heroes” of the COVID-19 pandemic, and that’s absolutely true; many are going above and beyond the call of duty. But most of these workers get to leave the heartache behind when they go home at the end of the day. Disabled activists don’t stop being disabled when their shift is over, just as single parents, women, people of colour and poor people can’t leave behind the discrimination that affects their lives.  

For more information on the subjects we discuss:

Thursday, May 21, 2020

Queensland Australia euthanasia bill is deferred until after the October election

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Queensland Australia Parliament
ABC News Australia, state political reporter, Josh Bavas, is reporting that the Queensland Australia euthanasia bill will be deferred until after the October 31, 2020 election. Bavas reported:

...Premier Annastacia Palaszczuk told parliament this morning the legislation would instead be referred to the Queensland Law Reform Commission for consideration, with an expectation it would respond after the October state election. 
Ms Palaszczuk said a response would be expected by March next year. 
"Voluntary assisted dying is very complex and it is a deeply personal issue in which competing interests and views of Queenslanders and experts have to be carefully balanced and the lives of our elderly and the most vulnerable people protected," she said. 
"The provision of compassionate, high quality and accessible palliative care for persons at their end of life is a fundamental right for the Queensland community and it is critical that we get this right.
The Health, Communities, Disability Services and Domestic and Family Violence Prevention Committee of the Queensland parliament has, in a report tabled on 31 March 2020, supported the legalization of euthanasia.

We hope that the October 31 election will change the position of the Queensland Australia parliament. 

Wednesday, May 20, 2020

Medscape UK report: More UK doctors oppose than support assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Medscape UK 2020 ethics report found that more UK doctors oppose assisted suicide than support assisted suicide. The Medscape report was based on online responses from 1355 UK physician.

The Medscape question asked:
Should physician-assisted suicide or 'physician-assisted dying' be made legal for the terminally ill - or for those who say they have irredeemable suffering, even if the disease may not be terminal for many years?
42% said No, 37% said Yes and 22% said it was a grey area. It is notable that 55% of the GP's said No.

Dr Gordon Macdonald
Dr Gordon Macdonald, Chief Executive of Care Not Killing commented, in March 2020 on the Royal College of General Practitioners decision to uphold their opposition to assisted suicide by stating:

'The current laws on assisted suicide and euthanasia exist to protect those who are sick, elderly, depressed or disabled from feeling obliged to end their lives. It protects those who have no voice against exploitation and coercion. 
'We are pleased that the Royal College of General Practitioners recognise this and the dog whistle message that singling out the terminally ill and disabled people would send. As Paralympian Tanni Grey-Thompson has said, "Legalising assisted suicide will only serve to reinforce deep seated prejudices that the lives of sick and disabled people aren't worth as much as other people's."
Dr Macdonald continued:
'Just look at what is happening in Canada, which introduced assisted suicide and euthanasia in 2016. Since then around 13,000 people have been killed. Then in September, the Quebec Superior Court struck down the requirement that a person be terminally ill before they qualify for euthanasia in Canada, allowing those with chronic conditions and mental health problems to have their lives ended. 
'But even before this court ruling there had been problems. In July a depressed, but otherwise healthy 61-year-old man, was euthanised in the province of British Columbia. Alan Nichols, a former school caretaker who lived alone was admitted to Chilliwack General Hospital, BC. Despite not being terminally ill, he received a lethal injection. Alan's case is not isolated. 
'The problems in Canada are not unique. This summer, a major US report from the National Council on Disability, found the laws in the handful of States that had gone down this route, were ineffective and oversight of abuse and mistakes was absent. 
'This is an important report as those championing assisted suicide in this country, put forward a model based on Oregon and Washington - Yet in both States a majority of those ending their lives cite fear of becoming a burden a reason. 
'The current laws that prevent assisted suicide and euthanasia do not need changing.'
Euthanasia and assisted suicide laws give doctors, the right in law, to cause the death of their patients. 

Canada's experience with legalized assisted dying is the prime example of how these laws will expand over-time.

Monday, May 18, 2020

Anonymous comments will not be published on this blog.

There have been many excellent comments posted to this blog that as a moderator I did not publish. My policy is that I do not publish Anonymous comments.

I will also not publish comments that attack others.

I will publish comments from people when they provide their name with their comment.

You must provide your name with your comment.

Alex Schadenberg

Friday, May 15, 2020

Jacques Campeau did not get the care that he needed.

This article was published by Toujours Vivant - Not Dead Yet on May 15, 2020, with an article on pandemic policies. (Link)

No Free Choice: Jacques Campeau
By Amy Hasbrouck

In July of 2019 several Québec media outlets reported on the suicide death of Jacques Campeau, who had Multiple Sclerosis. The stories focused on his family’s anger over the fact that he was denied euthanasia several times because he was not at the “end of life;” the family brought his death to the attention of the media in order to put pressure on politicians and the courts to loosen this eligibility criteria. But details from the articles show that Mr. Campeau really needed help to live, not to die.

According to his daughters, Mr. Campeau was “increasingly despondent and withdrawn” and his wife said he had talked about suicide for a year. “I would come home every evening afraid he had done it.” Depression is a well-known problem associated with MS, both as a reaction to flare-ups, and as part of the disease itself. It can be made worse by pain and fatigue that often come with MS. If Mr. Campeau was not being treated for depression, he was not getting the care he needed.

The articles not only showed that Mr. Campeau had low self-esteem, but also reinforced those beliefs about people living with MS and other chronic diseases. According to the Journal de Montréal, he told his family that he was nothing more than a digestive tract. The reporter described his «suffering» by saying he used a wheelchair and incontinence products, and “hadn’t seen the light of day since November.” His daughter said he had “no quality of life,” and that he was a “prisoner of his body.” Rather than asking if Mr. Campeau had received peer support or “dignity therapy” to deal with his existential distress, the journalists repeated negative stereotypes of life with a disability as a fate worse than death.

Media reports suggested Mr. Campeau was losing autonomy, but there was no mention of in-home assistance. His daughter told of receiving a call at work “telling her [Mr. Campeau] had fallen at home and had been lying on the floor for two hours, waiting to call when he knew she was on break.”

Mr. Campeau’s family expressed disappointment over not getting a chance to say good-bye. “We would have preferred to have a last moment with him ... to have a dinner with him, tell him that we love him. We would have liked to talk to him before he did this." They believe a planned death would have met their need for closure.

The only other sources cited by the journalists were spokespeople for “Dying with Dignity” and a pro-euthanasia doctor. The reporters included a link to the family’s petition to change the “end-of-life” eligibility criterion. The articles did not quote people living with MS or experts in palliative care or suicide prevention. The Journal de Montréal included information on how to obtain MAiD and the suicide prevention telephone number.

The tragedy here is not that Mr. Campeau didn’t die by euthanasia, or even that he committed suicide. The tragedy is that those who surrounded him seemed to think that MS, a chronic illness that includes flare-up and remission, was a terminal illness, and that his life was not worth living because of his disability. The tragedy lies in the fact that he did not have the services and supports he needed to adapt to his changing condition, feel good about himself, maintain his independence, and get peer counseling and suicide prevention services that could have improved the quality of his life, and ultimately saved it.

Amy Hasbrouck is the President of the Euthanasia Prevention Coalition and the founder of Toujours Vivant - Not Dead Yet (TVNDY) a non-religious organization by and for disabled people.

Thursday, May 14, 2020

Suicide confusion: Suicide, assisted suicide and Covid-19.

This article was published by National Review online on May 12, 2020.

Wesley Smith
By Wesley J Smith

New Jersey recently became one of the seven states (plus the District of Columbia) to legalize assisted suicide by statute. In effect, New Jersey sanctions suicide for some residents through its public policy.

Now, with COVID-19, New Jersey officials are worried about a spike in suicide caused by the shutdown, so for them, suicide is bad. From the NJ.Com story:

On top of the more than 78,000 Americans who have already died from the fast-spreading virus, a new study from the Well Being Trust found conditions from the pandemic — including lost jobs, isolation, and fear over the future — could lead to 75,000 deaths in the nation from drug or alcohol abuse and suicide over the next decade.

This comes as a number of critics say they’re worried lockdowns designed to save lives from COVID-19 could have an even greater toll due to economic and mental despair.

[NJ Gov.] Murphy was asked Saturday during his daily coronavirus briefing in Trenton if the state will track suicides and consider this when determining how to reopen the state. “I don’t know specifics in terms of tracking suicides, but we have said this: The combination of isolation and now other factors like job losses are having big impacts on folks, there’s no question about it,” the governor said.
So, let me get this straight. If someone is in despair because they lost everything when their business collapsed or had a loved one die from COVID-19, they shouldn’t be able to commit facilitated suicide.

But if they are in despair because they have been diagnosed as terminally ill with COVID-19, they should not only be able to self-terminate, but also, have their suicide facilitated by a doctor under a law signed by Governor Murphy.

No! That’s nonsensical. Governor Murphy should be concerned about preventing all suicides, not just some.

Suicidal ideation is suicidal ideation — regardless of the reason for wanting to die. Everyone who becomes suicidal because of a COVID-19 impact — or for any other reason — should receive prevention services. Everyone. It is illogical and destructive to the value of human life for New Jersey (and other pro–assisted suicide states) to have such a lethally dichotomous public policy.

T-4 euthanasia program began killing people with disabilities 80 years ago.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Nazi doctors at Nurembourg trial.
Many people are unaware that the Nazi T-4 euthanasia program created the method of mass killing that was then implemented in the holocaust killing camps.

I have published excellent articles about the Nazi T-4 euthanasia program but this new article by Matt Lebovic, published last week by The Times of Israel is an excellent historical account of how the T-4 euthanasia program led to the mass killing of Jewish people, and others. Lebovic writes:

Eighty years ago this week, the most lethal “T4” euthanasia center began implementing “merciful deaths” for physically and mentally disabled Germans.

Hartheim Castle was not far from Austria’s Linz, where Adolf Hitler grew up. With Renaissance roots, the sprawling castle’s colonnaded courtyard was used by the Nazis for one of Hartheim’s two crematoria.

The plan for so-called “useless eaters” to be killed came from Nazi theories of eugenics, “racial hygiene,” and social Darwinism. By the end of the war, an estimated 230,000 people with physical or mental disabilities were murdered in “T4” and its successor program, sometimes called “wild euthanasia.”
Tiergartenstrasse 4
Lebovic explains how the euthanasia program worked:

Hitler’s 1939 decree had specified doctors should determine who receives “merciful deaths,” so the “T4” operation had to be given a medical appearance. Not only did doctors determine who died, but they usually operated the carbon monoxide gas tap at killings.

Within days of Hitler’s “merciful death” order, a euthanasia apparatus was set up to eliminate thousands of asylum patients across Germany. Operations staff were housed in Berlin at Tiergartenstrasse 4 — hence the nickname “T4” — in a house confiscated from a Jewish family.
Nazi euthanasia victims
Similar to today, the government wants euthanasia to be seen as a medical act that is determined by doctors.

Inside headquarters, committees reviewed patient information cards for people suffering conditions such as schizophrenia, epilepsy, dementia, or other chronic disorders. Also examined were cards for the criminally insane and people who had been confined to an institution for more than five years.

By virtue of how many hours a patient was capable of working each week, as well as by how many visitors he or she received, the committee determined life or death.
Bus used for euthanasia victims
The T-4 program started by killing children with disabilities, but quickly expanded.

In the early months of “T4,” most of the victims were children. Some were handed over voluntarily by ashamed parents, such as when a new father wrote to Hitler asking for permission to kill his “deformed” infant. According to historians, that letter prompted Hitler to issue the order for “T4.”

The “Charitable Patient Transport Company” was set up to transfer victims from their asylums to six new killing centers, including Hartheim. The armed nurses had plenty of drugs on hand to calm down agitated patients in the dark grey buses with opaque windows.
Bishop von Galen
Protests by religious leaders and groups led to the "cancellation" of the euthanasia program.

Within months of “T4” starting, some Germans — including Nazi party members — sent protest letters to the Reich Chancellery and Minister of Justice. In February 1941, Franconia was the scene of Catholics protesting the emptying of an asylum. Even some Protestant clerics — a group usually in line with Nazi policy — expressed dismay about the slaughter of disabled Germans.

In addition to public awareness of the euthanasia program, a tipping point was reached when an outspoken Catholic bishop escalated his rhetorical attacks on the regime. 
The influential Clemens August Graf von Galen, the bishop of Munster, became known as the “Lion of Munster” for his homily denouncing the euthanasia program on August 3, 1941.

As the bishop told congregants, Germans were being murdered “because in the judgement of some official body, on the decision of some committee, they have become ‘unworthy to live,’ because they are classed as ‘unproductive members of the national community.’”

The commandment not to kill, said von Galen, could not be erased by National Socialism, as it was written “on the souls of men.” He also asked if injured German soldiers would be subject to euthanasia upon returning from the front.

Von Galen’s sermon was reproduced and made its way around Germany. According to historian Anton Gill, the bishop “used his condemnation of this appalling policy to draw wider conclusions about the nature of the Nazi state.”
Article on the book: The Lion of Munster: The Bishop who roared against the Nazi's (Link).

In reality, the protests slowed down and changed the euthanasia program. Lebovic writes:
In retrospect, we know the regime was preparing a much larger murder apparatus while “T4” was being pushed underground. From Hartheim, at least 27 staff people were sent to occupied Poland to build the death camps of “Operation Reinhardt,” including SS men whose names are synonymous with those camps.

At Chelmno, Treblinka, and Sobibor, the “T4” methods of killing were revived for the “disinfection” of Jews. The Holocaust transitioned from mass shootings in occupied Soviet lands to the death camps, where fewer Germans were needed to murder millions of Jews.
The T-4 euthanasia program was medicalized, requiring doctors to do it. Today, the euthanasia programs falsely claim to be based on choice and autonomy, whereas in reality, the approval to kill and the act of killing is done by doctors and nurse practitioners, with the approval of the government.

Here is a list of other excellent articles concerning the T-4 euthanasia program.

Wednesday, May 13, 2020

New York policy may have led to the deaths of thousands of nursing home residents.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

On April 14 I published the article: Covid-19, Triage guidelines and nursing home deaths. In this article I argued that some Covid-19 nursing home deaths were related to Triage guidelines and protocols preventing the transfer of Covid-19 patients to hospitals to receive treatment.

The article recognized that many nursing home residents with Covid-19 were likely going to die based on pre-existing health conditions, nonetheless, some of the deaths were related to guidelines and protocols to not provide treatment. I stated that these guidelines and protocols were a form of discrimination, ageism and elder abuse.

New York State is one of the most devastated regions for Covid-19. As of May 13, the New York state has reported more than 338,000 Covid-19 cases and almost 22,000 deaths.

Governor Andrew Cuomo
Further to the devastation experienced by New York state is the number of Covid -19 nursing home deaths.

Governor Cuomo has just rescinded a policy forcing nursing homes to accept residents who were Covid-19 positive without providing the resources and protective equipment needed to care for these people.

Clearly, a policy forcing nursing homes to accept residents who are infected with a deadly virus that spreads to others is a policy that would cause many deaths.

It is disappointing that a NBC news May 10 report seems to champion Governor Cuomo's decision to reverse the policy forcing nursing homes to accept Covid-19 positive residents rather than recognizing that the policy reversal was long-overdue.

NBC news report by Cynthia McFadden comparing the Connecticut policy to the New York policy does indicate that New York's policy had lethal consequences.

Governor Ned Lamont
Connecticut Governor Lamont established a policy of sending Covid-19 positive residents into special facilities to prevent the spread of the virus. Lamont stated to McFadden that:

"Nursing homes are like a petri dish for this pandemic," added Lamont, who pushed the plan for facilities restricted to coronavirus patients only.
The same NBC news report points out that:
Gov. Andrew Cuomo has drawn criticism for his response to outbreaks in nursing homes, including a mandate that required the facilities to take back coronavirus patients being discharged from hospitals. 
...Cuomo has also faced scrutiny for saying it's "not our responsibility" to provide protective equipment like masks and gowns to privately owned nursing homes, although the state has now done so.
A May 9 Associated Press report criticized Cuomo's policy and the number of Covid-19 deaths in New York's nursing homes. The article quoted Elaine Mazzotta, a nurse whose mother died last month of suspected COVID-19 at a Long Island nursing home:
“The way this has been handled by the state is totally irresponsible, negligent and stupid,” 
“They knew better. They shouldn’t have sent these people into nursing homes."
The Associated Press article pointed out that:
Of the nation’s more than 26,000 coronavirus deaths in nursing homes and long-term care facilities, a fifth of them — about 5,300 — are in New York, according to a count by The Associated Press, and the toll has been increasing by an average of 20 to 25 deaths a day for the past few weeks.
Whether Cuomo's policy was an oversight, stupid or criminal, Connecticut's Governor Lamont got it right when he said:
"I think, especially in a crisis, the buck stops right here,"
Cuomo's negligent policy has likely resulted in the deaths of thousands of nursing home residents. His policy was not only a form of discrimination, ageism or elder abuse, but rather it was criminal.

Tuesday, May 12, 2020

Conceiving the inconceivable: assisted suicide for people with mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Thank you to Dr Mark Komrad for sharing this superb paper by Bernardo Carpiniello published in the Journal of the Italian Society of Psychiatry. Carpiniello works in the Department of Medical Sciences and Public Health-Unit of Psychiatry, University of Cagliari Italy.

Carpiniello's paper - Conceiving the unconceivable: ethical and clinical concerns over assisted suicide for people with mental disorders is a significant paper dealing with the concerns related to euthanasia for psychiatric reasons. 

Carpiniello recognizes that only a few jurisdictions in the world have legalized euthanasia and assisted suicide and in these jurisdictions only a small number of these deaths done to people with mental illness. 

Carpiniello points out that only 34% of Dutch physicians will participate in euthanasia for mental disorders.

Polling data indicates that there is more opposition by Dutch psychiatrists to psychiatric euthanasia with 53% of psychiatrists opposed to euthanasia for mental illness in 1995 and 63% in 2015. He suggests that the drop in support for psychiatric euthanasia is related to moral distress. He states:

Euthanasia or assisted suicide represents a typical example of a situation in which psychiatrists are faced with the impossibility of having to reconcile two moral obligations, a duty of care and respect of patient autonomy. To put it bluntly, for many psychiatrists euthanasia is ethically unacceptable, particularly as the main aim of psychiatry is to limit patients’ suffering.
Carpiniello then points out the position of the American Psychiatric Association.
“the American Psychiatric Association, in concert with the American Medical Association’s position on Medical Euthanasia, holds that a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death”
Carpiniello expresses his concern for the growth of euthanasia in countries where it is legal.
Euthanasia has been reported as a typical example of the “slippery slope, down which we have rolled to now allow something that was impossible to conceive as ever being acceptable”
Based on the increase in the number of euthanasia deaths and the expansion of acceptable reasons for euthanasia, I agree that incremental extensions will occur, if legalized.

Carpiniello tackles the question of suicide prevention, a primary public health concern. He quotes from the WHO Director-General, Tedros Adhanom Ghebreyesus stated:
“despite progress, one person still dies every 40 seconds from suicide. Every death is a tragedy for family, friends and colleagues. Yet suicides are preventable. We call on all countries to incorporate proven suicide prevention strategies into national health and education programmes in a sustainable way”
Carpiniello indicates that suicide prevention and suicide assistance are irreconcilable.
Indeed, an emphasis on suicide prevention from a public health perspective seems to be somewhat hard to reconcile ...for those countries simultaneously equipped with social and health policies established for the specific purpose of preventing suicide. Considering the specific role of psychiatry in preventing suicide, put in very simple terms the question is: what is the point of psychiatrists trying in every way possible to prevent suicide if the person concerned is entitled by law to seek assistance to commit this action?
Carpiniello examines the clinical concerns related to psychiatrists approving euthanasia. He points out:
“assessments of competency, sustained wish to die prematurely, depressive disorder, demoralization and ‘unbearable suffering’ in the terminally ill are clinically uncertain and difficult tasks ... As yet psychiatry does not have the expertise to ‘select’ those whose wish for hastened death is rational, humane and ‘healthy’
He explains that there are no objective measures to determine if someone has lasting or unbearable suffering.

Further to that Carpiniello finds that it is impossible to determine if treatment is futile for the patient. He states:

How can we confirm that a single case should definitely be considered untreatable if “there are no universal standards defining incurability in most cases of mental illness” and “there is no reliable mechanism to define incurable disease and determine medical futility for psychiatric care
He points out that there is no definition for the condition known as treatment resistant depression (TRD). He states:
it could prove an arduous task, even for the most experienced psychiatrist, to confirm that the case undergoing evaluation for assisted suicide is an actual TRD, ...Accordingly, it should be kept in mind how approx. 20% of Dutch patients requesting euthanasia had never undergone psychiatric hospitalization, 56% had refused some form of recommended treatment, and how in 27% of cases patients had requested assistance with dying from a physician who had not previously been involved in their treatment.
He continues by quoting from a study indicating that the majority of TRD patients get better.
More recently, 155 TRD patients were evaluated over a 1-7 year (median 36 months) follow-up, revealing how 39.2% of follow-up months were asymptomatic and 21.1% at sub-threshold symptom level, while 15.8% featured a mild, 13.9% moderate, and 10.0% severe depressive episode level, thus demonstrating how the majority of patients with TRD manage to achieve an asymptomatic state.
Further to that, he shows how there is no standard to assess competence or decisional capacity amongst these patients. He quotes from a study that was based on information from the Dutch Regional Review Committees that found:
in their evaluations physicians frequently stated that psychosis or depression did (or did not) affect capacity but provided little explanation to corroborate their opinions. The findings of this study once again raised a series of doubts as to the reliability of evaluation of decisional capacity of patients requesting EAS, at least in the Netherlands.
He then examines the phenomenon of transference and countertransference that exists in a therapeutic relationship with a patient and he states:
Some authors have criticized the assumption according to which a physician will always act in the interests of their patients, mostly because it fails to consider the doctor’s unconscious, and at times conscious, desire for the patient to die and alleviate distress for all concerned, including the physician. ...Doctors who are affected by countertransference or who have psychologically committed themselves to PAS may be prone to accepting patients’ reasons for PAS at face value without thorough exploration”
He then explains how physician/patient relationships can lead to pseudoempathy. He states:
One of the most frequently cited consequences of countertransference is over-identification with the patient, giving rise to a so-called ‘pseudoempathy’, a condition resulting in the physician experiencing the feeling that the patient’s suicidalwish is ‘normal’ and that they would feel the same way.
Carpiniello examines what he calls, the undesiralbe consequences of assisted suicide. He sites several concerns including:
  • “... will psychiatrists conclude from the legalization of assisted death that it is acceptable to give up on treating some patients? If so, how far will the influence of that belief spread?”
  • data from the Netherlands, reports “56% of cases in which social isolation or loneliness was important enough to be mentioned in the report”, arguing that “the latter evokes the concern that physician assisted death served as a substitute for effective psychosocial intervention and support”
  • EAS in psychiatric patients may be detrimental in the advancement of research and implementation of new treatments, given that it “may reinforce poor expectations of the medical community for mental illness treatment and contribute to a relative lack of progress in developing more effective therapeutic strategies” 
  • “What consequences on social representations of mental illnesses, on how to deal with a mental illness and on professional profile if psychiatrists recognize that life with mental illness – even if “only” in individual cases – is not worth living?
Carpiniello concludes that no firm conclusions can be drawn based on data related to euthanasia for psychiatric reasons.

Carpiniello's paper clearly indicates that the negative consequences related to euthanasia for mental disorders suggest that this should not be done.