Wednesday, July 1, 2015

Assisted Suicide as a Treatment for Depression

One understands that people who are in the last stages of an inevitably fatal disease would prefer to die sooner. Some of them refuse further treatment, the better not to prolong their agony.

One understands that some people disagree with this view on the grounds that… once you legalize euthanasia, where do you draw the line?

In Belgium the law says that an individual can receive a lethal injection—which sounds rather similar to an execution—if he or she is in “intractable and unbearable pain.”

But, who knows whether your pain is intractable and unbearable? And, what if your pain is mental, thus, not associated with an identifiable physical illness.

Now,we have the answer. Doctors in that nation have decided to help a 24 year-old-woman to put an end to her life—under medical supervision—because she is suffering from … depression. Since she has often failed when attempting suicide, doctors want her now to be able to succeed. Do they think it will make her feel better?

Newsweek has the story:

Doctors in Belgium are granting a healthy 24-year-old woman who is suffering from depression the right to die, as she qualifies for euthanasia, even though she does not have a terminal or life-threatening illness.

The 24-year-old female, known simply as Laura, has been given the go ahead by health professionals in Belgium to receive a lethal injection after spending both her childhood and adult life suffering from "suicidal thoughts," she told local Belgian media.

Laura has been a patient of a psychiatric institution since the age of 21 and says she has previously tried to kill herself on several occasions. She told journalists: "Death feels to me not as a choice. If I had a choice, I would choose a bearable life, but I have done everything and that was unsuccessful." The date of Laura's death is yet to be decided.

Pay close attention: because just because it does not feel like a choice... that does not make it less of a choice. It’s almost as though Laura is saying that she is going to die anyway—doesn’t everyone?—why prolong the agony?

Besides, if this is what she really, really wants how can anyone deny her her heart’s desire?

How does one fail to note that she is wallowing in depressive thinking? Surely, there are treatments for such thinking. A dose of optimism might do wonders for her. Haven’t the latest cognitive and behavioral treatments for depression, to say nothing of the latest medical treatments reached Belgium.

Belgium, a nation that does not have the death penalty, is going to put Laura to death by lethal injection because she is depressed.

If Laura were an nonagenarian with terminal cancer, we would understand. Since she is a young woman with her life ahead of her, we do not understand why physicians would give up on treatment and allow her to be put to death.

Clearly, this sends the wrong message. It feels like a physician’s revenge, an effort to wipe a difficult patient off the books. It also looks like the kind of problem you encounter when you base medical decisions on a person’s beliefs and when you confuse a deeply held conviction (which used to be called a delusion) with reality.


Leo G said...

Time to add to Kathy Shaidle's list -

Ares Olympus said...

It certainly doesn't sound very good, but when a patient has repeated attempted suicide and seems determined, perhaps some cooperation is called for.

I think of the M.A.S.H. theme "Suicide is painless, it brings on many changes, and I can take or leave it if I please." What does that song mean except that live is painful, and one form of dignity is to know you are in control over your own suffering.

I guess the ideal for me would be to express a "ritual process of suicide", that is to say contemplating about ending your life moves people outside of ordinary awareness, and perhaps almost like the "awakeness" of combat of external enemies, we also have internal enemies, and if some part of us is sabotoging us, making destructive decisions, that part can't be reasoned with, and may not be defeatable, except through death. On the battlefield you can kill all your enemies perhaps, but if your enemy is within, then you can only kill yourself to kill that enemy.

So my thought is depression exists when we're cut off from a part of ourselves, and if that's a constant state, we have to wonder how to invoke what's missing. So I imagine suicidal fantasies and actions are ways of forcing attention to some inner conflict, like (metaphorically) having a roommate who won't get out of bed, and then you set the house on fire and see if he's really so depressed he'd rather burn alive than get out of bed.

So if suicide contains that sort of unconscious struggle, then a ritualized aided suicide should contain something that is "real" enough to bring out the will-to-live before an irreversible action is completed.

And on the same grounds, you can imagine life for a person contains an "unacceptable truth" they've avoided, perhaps like a refusal to take any risks. So perfect safety becomes a sort of depression, and self-harm threatens that safety that no longer serves its original need. So perhaps you could say we all hide behind certain habitual defense mechanisms, and they control us by defining who we think we are, but if we can end our existence, that offers a potential reset, where all old agreements with self can be renegotiated.

But again, I'd wonder how doctors could "simulate" this suicide process in a way that allows these primal struggles to arise to conscious awareness? And perhaps if a process can be slow enough, something could come out that otherwise wouldn't.

Perhaps that's also why women fail at suicide more than men, because they tend to pick less violent ways to end their lives, with more steps where they find that inner voice that fights for life?

I guess I always would follow Jung or Einstein's ideals of a "thought experiment", but some thoughts are so unacceptable perhaps that actual physical danger, including imminent death is necessary to bring them to the surface.

Myself I never got close to actual suicidal plans, but in my mid-20's I decided 20% of me didn't want to live, and I did indeed find that risk-taking was what I was refusing, and also a willingness to do things my way regardless of what others thought. So that 20% told me important stuff that my socialized self would never accept as necessary.

I also read some from Joseph Campbell back then too, and the ideals from primitive cultures that boys don't grow up without facing physical trials, and I imagine girls have similar need for trials. Anyway, these are things that don't make sense to mordern enlighted thought.

And any modern person who sees reason in seemingly irrational suicide is a dangerous person who shouldn't be trusted with important things like forcing adults to find their reason to be alive. Who could ever be trusted with the power of life and death anyway?

zbignu said...

If she truly wanted to kill herself she probably wouldn't have failed multiple attempts. It seems to me that having her doctors involved gives a tacit 'O.K.' to her killing herself. As if it's the correct thing to do. It's a shame really, so young. What are her therapists thinking? Apparently this young lady has "Had Enough Therapy"

Sam L. said...

She won't be feeling better; she won't be feeling.

Anonymous said...

I have some ambivalence regarding assisted suicide for mental illness and chronic pain. I absolutely disagree that a 24 yr old should not qualify given the limited amount of time that her body has had to fully form (hormones, brain development...).

But what about the 50, 60, 70 yr old that has had severe depression or chronic pain since childhood? Would it help for someone to know they had the option? If we had better treatments for people with chronic suicidal ideation would assisted suicide still seem at all relevant?

Suicide hotlines are useless for people in these situations. Most mental health providers and institutions are not of much help since the individuals helping have issues/negative feelings towards the suicidal. There is a point where the pain is too much and suicide is a rational decision. I know that's unpopular to say because there are many that have impulse issues and/or good prospects for improvement but that isn't the case for everyone.

I'm not suicidal but I have been severely depressed and I've had severe chronic pain. If my depression and high levels of pain had continued many years past the many I had already there is no way I'd stick around and it would only be compassionate to help me end the suffering.

Anonymous said...

Oops, meant to say I do not think the 24 year old should qualify!

Ignatius Acton Chesterton OCD said...

As Sam L. alluded to, I suspect euthanization treatment has a 100% success rate. At least until Purgatory. Or Hell if one gets to move on immediately with a suicide pass.