Tuesday, August 6, 2019

Dr Mark Komrad: Why psychiatrists should oppose euthanasia.

Dr Mark Komrad, MD is a psychiatrist at Johns Hopkins, who speaks to the Anscombe Bioethics Centre about why psychiatrists should oppose euthanasia.

The following text is a paraphrase, of the video interview produced by the Anscombe Bioethics Centre. (Alex Schadenberg)

The situation concerning euthanasia or assisted suicide for psychiatric reasons.

Since 2002, the Netherlands and Belgium (Luxembourg in 2009) legalized euthanasia without a distinction between terminal and non-terminal conditions. These laws allowed for euthanasia for physical and psychiatric reasons.

This has led to some patients receiving suicide assistance rather than suicide prevention.

As a psychiatrist, I disagree with these developments based on my Hippocratic tradition of medical ethics which is based on the value of not killing. The mighty tree of medicine grew from the Hippocratic tradition.

My concerns as a psychiatrist relate to the core values of psychiatry which focus on helping people in despair, helping people who are demoralized, helping people who cannot see their way cognitively and emotionally to a better future, helping to mitigate suffering, taking the journey of suffering with them, listening to them intently, to help find meaning in suffering and to fundamentally prevent suicide.

Preventing suicide is core to the individual and social mission of a psychiatrist.
Euthanasia takes this mission of ours and stands it on its head. To be involved with causing death is an anathema and inversion of the fundamental ethos of psychiatry.

Euthanasia affects mental health care since our patients generally experience a lack of access to resources. Once you begin to make euthanasia an alternate path my fear is that the advocacy to treatment may disappear.

All of the work we are doing to open access to mental health care is threatened when short circuited by euthanasia and assisted suicide.

Euthanasia affects attitudes towards life because once the concept takes hold the lives of people with disabilities or certain mental or medical conditions are seen as somehow not as worth living.

I have a colleague in Belgium, whose father has a chronic condition and has chosen not to have euthanasia. I am told, when his father complains about his symptoms that some of his friends will say - you chose not to have euthanasia.

The sympathy that normally people would have had, now they are explicit that he doesn't deserve their sympathy.

The subtle changes to the collective psyche as we begin to open to these things leads us to accelerate down the slippery slope to the point where the train ends up going off the rails.


marlene said...

Euthanasia should be used under only one circumstance - a patient suffering constant, unrelenting, excruciating pain from a terminal illness and finds very little, if any, relief from that pain while in the hospital because hospitals, especially those that engage in euthanasia for any reason, have reduced the dosage and frequency of morphine. When a patient resorts to begging someone to end their physical pain by ending their life, euthanasia would be merciful. I cannot think of any other reason for euthanasia.

Deacon Bill Gallerizzo said...

Wholeheartedly agree. So much essential medical support is undermined by Euthanasia, not to mention the social support that provides encouragement to keep going. The assumption that the desire to die can be made in sound mind denies what has been observed for decades that any psychologically obtuse or illicit action is based in an internal logical analysis, albeit flawed by depression of some kind. Euthanasia therefore denies the ability of the human person to think and to reason is altered by physical and mental affectual circumstances. Three decades ago, I fought my way out of depression following a horrendous accident that left me with increasing levels of disability. My supportive wife and a great psychiatrist both helped me rediscover that I had so much more to give than cashing in my chips. I learned in the process that those who think I should take the easy way and give up, whether by euthanasia or wasting away, were not worth my time or my energy. Later on when disability hit them, they were knocking on my door for help to overcome their own depression rather than give in to their own destruction. Self-pity and depression are mutually supportive animals that destroy the human spirit. We should be better than that, and we are.

Alex Schadenberg said...

Dear Marlene:

I appreciate your concern. I have no wish for people to suffer in that manner or any uncontrolled manner, but the situation that you have described is based on an abandonment of good care and treatment. Nobody needs to suffer in the manner that you have described.

marlene said...

"...the situation that you have described is based on an abandonment of good care and treatment." Yes. Thank you. I was wondering, however, how much pain-relieving drugs terminal patients can sustain before the drug itself terminates their life...