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The Complexity of Right-to-Die Legislation Including Mental Illness

Editor's Note

If you experience suicidal thoughts, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741741.

It was 1988 when my mom wrote the first in a series of letters to our Prime Minister at the time, Brian Mulroney, regarding being able to end her terminal illness in a manner in which she had some control.

It was in 1989 that she contacted a Right to Die organization based in Oregon, and after numerous rounds of correspondence, was mailed a book written by the founder about euthanasia. This book was not only a memoir, but contained information about certain drugs and the amounts that would be required to overdose. The letters and pleas continued, to no avail, and after battling cancer for six long years and deteriorating to the point of having no quality of life, on September 10, 1990, she took a lethal overdose in the comfort of her home. She had spoken multiple times about this plan over the previous months and made it quite clear she had no intention of dying in hospital. She already had a DNR (Do Not Resuscitate) order and wanted to have some control over the last moments of her life.

She lay in her bed for hours but had merely slipped into a coma, which caused enough concern that she was transported to the hospital. When I arrived at the hospital and saw her lying motionless, she looked so peaceful, like she had fallen into the deepest sleep. She remained comatose for almost a week before shocking everyone and waking up, which no one could explain given they said what she consumed would have killed a horse. She had nothing but painkillers and IV fluids and continued to rapidly decline. There was one more failed attempt in hospital before the last one finally brought her the peace she was so desperately seeking. That was October 5, 1990. She had written nearly 100 letters.

In February 2015, the Supreme Court of Canada made physician assisted suicide (euthanasia) fully available to all mentally competent Canadians with terminal illnesses. Prior to the ruling, assisted suicide was illegal in Canada and punishable by up to 14 years in prison. There are strict laws governing the process, such as assisted suicide not being available to minors and only available to those residents eligible for Canadian healthcare. It cannot be used to relieve any mental illness or long-term disability, and patients are not allowed to arrange to consent in advance to die; for example in cases of dementia or Alzheimer’s. This protocol has sparked debates in many areas but none as big as when a parliamentary committee recommended that people with mental illness be eligible to seek euthanasia to end their lives in the same manner as those with a terminal illness.

The Netherlands was the first country to legalize euthanasia in cases of terminal illnesses almost two decades ago, and in that time, the practice has become legal in Belgium, Luxembourg and Switzerland as well as in nine U.S. states. The feelings are mixed when it comes to people’s beliefs of right and wrong, but if you have ever watched another human being slowly, painfully, rot away with not an ounce of dignity left, it might just open your eyes to the reasoning.

Assisted suicide based on psychological suffering is permitted in the Netherlands, Belgium and Quebec. A 2015 Netherlands euthanasia report stated that there were 5,516  assisted deaths that year, with 1% being for psychiatric reasons and 2% for dementia. In early 2012, a group called the End-of-Life Clinic went into operation for people whose doctors refused to assist in their suicides. The clinic has pushed the moral debate to its highest peak by helping people with chronic depression to die, and allowing some dementia patients to sign a euthanasia declaration in the early stages of their disease. The number of assisted suicides has continued to go up, and has included people who have had autism, borderline personality disorder, chronic fatigue syndrome and chronic depression. In two of the more famous cases, the women had lived with multiple mental illnesses over the years, tried pills, therapy and everything else possible before giving up on the thought of their lives ever improving. Should doctors respect their wishes to die in the same way they would respect the wishes of a patient with stage four cancer?

With mental illnesses, the biggest issues are whether legalized euthanasia can lead to a suicidal frame of mind based on a desire to escape prolonged suffering, and whether a person struggling with chronic mental illness has the capacity to make such a life and death decision. Given that mental illness can distort thinking and impair judgment, perhaps on the finality of the consequences, we have to question — is it the “rational” mind speaking or the voice of the illness? “Right to Die” advocates point out that doctor assisted suicide would be less traumatic than other forms of suicide, for everyone involved.

The protesters say that accepting euthanasia as an option for those living with mental illnesses would create a “presumption of sanity” for those who attempt suicide or request assisted suicide — as candidates are supposed to be mentally competent to make an informed and voluntary decision. Many people who die by suicide live with mental illnesses, and there lies the conundrum. Do we help people achieve a peaceful death, or do we allow them to struggle until they take their last breath?

Here in Canada, there is a bill on the table that would potentially make it legal for people with severe mental health issues to end their lives with MAiD (Medical Assistance in Dying). The problem being the lack of clarity surrounding the legalities.

Will I be allowed to end my life after struggling for more than 40 years? Should I be allowed to? Where is the line drawn?

The irony is that many spend years trying to prove they have a mental illness in order to apply and receive a disability income, yet to receive that we are declared mentally disabled. This leads me to question whether I would be declared mentally unfit to make a decision about MAiD; or will the government now determine that I am sane enough to end my life? There are far too many little holes and unanswered questions regarding this topic, and this Bill. With the leadership in Canada right now, one has to wonder if this is really for the benefit of the people or has it become easier to kill us off than pay us a liveable wage.

Only time will tell.

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Getty image via ThitareeSarmkasat

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