Should psychiatrists and other doctors assist the suicides of mentally ill patients? Not that long ago, the answer to that question would have been unequivocally, “No” The job of a mental health professional is to save the lives of suicidal patients, not help them die.
But that was before assisted suicide became an up and coming cultural cause. Most people think that the “right to die” movement is restricted to people with terminal illnesses. While true in this country—so far—that’s just the proverbial camel’s nose under the tent. Once people accept the lethal premise that killing/suicide are proper responses to suffering, there is no permanent way to logically limit “death with dignity” to those who are diagnosed as dying.
There is already abundant advocacy in professional journals and among euthanasia activists to allow lethal injection or prescribed suicide as a “treatment” for the suffering caused by mental illness. Welcome to the subversive mental health concept known as “rational suicide,” a concept now deemed wholly respectable and worthy of reasoned discussion and debate in learned medical journals.
Under the theory, mental health professionals only have an absolute duty to stop suicides that are impulsive or frivolously based. If the suicidal person is deemed by the mental health professional to have a rational basis for self-destruction—that is, if the patient “is able to reason, possess sufficient information, have a realistic worldview, and act [to end their own life)] according to their own essential interests”—the professional’s duty shifts to nonjudgmentally help the patient engage in proper decision-making techniques about whether to commit suicide.
Indeed, some advocates believe that the proper response to a patient’s “rational” desire to die is for the mental health professional to facilitate the suicide as if death were a palliative medical treatment.
The rational suicide movement appears to be gaining traction, helping advance the assisted suicide public acceptability well beyond the terminal illness limitation. Once society rejects the sanctity of human life ethic, that makes sense. If killing/suicide is an acceptable and respectable response to suffering, why should it be limited to the dying? After all, people with mental illnesses may suffer far more intractably—and for a far longer time—than the terminally ill.
That is certainly what the influential Princeton bioethicist Peter Singer thinks. In a recent column, he wrote, “There can be little doubt that some mentally ill people are not helped by treatment and do suffer greatly.”
Hence, he could think of no reason why “incurable mental illness should not also be sufficient” grounds for facilitated death. In his view, even a mental health professional’s disagreement with the suicide or the prospect for amelioration should not be a ban on euthanasia: “In the end, only the patient can judge how unbearable the suffering is, and therefore, how much weight should be given to the possibility that it will end, either with further treatment or on its own.”
Oh, Wesley! That’s just a “slippery slope” argument! Doctors will never actually kill the mentally ill.
Wrong! Belgium and the Netherlands legally permit euthanasia based on mental illness alone. Meanwhile, Canada’s Parliament just legalized lethal jabs of the mentally ill after a waiting period to permit bureaucratic death protocols to be worked out. This is particularly worrisome for the United States as Canada is our closest cultural cousin.
And here’s an insidious twist: Euthanasia for mental illnesses has become conjoined with organ donation in both the Netherlands and Belgium, Such kill-and-harvest procedures have even been written up approvingly—or, at least without criticism—in notable international organ transplant medical journals.
For example, one study discussed the euthanasia and harvesting of four non-terminally ill patients in shocking detail: “Donors were admitted to the hospital a few hours before the planned euthanasia procedure. A central venous line was placed in a room adjacent to the operating room. Donors were heparinized [a drug to maintain organ viability] immediately before a cocktail of drugs was given by the treating physician who agreed to perform the euthanasia. The patient was announced dead on cardiorespiratory criteria by 3 independent physicians as required by Belgian legislation for every organ donor. … The deceased was then rapidly transferred, installed on the operating table, and intubated [in preparation for organ removal] …”
Ponder the enormity of what was done by doctors! Four people—who were not otherwise dying—were killed and then swiftly wheeled into a surgery suite to have their organs removed. One of these was mentally ill. In a particularly bitter irony, the latter patient was a chronic self-harmer, the “treatment” for which was administration of the ultimate harm: death.
Some might ask, if mentally ill patients want euthanasia, why not get some good out of their deaths by taking their usable organs?
But coupling organ harvesting with mercy killing of the mentally ill creates a strong emotional inducement for people in anguished mental states to commit suicide. Indeed, it could be the tipping point that pushes patients into the abyss.
Worse, the acceptance of joint killing and harvesting sends the cruel message to mentally ill people and society: “Your deaths have greater value than your lives.” In such a milieu, self-justifying bromides about “choice” and the “voluntary” nature “of the process” become mere rationalizations.
Here’s the bottom line: Assisted and rational suicide are really about abandonment. It might start slowly with restrictions. But once a society accepts the lethal premise that killing is an acceptable answer to suffering, sheer logic will take us where Belgium, Netherlands, and Canada already are. We go down that road at our great moral peril.