Physician Assisted Suicide

Sometimes as I read my morning news - a potential blog topic just pops up. The first few sentences are there in my mind before I am even aware that I am thinking about  writing. But for most topics I need to think about them longer than that - sometimes for a day or two, sometimes for a week before I start to write.  But every once in awhile a topic that I had discarded as not being interesting enough to write or to read about starts (unknown to my conscious mind) to simmer, germinate - some might even say fester in the deep recesses of my brain. Then some morning I wake up and realize that I do have something I want to say about that topic. Physician assisted suicide was a topic that I thought I was done with. I have been clear in the past that I believe that we should all have the right to say" I am ready to go". There was not much else for me to say. But.......

In my mind any law governing my right to die needed to be as simple as possible given society's need to ensure that there is capacity and consent. I was surprised therefore when the Parliamentary committee' report wandered (I thought) somewhat off track and made the conversation needlessly more complicated. They proposed that minors and people living with a significant mental illness should also have the right to say that they were ready to die. Whenever I had thought about  physician assisted suicide, I thought it would apply to those individuals who had some sort of terminal condition that was causing them pain or anguish.  To "allow" those with a mental illness - surely by definition people who do not have the capacity to make such a decision, to decide to request assistance would be absurd and open to allegations of abuse.

But I have thought about it and it now seems to me that there are clearly times when living with a mental illness, specifically those conditions  that are related to a chemical imbalance and living with a physical ailment are perhaps more analogous than I originally thought. It is well documented that while the effects of such mental illnesses as schizophrenia or clinical depression can be ameliorated with medications, individuals frequently complain that the side effects are so uncomfortable that they would rather not take them. The medications can cause a deadening  of emotions and a lessening  awareness of the world around the individual. They can make it impossible for the individual to participate  effectively in their environment . For some the medications are only effective when their emotions are so deadened that it feels as if they are living in a cotton batten lined cocoon.  The choices as to whether or not to take medication is not really a choice.  The individual can either live with the symptoms of the mental illness - a lifelong condition that will limit their effectiveness and participation, caused them great anguish and at the very least will keep them marginalize from much of society, or they can take medication that will limit their effectiveness and participation, caused them great frustration and at the very least will keep them marginalize from much of society. It doesn't seem to be much of a choice. Is being in great physical pain the only reason as to why we, as a society would allow physician assisted suicide?

I am not in any way suggesting that those individuals who live with a profound, incurable mental illness should have easy access to physician assisted death. But I am wondering, for the first time, if we need to have a conversation about it. I think for example that the issue of capacity and consent is far more complex than when talking about terminal physical ailments. We may need to change the definitions of those terms.  I think that we need to have a conversation about what  is suffering and when is it too much, I think we need to have a discussion as to when is the patient in control of their treatment. For example if I decide that I will not have treatment (with all of it side effects)  for a cancer - am I a suitable candidate for physician assisted suicide? If so, why can't an individual living with a lifelong and debilitating mental illness reject treatment and all of its side effects and request physician assisted suicide?

So perhaps the parliamentary committee did not get off track.......perhaps they went exactly where they needed to go.