Physician-assisted suicide: Scope and dynamics in the U.S.
In the wake of Nov. 12, 1915, Anna Bollinger gave birth to a blue and badly deformed baby boy at Chicago’s German-American Hospital. Harry J. Haiselden, the hospital’s chief of staff, diagnosed an array of physical defects, predicting the child’s death without surgery. In a decision that marked a milestone in the history of euthanasia in America, Haiselden advised the parents against surgery and announced his drastic decision in a press conference. The child died on Nov. 17, in the course of growing controversy.
This year, a California law for assisted suicide will come into effect, making California the fifth state to legalize physician-assisted suicide. Prior to California, Oregon, Washington, Montana and Vermont have pioneered the law.
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Assisted suicide for mental illness gaining momentum
A report, published in 2013, explored requests for euthanasia on the basis of agony associated with psychiatric illness in Belgium, where euthanasia has been legal since 2002.
Dr. Lieve Thienpont, Ph.D., of University Hospital Brussels, alongside his colleagues, assessed 100 requests that were grounded in the suffering afflicted by psychiatric disorders between 2007 and 2011.
The study revealed:
- 48 requests were accepted and 35 were carried out
- Among the remaining 13 approved requests, eight patients postponed or canceled the procedure simply because attaining the option put their minds at ease to continue living
- Six patients whose requests had been denied committed suicide
- 91 patients were referred to psychiatric counseling
“We found that when considering patients’ demands seriously, most do find a way to continue with their life,” Dr. Thienpont said. “We also found that some patients postpone or cancel their euthanasia request or procedure themselves, saying that knowing they have the option to proceed with euthanasia gave them sufficient peace of mind to continue living.”
“The stakes are too high”
Kenneth W. Goodman, Ph.D., professor and director of the Institute for Bioethics and Health Policy at the University of Miami Miller School of Medicine, believes the stakes in deciding a patient’s fate are extremely high. There is a serious risk of jumping to conclusions.
“Although psychological pain can hurt just as much as physical pain, my fear is that the planned death of psychiatric patients represents a failure of treatment; perhaps more or better treatment would work.”
He deems the idea of mental health issues as a basis for physician-assisted suicide to be “a bridge too far for the United States.” He attributes this to an incomplete understanding of the full scope of mental anguish including many unique needs of psychiatric patients.
The flip side: Emerging concerns
A more recent study of doctor-assisted suicide for individuals struggling with mental disorders raises important questions. Findings reveal that in more than half of approved cases, people declined treatment that could have potentially helped. In fact, loneliness emerged as a fundamental reason for wanting to die.
Dr. Scott Y. H. Kim, Ph.D., and colleagues evaluated 66 cases of patients who received assisted suicide from 2011 to 2014. The population studied included 70 percent women. Most of the patients struggled with chronic mental illnesses accompanied with histories of suicide attempts and psychiatric hospitalizations.
The following concerns emerged:
- The ratio of women to men raised concerns of whether having the option of an easier suicide encouraged women who ordinarily might not have made the choice
- 24 percent of cases showed a disagreement among professionals
- 11 percent of cases incorporated no autonomous psychiatric input at all
- One case failed to meet the legal due-care criteria altogether
- Out of the physicians facilitating assisted suicide, only 41 percent were psychiatrists
- 32 percent of patients had past assisted suicide requests that had been rejected. Physicians of three of these patients switched decisions, while the remaining 18 received assisted suicide from unfamiliar physicians. Fourteen physicians were associated with a euthanasia clinic called the End-of-Life Clinic.
- 12 percent of cases included psychiatrists who did not find the criteria for granting a request to have been met. The assisted suicide was carried out anyway.
“The debates over psychiatric EAS [euthanasia/assisted suicide] tend to focus on a particular picture: a patient with long history of severe treatment-resistant depression who, after insightful assessment of her situation, exercises her autonomy to choose EAS,” said Kim. “But the biggest surprise was that people who received EAS and the usual picture of what that person should look like didn’t quite match.”
“There is no evidence base to operationalize ‘unbearable suffering,’ ” he continued.”There are no prospective studies of decision-making capacity in persons seeking EAS for psychiatric reasons.”
The End of Life Option Act
The California law places vigorous protections for patients to discourage reckless taking of their own lives:
- Approvals and certifications of two different doctors for the patient who has six months or less to live
- Patients must be able to ingest medications themselves
- Patients must be in a sound state of mind with no pressure from their families
- Hospitals and doctors have the right to decline participation
Governor Jerry Brown, when deciding upon the implementation of this law, examined the opposing materials provided by a number of doctors, religious leaders and advocates of disability rights in much detail.
In the end he concluded, “I do not know what I would do if I were dying in prolonged and excruciating pain. I am certain, however, that it would be a comfort to consider the options afforded by this bill. And I wouldn’t deny that right to others.”
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About the author
Sana Ahmed is a staff writer for Sovereign Health Group. A journalist and social media savvy content developer with extensive research, print and on-air interview skills, Sana has previously worked as an editor for a business magazine and been an on-air news broadcaster. She writes to share the amazing developments from the mental health world and unsuccessfully attempts to diagnose her friends and family. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.