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.
