Good Old News: In Early 2023, Suicidology Group Withdrew Statement on Assisted Suicide

This article was published by Not Dead Yet on July 10, 2023.

In October 2017, the American Association of Suicidology (AAS) issued a Statement announcing that physician assisted suicide is not “suicide”. The Executive Summary states:

“The American Association of Suicidology recognizes that the practice of physician aid in dying, also called physician assisted suicide, Death with Dignity, and medical aid in dying, is distinct from the behavior that has been traditionally and ordinarily described as ‘suicide,’ the tragic event our organization works so hard to prevent. Although there may be overlap between the two categories, legal physician assisted deaths should not be considered cases of suicide and are therefore a matter outside the central focus of AAS.”

At their annual conference held seven months later, disability activists protested the Statement and distributed a leaflet to conference attendees, many of whom were previously unaware of the Statement.

In early 2023, according to an online AAS posting, the Statement was “retired.” Disability activist Meghan Schrader discussed the original Statement and its retirement in her recent article published in the Euthanasia Prevention Coalition blog, which criticizes Thaddeus Pope and others who favor expanding eligibility for assisted suicide to include disabled people without a “terminal” prognosis. The following is the relevant excerpt from her article:

The disabled community is reaping the consequences of a society that is so apathetic toward disabled people’s basic needs that it can’t even be bothered to provide us with suicide prevention. We are dirt.

…All self-respecting suicide prevention advocates and organizations really need to do some honest and humble reflection on their silence regarding assisted suicide. Not saying anything while people like [Thaddeus] Pope shamelessly sell suicide to the disabled community communicates that suicide prevention is for ablebodied, neurotypical people. The Canadian Association for Suicide Prevention strongly opposed extending assisted suicide to the disabled community in 2021, but their opposition came too late to prevent the law change.

Indeed, the American Association of Suicidology’s 2017 statement about “medical aid in dying” being different from suicide had tragic consequences for the disabled community. Regrettably the board had somehow fallen under the influence of assisted suicide advocate, academic Margaret Battin, and its statement about PAS has repeatedly been used to justify PAS in all sorts of different contexts. The 2019 Truchon court decision in Québec which extended euthanasia to people with disabilities, cited the AAS’s statement to support its judgment that “MAiD” for disabled people was not suicide.

The AAS had made that statement in the context of physician assisted suicide for people with terminal illnesses, but in the end, the organization’s intentions did not matter. Its statement that some suicides weren’t suicides was used to cause multiple disabled Canadian’s suicides.

To its credit, the AAS became apprised of the genie it had let out of the bottle, and it retracted its statement about PAS not being suicide in 2023. Now the assisted suicide movement has no scientific basis for its assertions that PAS is not suicide. (Link to article)

Euthanasia promoter urges disabled people to die by suicide

Meghan Schrader is an autistic person who is an instructor at E4 Texas at the University of Texas (Austin) and an EPC-USA board member.

By Meghan Schrader

Meghan Schrader

I spend too much time on Twitter. It’s kind of a vice; given the cesspool that Twitter can be, I probably should get a better hobby.

But, then again, Twitter is an important socialization tool for many people with disabilities, and it provides an opportunity to connect with other people who have disabilities. Opposition to assisted suicide runs deep in the disability justice community, and if one hangs out on what activists call #DisabilityTwitter often like I do, one will probably observe tweets expressing opposition to assisted suicide about once or twice a month, even if one doesn’t follow accounts focused on that issue specifically.

That means that one also becomes apprised of what assisted suicide advocates are doing on Twitter as well, and Twitter provides an opportunity to dialogue with them if one is so inclined.

One of the most honest American proponents that one can dialogue with on Twitter is Thaddeus Mason Pope. Some United States proponents say, with various degrees of sincerity, that what they call “aid in dying” has nothing to do with disabled people and that of course they don’t support killing disabled people, but not him. He’s out, he’s proud, and he wants disabled people everywhere to know that if we would like to die by suicide, he would like to help make that happen. It’s really gross, and really disturbing that society has allowed people like that to have a platform.

Hence, on June 15, 2023, I tweeted to Pope: 

“You run around all day screaming, ‘It’s good for disabled people to die by suicide; it is!’

Do you honestly believe that your advocacy isn’t contributing to suicide contagion among people with disabilities?” 

Pope tweeted back, 

“Good for people with disabilities if they themselves determine that this is in their own best interest.” 

I tweeted, 

“So the suicides of people with disabilities are good?” 

He wrote, 

“Yes. If that is what THEY want.”

One has to admire Pope’s honesty. But, there’s something really ugly about his logic. His tweets carry the message:

“Nothing matters but me.” Those tweets communicate, “I’m so educated, important and enlightened that I’m above the rules-moral rules about not encouraging others to harm themselves don’t apply to me.” His tweets say, “F-k any disabled Twitter users who might be living with suicidal ideation and could be triggered by my tweets.”

A second thing that Pope acknowledged on Twitter that day was that he knows disabled people will be coerced, forced, traumatized or otherwise harmed by assisted suicide, but he’s ok with that.

In regard to the potential for mistakes in the application of physician assisted suicide, Pope tweeted, 

“Yes yes. So many medical errors. Even about death determination. Even about MAID. We never demand perfection before implementing healthcare.” 

I tweeted, 

“Your logic is deeply disgusting. It establishes that you know that some people will die in accidents related to physician assisted suicide, but you're determined to do it anyway.” 

He wrote, 

“Yes. Just like we allow advance directives, surrogate decisions, withdrawal of life sustaining treatment - and they are all subject to errors too.”

DNRs are in fact weaponized against disabled people. However, there’s an important distinction between a DNR and assisted suicide:

DNRs don’t kill people outright, so there’s a chance that a disabled person subjected to a compulsory DNR could survive and fight back.

Someone who dies in a “MAiD accident” has no opportunity to recover or resist the death being forced on them. All chances of survival are lost.

So, Pope isn’t content to promote disabled people’s suicides. No, no-he wants some of us to become homicide victims, so that privileged academics like himself can plan their deaths. The human rights of the coerced, traumatized or forced people don’t matter to Thaddeus Pope and his friends.

Unfortunately, people like Pope are deriving a political benefit from living in a culture where suicide is viewed as being acceptable if an individual has disabilities. A peer reviewed study by researcher Emily Lund establishes that people are more likely to consider suicide acceptable if the suicide victim has an impairment. (Link to article).

Thaddeus Mason Pope’s tweets are an example of how assisted suicide is linked to oppression, demoralization and violence toward people with disabilities. It’s 2023; disabled people should have been experiencing a much fairer world by now, in several aspects of life.

Instead, the disabled community is reaping the consequences of a society that is so apathetic toward disabled people’s basic needs that it can’t even be bothered to provide us with suicide prevention. We are dirt.

In regard to the disabled community being treated like dirt, statements like Pope’s make it clear that all self-respecting suicide prevention advocates and organizations really need to do some honest and humble reflection on their silence regarding assisted suicide. Not saying anything while people like Pope shamelessly sell suicide to the disabled community communicates that suicide prevention is for ablebodied, neurotypical people. The Canadian Association for Suicide Prevention strongly opposed extending assisted suicide to the disabled community in 2021, but their opposition came too late to prevent the law change.

Indeed, the American Association of Suicidology’s 2017 statement about “medical aid in dying” being different from suicide had tragic consequences for the disabled community. Regrettably the board had somehow fallen under the influence of assisted suicide advocate, academic Margaret Battin, and its statement about PAS has repeatedly been used to justify PAS in all sorts of different contexts. The 2019 Truchon court decision in Québec which extended euthanasia to people with disabilities, cited the AAS’s statement to support its judgment that “MAiD” for disabled people was not suicide.

The AAS had made that statement in the context of physician assisted suicide for people with terminal illnesses, but in the end, the organization’s intentions did not matter. Its statement that some suicides weren’t suicides was used to cause multiple disabled Canadian’s suicides.

To its credit, the AAS became apprised of the genie it had let out of the bottle, and it retracted its statement about PAS not being suicide in 2023. Now the assisted suicide movement has no scientific basis for its assertions that PAS is not suicide. (Link to article)

But, simply retracting that statement does not go far enough. Given the right to die movement’s tolerance for expansionists (Compassion and Choice’s president appeared on Dr. Phil with Thaddeus Mason Pope in 2022), suicide prevention organizations have no reasonable basis to assume that the right to die movement isn’t undermining suicide prevention for people with disabilities.

Now is the time for mainstream suicide prevention organizations to speak up, before people like Pope gain even more influence over America’s medical system.

Not taking steps to resist the assisted suicide movement leaves resistance to Pope et al’s suicide baiting to all of us autistic crazy people on Twitter.

In the meanwhile, disabled people have no obligation to accept subjugation in respect to suicide prevention or anything else.

Privileged, educated control freaks like Pope aren’t entitled to off a few disabled people, and routinely tell us to kill ourselves, so that they can plan their deaths. We are people; not insects that people like Pope can blithely grind into the dirt.

Response: “Neurologic Diseases and MAiD” in The American Journal of Bioethics

This article was published by Not Dead Yet on August 30, 2022.

Jules Good writes in response to “Neurologic Diseases and MAiD: Aid-In-Dying Laws Create an Underclass of Patients Based on Disability” by Lonny Shavelson, Thaddeus M. Pope, Margaret Pabst Battin, Alicia Oulette & Benzi Kluger, published in The American Journal of Bioethics 16 August 2022:

Jules Good

Legal assisted suicide puts disabled people in danger of being killed on the basis of disability alone. This is especially true when assisted suicide laws allow someone other than the patient to administer the drug. The authors claim that denying someone euthanasia is an ADA violation. Their argument is that getting assistance in administering the lethal drug should be seen as a “reasonable accommodation” used to allow someone without the physical capacity to take the drug access to assisted suicide. The provision of the ADA cited in the article to support this claim states that “No qualified individual with a disability shall…be excluded from participation in or be denied the benefits of services, programs, or activities of a public entity, or be subjected to discrimination by any such entity” when reasonable accommodation can be provided.”

There is a much more compelling case for invoking the ADA here that focuses less on making it easier for disabled people to die and more on making it easier for us to live life on our own terms. In places where assisted suicide is legal, disabled people who wish to die (some actually terminal, some not) are given the tools to do so, while nondisabled people who wish to die are given access to mental health resources. Is being coerced toward “choosing” death really an example of disabled people accessing the “benefits of services, programs, or activities of a public entity”? Is being denied mental health treatment because our lives are seen as less valuable than the lives of nondisabled people not a more pressing example of the ADA being violated?

Thaddeus Pope, co-author of the article, has himself admitted that he sees having a disability, and not exclusively a “terminal” prognosis, as an acceptable reason for someone to be permitted to die by assisted suicide. We reject this notion. True healthcare includes treatment and resources that allow someone to live with as little pain and with as much independence as possible. Legal assisted suicide, which, on a systemic level, results in the premature and unnecessary deaths of our community members, is not a “service, program, or activity” that disabled people “benefit” from. This is a blatant misuse of the ADA.

It is clear that the authors of this article are out of touch with the core tenets of disability justice, which state in part that we have a responsibility to keep each other safe. Policies that champion the desires of individuals over the safety and vitality of the most marginalized disabled people are not grounded in a true disability justice framework. Disabled people do not need more help dying. Crisis standards of care in the face of COVID-19 that deprioritize us for treatment, our profit-driven healthcare system that regularly denies care to those who need it most, and a general societal attitude that people are “better off dead than disabled” make death more accessible to us than life. The ADA, while imperfect, was passed because the disabled community worked to ensure that the inherent value of our lives would be recognized in the eyes of the law. It should not be used to further jeopardize the safety of the most vulnerable members of our community.

Standing firm against assisted suicide.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Two weeks I published an article titled: Is assisted suicide a suicide? based on the ongoing debate in the Psychiatric Times between Psychiatrist, Dr Mark Komrad and long-time euthanasia activist Margaret Battin PhD.

Dr John Maher

Today I published an article by psychiatrist, Dr Komrad's responding to Battin's assertion that there is no proof of a slippery slope in jurisdictions that have legalized euthanasia or assisted suicide.

Yesterday, eminent psychiatrist Dr John Maher also responded to the ongoing debate with his article published in the Psychiatric Times, titled: Why Stand Firm Against Physician-Assisted Suicide.

Maher who is president of the Ontario Association for ACT & FACT and editor-in-chief of the Journal of Ethics in Mental Health also responds to Battin's theory negating slippery slopes in jurisdictions that have legalized euthanasia or assisted suicide. Maher responds to Battin by stating:

The letter objects to slippery slope arguments, saying that allowing medical aid in dying (MAID) will not lead to abuses. In response it must be said that there are already unequivocally widespread abuses in the Benelux countries (euthanasia without consent, euthanasia without standard treatments tried first, euthanasia with psychiatrists’ objections on eligibility being overruled/ignored, doctor shopping to get the desired outcome) and these abuses could not have occurred without the original practices being allowed, paving the way. The slippery slope is indisputably real, and the reality is that given an inch, proponents of MAID in those nations took a mile...

The letter claims that, “it is deeply contentious whether euthanasia for patients who regard themselves as having had a complete life, or who find that they are tired of living, is itself wrong.” This statement completely undermines the claim that slippery slopes are not a concern. Once assisted suicide is allowed for some, it will be allowed for others, for increasingly dubious reasons.

Maher then responds to Battin's assertion that legalizing assisted death does not negatively affect people with disabilities. Maher writes:

The letter also claims that “thus far there is no compelling evidence that aid-in-dying legislation in any country is causally associated with worsened treatment of patients with disabilities.” Is the repeated, passionate testimony from individuals with disabilities who were offered medical suicide before care not compelling? The 7-minute testimony of Gabrielle Peters before the Senate of Canada is particularly poignant and compelling in this regard. The stories and experiences of individuals with disabilities are being ignored.

Maher concludes his article by stating:

If you substitute the word suicide for MAID in this sentence what is apparent is that the important questions are really: can rational suicide be morally acceptable? And should psychiatrists do only selective suicide prevention? I believe the answer, to both questions, is no. Either psychiatrists have a unique and sacrosanct duty of care (that inextricably entails the preservation of life) or they do not. Our job as psychiatrists is to help bring meaning, purpose, and hope and to be unfailing in our efforts to do so.

Margaret Battin Phd has been a promoter of euthanasia and assisted suicide for most of her professional life. I thank these emminent psychiatrists for challenging Battin's false statements and beliefs. The euthanasia lobby has created a false reality by redefining suicide and denying the existence of a slippery slope. Experts are now challenging Battin's assertions.

Does a slippery slope exist when legalizing assisted suicide?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Dr Mark Komrad

Two weeks I published an article titled: Is assisted suicide a suicide? based on the ongoing debate in the Psychiatric Times between Psychiatrist, Dr Mark Komrad and long-time euthanasia activist Margaret Battin PhD.

Komrad's response to Battin's assertion that there is no proof of a slippery slope in jurisdictions that have legalized euthanasia or assisted suicide was published in the Psychiatric Times, on August 27. Komrad responds:

The letter objects to my use of a slippery slope argument. Unfortunately, the slope is very real. We have chilling observations of these practices outside the halls of political debate and philosophical discourse. When MAID laws are first passed, they initially have limited conceptions and eligibility, but the eligibility always expands over scope and time. Even now, many US states with legalized assisted suicide are trying to expand eligibility criteria and decrease waiting times. These creeping thresholds of acceptability, propagating the emerging new tier of supposedly good and noble suicide —celebrated with goodbye parties and lauded by the press—may be having the effect of suicide contagion. For example, the success of the Netflix television series 13 Reasons led to a marked increase in googling methods of suicide. By 2012, Oregon’s suicide rate rose 41% higher than the national rate. In Canada, children and teenagers are starting to ask their pediatricians about receiving euthanasia, though this option is not available for minors, for now. So, references to slippery slopes are not philosophical casuistry. The reality is that such slopes lessen the traction of suicide prevention. A taboo (not stigma) against suicide is an instrumental piece of suicide prevention.

Of course, the absence of evidence is not evidence of absence. Though many disability organizations have strongly objected to MAID practices (and provided disturbing anecdotal evidence of how a euthanasia option may short circuit the care of the disabled) no one has systematically studied the effects of euthanasia on individuals with disabilities. We have very few data regarding any outcomes of this practice, although we know that suicide loss survivors have profound secondary trauma.

Komrad then comments on Canada's upcoming experiment with permitting euthanasia for psychiatric reasons:

Furthermore, there is no validated empirical method or agreed-upon standard for determining that any psychiatric illness is irremediable; or when it would be reasonable to so conclude. There is tremendous controversy over futility in psychiatry and prognostication regarding psychiatric illness is highly unreliable. An absence of response to treatments already provided is in no sense, and by no stretch of logic, a demonstration that the patient’s condition is irremediable. Canada will be struggling mightily to figure this out in the next 2 years.

Komrad completes his response by refering to the research by psychiatrist Robert J Lifton:

When we lower the threshold for killing other human beings, disaster can follow. The celebrated psychiatrist, Robert J. Lifton, MD, author of The Nazi Doctors: Medical Killing and the Psychology of Genocide, warned of “malignant normality,” times when what we put forward as self-evident and normal may be deeply dangerous and destructive. “When normality becomes malignant, professionals can be all too ready to serve that version of it as well. Indeed professionals are required for maintaining that malignant normality and bringing others into it.”

Thank you Dr Komrad for continuing the debate on whether psychiatrists should be involved with killing their patients.

Is assisted suicide a suicide?

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Psychiatric Times has published several back and forth articles from Psychiatrist and ethicist Dr Mark Komrad (Article 1) (Article 2) and long-time euthanasia and assisted suicide activists, Margaret Battin PhD and associates (Article 1) (Article 2).

One of the key issues that separate psychiatrists and ethicists concerning assisted death is should psychiatrists prevent suicide or provide it? Komrad argues that assisted suicide constitutes a form of suicide and psychiatrists are trained to prevent suicide not provide it while Battin argues that assisted suicide does hasten death but it is not a suicide.

For instance Komrad et al stated in one of their article titled - Against Assisted Suicide:

The mere fact that some state legislatures have passed statutes redefining suicide, such that MAID is not suicide, does not prove that this redefinition is conceptually or ethically justified; in fact, several judicial decisions have held this opinion. In 2017, the New York Court of Appeals held that “suicide has long been understood as ‘the act or an instance of taking one’s own life voluntarily and intentionally’ ... Aid-in-dying falls squarely within the ordinary meaning of the statutory prohibition on assisting a suicide.” Similarly, in 2016, the New Mexico Supreme Court held that the prohibition against assisted suicide unambiguously covered self-induced death in situations such as those described by Strouse et al. Furthermore, in Washington v. Glucksberg (521 US 702, 1997), the US Supreme Court permitted laws prohibiting assisted suicide because of the states’ compelling interest in suicide prevention, effectively equating assisted suicide with suicide.

While redefining suicide averts legal liability for physicians providing MAID, it does not change the essentially unethical nature of the act itself. The term medical aid in dying fundamentally means helping patients kill themselves. This is why the American College of Physicians rejects the term and explicitly endorses the term physician-assisted suicide/PAS. Perhaps even more significant, following a comprehensive evaluation by the Council on Ethical and Judicial Affairs, the American Medical Association (AMA) House of Delegates rejected the term aid in dying and elected to retain the term physician assisted suicide in all AMA documents and references. Indeed, the process typically described as MAID in no sense aids dying; on the contrary, it rapidly converts an ill individual into a dead one. This is substantively different than the withdrawal of heroic but nonbeneficial or inappropriate measures, such as the use of ventilators that merely prolong the dying process in the final stages of a terminal illness.

Finally, statutorily declaring that self-induced death via a physician’s assistance is not suicide may soothe the consciences of legislators and allow payouts on life insurance policies; but, perversely, it may also incentivize some terminally ill patients to kill themselves. Furthermore, as Sulmasy notes, preliminary reports suggest increased rates of suicide in the general population of states that have legalized PAS. Specifically, “legalizing PAS has been associated with an increased rate of total suicides relative to other [non-PAS] states, and no decrease in non-assisted suicides.” Similarly, suicide rates in the Netherlands (where medical euthanasia is legal) have accelerated, compared to neighboring countries that have not legalized medical euthanasia.

Whereas Battin was a key force in the development of the AAS statement on suicide and physician-assisted suicide which proclaims that they are different acts. The AAS statement says:

The American Association of Suicidology (AAS) recognizes that the practice of physician aid in dying is distinct from the behavior that has been traditionally and ordinarily described as “suicide,” the tragic event our organization works so hard to prevent. This recognition does not assume that there cannot be “overlap” cases, but only that the two practices can in principle be conceptually distinguished and that the professional obligations of those involved in suicide prevention may differ.

How can there be such diverging views?

First of all, the AAS statement is philosophically based while the position of Komrad and his colleagues has a scientific, experiential and data basis. Battin recognized that the research by Dr Scott Kim found that some people who died by euthanasia for psychiatric reasons in the Netherlands were not treated for their psychiatric conditions, and furthermore some of these psychiatric conditions are associated with suicidal ideation. 

Komrad and colleagues recognize that: 

“Most suicidal people do not want to die. They are experiencing severe emotional pain, and are desperate for the pain to go away.” We would suggest that the same may be said of at least some individuals with cancer who seek MAID.

I have spoken to many people who called me concerning a family member or friend who was seeking an assisted death. The further our discussions go the more it appears that the person seeking an assisted death is experiencing suicidal ideation or often a fear of future suffering.

Canadian Psychiatrist Dr John Maher responded to CTV news on how Bill C-7 will affect his psychiatric patients, he said:

that the upcoming rules that could allow medical assistance in dying solely because of a mental illness don't take into account that those suffering from severe illness may not be capable of making the best decision for themselves.

"Last week I had a patient in her 30s who refused treatment who wants MAID. This is a young woman, who will get better who literal has --she's in her 30s -- she has at least 50 years of life left,"

In his concern about Canada's Bill C-7 expanding assisted death to people with mental illness, Psychiatrist Dr Sonu Gaind stated:

We are poised to provide death for mental illness to potentially suicidal, non-dying marginalized people suffering from life distress who have the potential to recover — all based on less evidence than is required for the approval of any sleeping pill. Given the ubiquity of mental illness, no family needs to look very far to appreciate the implications.

Battin argues philosophically that suicide is different than assisted suicide. In reality, psychiatrists who treat patients experience a different paradigm.

It is disconcerting that Battin, who was instrumental in developing the argument that suicide and assisted death are distinctly different, now defends her thesis with researchers, psychiatrists who are actively providing treatment and ethicists who are researching the actual facts.

My experience does not compare to the training and experience of Dr Komrad et al, but I am convinced that the reasons people ask for assisted death are the as the reasons people die by suicide, even though the circumstances may be different.

Assisted suicide researchers want suicide devices for people with dementia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Just as you thought the assisted suicide lobby has gone too far, long-time assisted suicide lobby leader and researcher, Margaret Pabst Battin opens the debate for developing a suicide device for people with dementia.

The Hastings Center Report published an article (May 2021) by Margaret Pabst Battin and Brent M Kious titled: Ending One's Life in Advance. (Link to the article).

Battin has studied and promoted euthanasia and assisted suicide since the 1980's. Battin is the same philosopher who argues that assisted suicide is not a suicide. Her new article concerns the following question:

People newly diagnosed with progressive dementia may not want to live through its later stages, but the options for those who wish to choose an earlier death are inadequate and can be dependent on others’ cooperation. What if, while still competent, these people could opt for implantation of a device that would achieve their goals—timed to release a painless, fatal drug at a future point they have selected?

Pabst and Kious justify their promotion of suicide devices for people with dementia by stating:

• to have control over how we die; 
• to avoid pain and suffering;
•  not to burden family members with overwhelming care needs; 
• not to impose overwhelming medical or other financial costs; 
• not to lose what we may experience as still-good life in the early and middle stages of progressive dementia; 
• not to impose painfully difficult decisions on our family members or loved ones—for example, between caring for us or facing unsupportable financial burdens; 
• not to have to ask our doctors to do what might violate their oaths or personal commitments or be emotionally unbearable for them; or 
• not to have to turn to preemptive suicide to avoid all of the above.
  

Talking about considering life with dementia as not worth living.  

I recently spoke to a woman who felt that she was being pushed to have her father, with dementia, die by dehydration. This woman loved and respected her father and did not consider his life as not worth living.

Pabst and Kious ask the question?

Suppose there is a simple medical device, based on the triple technology of the timed-release capsule, the subdermal contraceptive implant, and a painless, quick-acting euthanasia drug developed in the Netherlands, where euthanasia is legal: it’s a delayed-onset, rapid-acting, painless euthanasic implant. Anybody newly diagnosed with Alzheimer’s or other irreversible progressive dementia, while still lucid and competent, can request one.

When evaluating the concept of killing by inserting a time delayed suicide device into a person with dementia creates significant concerns. For instance:

1. Implanting a suicide device into a person with dementia creates a belief that living with dementia is worse than death. This is based on a eugenic ideology that certain lives are not worth living. The assisted suicide lobby will counter that argument by saying its about choice, but that negates the reality that someone has agreed to implant the device. 
2. Who decides that the person qualifies to have a suicide device implanted? Similar to assisted suicide the death lobby will argue the decision is based on choice. Considering the fear mongering used by Battin and Kious in this article to justify killing, is it truly based on a "choice". 
3. What happens if the person changes their mind? Once a person is deemed incompetent, they will lose the right to change their mind with the inevitable outcome being death without consent.
   

Finally, why limit the death device to people with dementia?

Whether it be assisted suicide by mixing a lethal drug cocktail into apple sauce or assisted suicide by suicide device, clearly Battin and Kious are pushing the death envelope and, in turn, dehumanizing people living with dementia.

In a previous article Battin suggests that suicide is different than assisted suicide. Her arguement concerning suicide is philosophically based. This article is clearly justifying suicide for people with dementia. 

As stated earlier, just as you thought things were bad, Battin comes along to justify more killing.

Should psychiatrists assist the suicide of their patients, even if it is legal?

This article was published by the Psychiatric Times on July 8, 2021

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Doctors Ronald W. Pies, MD, Mark S. Komrad, MD, Cynthia M.A. Geppert, MD, MA, MPH, MSBE, DPS, and Annette Hanson, MD tackle the difficult question in the Psychiatric Times, that being should psychiatrists assist the suicide of their patients, even if if is legal?

All of the writers have been published on issues concerning their professional obligations and why psychiatrists should never participate in assisted suicide, but now they have written about a more nuanced questions concerning the participation in acts of suicide.

This article is a response to the article "A New Question in End-of-Life Ethics" by Strouse, Battin, Bostwick, et al. Their article in turn addresses an earlier essay on suicidal ideation and behavior in oncology patients.

The response by Pies et al breaks down their concerns into several key issues.

Dr Ronald Pies

The first issue is - What is legal vs what is right. Pies et al state:

The mere fact that some state legislatures have passed statutes redefining suicide, such that MAID is not suicide, does not prove that this redefinition is conceptually or ethically justified...

While redefining suicide averts legal liability for physicians providing MAID, it does not change the essentially unethical nature of the act itself. The term medical aid in dying fundamentally means helping patients kill themselves. This is why the American College of Physicians rejects the term and explicitly endorses the term physician-assisted suicide/PAS. Perhaps even more significant, following a comprehensive evaluation by the Council on Ethical and Judicial Affairs, the American Medical Association (AMA) House of Delegates rejected the term aid in dying and elected to retain the term physician assisted suicide in all AMA documents and references. Indeed, the process typically described as MAID in no sense aids dying; on the contrary, it rapidly converts an ill individual into a dead one. This is substantively different than the withdrawal of heroic but nonbeneficial or inappropriate measures, such as the use of ventilators that merely prolong the dying process in the final stages of a terminal illness.

Finally, statutorily declaring that self-induced death via a physician’s assistance is not suicide may soothe the consciences of legislators and allow payouts on life insurance policies; but, perversely, it may also incentivize some terminally ill patients to kill themselves.

Dr Annette Hanson

Pies et al then clarify that Taking One's Own Life is Suicide:

Redefining suicide to exclude PAS in the context of terminal illness represents a radical linguistic maneuver that flies in the face of ordinary language, expressed over thousands of years. The Latin suicidium—from which the English word suicide is derived—means the act of killing oneself intentionally or voluntarily. To be clear: we do not deny that there are often psychological and motivational differences between those with terminal illnesses who take their own lives and those who do so in the context of severe psychiatric illness, as the AAS statement details. But in both instances, the act is that of suicide.

As philosopher Gerald Dworkin, PhD, has put it

[A] s a philosopher, I feel an obligation to point out that, as a conceptual matter, there is nothing inaccurate or false about stating that a person who takes a drug, knowing that it will cause her death, and takes it because it will cause her death, is committing suicide on any reasonable conceptual analysis of what suicide is.

Dr Mark Komrad

They then discuss the issue of patients with Cognitive Distortions, who are not mandated to accept treatment:

Furthermore, most MAID laws do not require treatment for serious medical conditions, even when it is available to the patient. For example, a patient whose metastatic cancer stands a reasonably good chance of remission with aggressive treatment, but who nevertheless chooses MAID, is not required by state laws to undergo the treatment. Choosing assisted suicide in such a scenario may superficially appear to be a rational choice; but may instead represent a decision grounded in certain cognitive distortions that also characterize so-called conventional suicide. Importantly, this may be so, even in the absence of a diagnosed psychiatric disorder.

For example, Tomer T. Levin, MD, and Allison J. Applebaum, PhD, noted that some cancer patients may make erroneous assumptions, like, “No one can help me” or “No one understands what I am going through.” Such cognitive distortions may respond favorably to cognitive behavioral interventions and potentially avert or abort a request for PAS. Indeed, it has been found that “Requests for physician-assisted suicide are unlikely to persist when compassionate supportive care is provided.”

Unfortunately, in almost every US jurisdiction where PAS is allowed, no attempt to offer treatment by a mental health professional is required by law; and the psychiatrist’s role is typically relegated to ruling out mental illness and certifying competency for PAS.

Dr Cynthia Geppert

They then discuss why the Issue is not about intractable pain and suffering:

As Daniel P. Sulmasy, MD, PhD, noted, “Despite public arguments that PAS is needed to avoid excruciating pain and other symptoms, the reasons attributed to patients who seek PAS are not uncontrolled symptoms but lost autonomy, independence, and control.” These are forms of psychological distress which, in our view, are best managed with supportive and empathic counseling and/or cognitive behavioral interventions, provided to patients and their families—not by prescribing lethal drugs.

They then discuss the often forgotten but essential - Precautionary Principle:

This means erring on the side of caution and treating MAID requests from patients with terminal illnesses with the same degree of psychiatric scrutiny and concern that we would bring to any patient’s expressed wish to die. However, in most states, psychiatric assessment is not mandated in the MAID process and does not occur unless specifically requested by the evaluating physician who has initiated the MAID process.. This rarely happens. For example, in Oregon in 2020, only 0.8% of patients who were prescribed lethal medication were referred for psychiatric evaluation.

Moreover, the fairly subtle cognitive distortions described by Levin and Applebaum are unlikely to be detected in a superficial assessment of mental competence. It is no contradiction or paradox to argue, as we have, that pronouncing a patient qualified or competent for MAID is a violation of psychiatric ethics, since this unethically colludes with the process of aiding a patient’s suicide. Psychiatric involvement in end-of-life care is indeed essential, but it should remain well outside the procedures and processes involved in MAID deliberations.

They then discuss the stigma of suicide and how assisted suicide shifts it to "other" suicides:

Indeed, as numerous suicide prevention websites note: “Most suicidal people do not want to die. They are experiencing severe emotional pain, and are desperate for the pain to go away.” We would suggest that the same may be said of at least some individuals with cancer who seek MAID. Whenever complex ethical dilemmas are formulated as black-and-white categories, the many grey instances are often misclassified, with tragic consequences.

In short, the AAS position may have the perverse effect of merely shifting societal stigma from one group—those with terminal medical conditions—to those whose suicidal behavior occurs in the context of psychiatric disorders. We do not need such a 2-tiered classification, in which there are good and bad methods of taking one’s own life.

...We believe that efforts to promote MAID would be better directed toward destigmatizing the mental illnesses that underlie the majority of suicides and toward bolstering the availability of state-of-the-art palliative care.

Pies et al then conclude their article with the following statement:

Physician-assisted suicide is neither a therapy nor a solution to difficult questions raised at the end of life. On the basis of substantive ethics, clinical practice, policy, and other concerns, the ACP does not support legalization of physician-assisted suicide. … However, through high-quality care, effective communication, compassionate support, and the right resources, physicians can help patients control many aspects of how they live out life's last chapter.

More articles on this topic:

• Psychiatrists must prevent suicide not provide it (Link).
• 12 myths about assisted suicide and medical aid in dying (Link). 
• Psychiatrists prevent assisted suicide not provide it (Link). 
• Euthanasia and physician-assisted suicide are unethical acts (Link).