Psychiatrists, Do We Offer Hope or Do We Offer Death?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr. Dinah Miller

An excellent commentary by Dr Dinah Miller, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, that was published by Medscape on July 7 examining the issue of assisted suicide for psychiatric conditions. 

Miller asks: Psychiatrists, Do we offer hope or do we offer death? 

Miller writes:

To offer the option of a death facilitated by the very person who is trying to get them better seems so counter to everything I have learned and contradicts our role as psychiatrists who work so hard to prevent suicide.

Miller makes reference to Canada's legislation that will permit euthanasia for mental illness. She states:

Physician-assisted suicide for psychiatric conditions creates a conundrum for psychiatrists. As mental health professionals, we work to prevent suicide and view it as an act that is frequently fueled by depression. Those who are determined to die by their own hand often do. Depression distorts cognition and leads many patients to believe that they would be better off dead and that their loved ones would be better off without them.

These cognitive distortions are part of their illness. So, how do we, as psychiatrists, move from a stance of preventing suicide — using measures such as involuntary treatment when necessary — to being the people who offer and facilitate death for our patients? I'll leave this for my Canadian colleagues to contemplate, as I live in a state where assisted suicide for any condition remains illegal.

Miller asks some serious questions about who will receive treatment and who will receive death:

As Canada moves toward facilitating death for serious mental illness, we have to wonder whether racial or socioeconomic factors will play a role. Might those who are poor, who have less access to expensive treatment options and social support, be more likely to request facilitated death? And how do we determine whether patients with serious mental illness are competent to make such a decision or whether it is mental illness that is driving their perception of a future without hope?

Miller asks if Canadian psychiatrists will offer death when a patient refuses effective treatment?

Miller comments that Dr Susan Kalish, a geriatric and palliative care physician who supports assisted suicide also recognized that allowing the laws to become too permissive is a problem. Nonetheless, Miller ends her article by stating:

As psychiatrists, do we offer hope to our most vulnerable patients, or do we offer death? Do we rail against suicide, or do we facilitate it? Do we risk facilitating a patient's demise when other options are unavailable because of a lack of access to treatment or when social and financial struggles exacerbate a person's hopelessness? Should we worry that psychiatric euthanasia will turn into a form of eugenics where those who can't contribute are made to feel that they should bow out? If we, as psychiatrists, aren't the emissaries of hope, who exactly are we?

Similar articles on this topic:

• The majority of Canadian oppose euthanasia for mental health (Link).
•  Canada's euthanasia law is the most permissive in the world (Link).
• Canada to delay implementing euthanasia for mental illness (Link).
• Toronto Star: Canada is going too far with euthanasia (Link).
• Globe and Mail Editorial: No to euthanasia for mental disorders (Link).
• Euthanasia panel member quit: Proposals don't adequately protect Canadians with mental illness (Link).
• Offering euthanasia to a suicidal person leads to premature deaths (Link).
• Euthanizing the mentally ill without providing proper supports is reprehensible (Link).
• Euthanasia for mental illness. Killing people with an uncertain prognosis (Link).
• Profound social change with euthanasia for mental illness (Link).
• Euthanasia for mental illness. Myth and Facts (Link).