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Friday, June 9. 2017
Psychiatry and voluntary suicide
The idea of dying "when God wills it" is mostly obsolete, because the patient often would already have died on God's time. The reason such topics have become an issue is because of the power of medicine to sustain life, however terminal, painful, humiliating, or degrading. Fortunately, today we have things like DNR and hospice, but the old-fashioned way of "Let's make him comfortable" with extra morphine might have been (or still is) more humane.
Some psychiatrists wonder whether people who wish to die with some dignity should need a psychiatric evaluation before proceeding. I would say, in almost all cases, no. Obviously, a suicidally depressed but otherwise well person needs psychiatric help.
I found it interesting that almost half of patients who were prescribed physician-assisted death never used it. That means to me that many just want to have some control over their fate, over pain, etc. Makes good sense to me. Nobody wants a lengthy death consisting of weeks of gasping for air, writhing in pain, and pooping in bed.
Posted by Dr. Joy Bliss in Psychology, and Dr. Bliss at 15:51 | Comments (19) | Trackbacks (0)
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Everyone should take the time to prepare a living will and a POA for heathcare. Make your wishes known and empower your loved ones to make decisions on your behalf.
The primary opposition here to right to die laws comes from the disabled community. They believe that it is only a short step from having the right to die to being compelled to die, and that members of the disabled community will be the first targets.
"Treatment is considered "extraordinary" if it is determined to be futile, meaning that it is either not going to work to keep the person alive or to reverse the course of the disease, or if the burdens of that treatment are disproportionate to the benefits."
"For example, terminal cancer patients who stop eating are not required to have feeding tubes inserted."
These are the guidelines I intend to follow. No doctor will murder me if I can help it.
"...wish to die with some dignity..."
A lot can be smuggled into the definition here. Who is defining the terms? Whose wish?
I'm in favor of a quick exit for myself and might set a very high bar for preserving my own dignity. But not all families love Gramps, whatever they say.
In fact, I have come to regard the line "I only want what's best for..." to be a tell that the opposite is more likely to be true.
And they are correct. Singer and Emmanuel have been clear on that.
In my view, the overriding issue in the future is not going to be suicide, it's going to be euthanasia. The nursing homes are filling-up with very old people who can no longer function. For them, euthanasia would be a godsend.
There is a popular blog that deals with this subject:
I am in favor of euthanasia because it's merciful for the patients; and also because taxpayers should not be held responsible for the cost of keeping these people alive.
fact that it's psychiatrists lobbying for mandatory psychiatric treatment tells me there just might be a conflict of interests at work here...
After all, who'd stand to benefit financially to a pretty large amount by having such a mandate, and then being able to draw out a conclusion at leasure until it's clear the source of that money is physically incapable of communicating with you...
reading what you wrote, you ended with a line that resonates with me and always have. I plan to step out before it gets to that point and I don't care if it makes other people unhappy. Not going that route.
I agree with your comment about not using the option.
Simply knowing you HAVE the choice can make the pain and struggle easier to bear.
Agree with Mike K. Right to die is all very well, and someone who clearly can't get well should be able to turn his face to the wall and go quietly, with as much help with comfort as we can give him. But if we're on the "vet" medical plan--someone else pays all the bills and therefore makes all the decisions, especially if we're debilitated--it's not likely to work out the way we hoped. Any "right to die" policy will have to be handled with extreme care, because the people around a person facing an agonizing death have extraordinary pressures on their compassion and ethics.
That strikes me as just the right definition of "extraordinary" treatment that no one in his right mind should choose, and no one should inflict on another without a very clear statement of choice. It can't possibly help, and the cure is worse than the disease. At that point it's time to think what kind of death the patient wants to aim for, if possible. It all becomes, as the Dr. said, about avoiding air hunger, intractable pain, and bedpans. If the patient has had no understanding of these dilemmas from earlier life, it's awfully hard for him to make good choices. We should all spend more time with the dying, for our own sake if for no better reason. I'll bet not many nurses get this wrong in their own lives.
So, you wish to murder everyone that cannot pay their way (partly, in this case, because the nanny-state has regulated the cost of providing such care to such extremely high levels)? Where would you expect to draw the line? The disabled, the chronically sick, the unemployed, children? And you virtue-signal as merciful.
I see two problems with these policies:
1. Some people who could be helped with medical care, i.e. surgery or treatment, will not be allowed to get that care because of their age. That is they are going to die anyway so why spend money on them. This happened to my wife's grandfather who at age 80 was told if he didn't have a quadruple bypass he would likely die within two years. Canadian health care basically didn't want to spend that mush money on an 80 year old so he did in fact die two years later. This was an otherwise health robust man who could have lived many years past his premature death if his health care hadn't been denied.
2. Patients who are terminal are sent home with "hospice" care and drugged and cared for by family until they die. But many die from lack of good care. They may die a week earlier than they might have with good care or they may die many weeks, many months or even years earlier because hospice isn't adequate. We will never know because they are not in the care of health professionals and they are expected to die so when they do no questions are asked. The biggest mistake that causes early death in hospice care I believe is inadequate hydration. The patient doesn't eat or drink well/enough is lethargic and the care giver doesn't know what to do. Don't keep pestering them to drink water or eat their food they are peacefully resting. But in fact they are in a progressive condition where they aren't getting enough liquids and thus they are lethargic and semi conscious and become more dehydrated and more lethargic and the caregiver may in fact simply be happy that they appear to be resting. But they are dying from lack of care. They have pain killers or pain patch and they feel nothing and simply go in and out of consciousness and the care giver is clueless. Then they die... as expected.
The glorious features of government run healthcare...
The patient is treated only if the treatment cost is lower than his or her expected tax payments over the next several years...
Not sure if it's true, but heard a few years ago the UK NHS put a hard cap on the amount of money to be spent on any single patient. If a course of treatment is expected to end up costing more than that, it's not offered.
If the patient has already used up his allowance, no further treatment is authorised.
In the Netherlands patients with serious conditions are actively pressured by medical staff to seek euthenasia, not for their own sake but to reduce the cost of keeping them alive.
This happened to my mother. Not hours after being diagnosed with cancer while in hospital for something else, we found she had been scheduled for a consult with a "terminal condition amelioration specialist" who, when we google'd the name, turned out to be a specialist on talking people into euthenasia, was even giving lectures and courses on how to do that.
We never asked for that appointment, my mother was certainly not "of sound body and mind" and capable of legally signing any related documents (though no doubt the hospital had a psychologist on staff for just the purpose to declare she was legally capable of signing).
To summarise, they were trying to murder her and make it look like she wanted it.
yup, and anyone with a lifelong condition that's not life threatening with medication but the medication is expensive.
And people with a terminal condition who have been given months to live.
Basically anyone who ends up costing the government or their insurance company more to treat than they're going to bring in in taxes/premiums is going to find themselves "offered a way out".
I don't think that the refusal to offer free life-extending medical care is a cause of premature death. Human life has been dramatically extended; for example, the average life span in the 1800's was 21 years.
Nope Nope Nope
There is no "compassion" here - just slippery-slope arguments for other's convenience, or for Leviathan to hold (the ultimate) power over others.
Wanna die with dignity? Check out and go home.
Don't corrupt the morals of the society you leave behind.
10,000 years of human history - or more, if you count archaeological evidence - indicate that actively killing another person off the battlefield, not in self defense, must, must, must remain completely taboo if evil mischief is to be avoided.
There must be a bright line. Doctors must not hasten death in any way.
Withdraw treatment? Sure.
Not forcibly feed a patient who can't feed themself? Sure.
Give the patient a morphine-dosing button? Probably.
But there can be no active measures allowed to hasten death.
That is my fear about organ donation permission on the back of driver licenses. If money can be made off the sale of organs then who can be sure when it is really time for the donor to go. I really don't trust others to make the right decision about when to remove viable organs especially if they think your life is insignificant and hey, there is money to be made.
That's pretty well right on the money.
There is a world of difference between actively killing someone and death by neglect.