Slippery slope?
In the debates regarding euthanasia, you hear a lot about the “slippery slope”. Simply, this is where small steps are taken, and often inadvertently, these can lead to a chain of events that ends up in disastrous consequences.
In terms of euthanasia, this can mean more and more criteria are added to what is acceptable so as to result in death and fewer and fewer safeguards against abuse.
It is a serious subject that deserves serious consideration.
More euthanasia
In March of 2023, Canada is to implement MAID – medical assistance in dying – for the mentally ill. This adds to the Benelux nations; Belgium, The Netherlands and Luxemburg which have implemented MAID practices that have included the mentally ill in 2002.
There are currently six countries where euthanasia and physician-assisted suicide is legal and where mental disorders are included.
While isolated instances of euthanasia have probably always occurred, there is now a trend of nation-states including the practice in government legislation.
Guiding Principles
The guiding principles behind voluntary euthanasia of the mentally ill in Canada and Benelux are first that it is supposed to be actually voluntary with the patient able to give informed consent.
While the patient does not have to be terminally ill, ” those whose psychological or physical suffering is deemed intolerable and untreatable” or similar, is the final determination. 1
We already know where this slope goes
As psychiatry could not cure, all these patients were offered was death.
Less than 100 hundred years ago, German psychiatry implemented Aktion T4 – the “involuntary euthanasia,” actually mass murder of some 270,000 of the disabled and the mentally ill by German psychiatrists.
All done on the basis of “unfit for life,” with all diagnoses thrown aside except one, “Can you work?”
Made acceptable by using slogans on how expensive it was to keep those with mental illnesses and yet based on lunatic ideas of cleaning the gene pool. As psychiatry could not cure, all these patients were offered was death.
Think Aktion T4 can’t happen again?
The hundreds of German psychiatrists, nurses and asylum administrators involved in Aktion T4 weren’t all psychopathic serial killers and yet took part in mass murder. All it took was social and professional pressures to carry out the killings as part of the eugenicist dogma of ” improving Germany.” Added to this, was the removal of restraint, whereby one order from Hitler made it ok for the entire German psychiatric profession to throw away all legal, ethical responsibility and culpability. Without that responsibility and restraint, German psychiatrists eagerly carried out the murders.
It is naive to believe that the world has somehow moved on and such men and circumstances cannot occur again. Simply do not underestimate the ability of mankind to embrace lunacy.
Poster published by Neues Volk (“New People”), a magazine published monthly by the Rassepolitischen Amt der NSDAP (Office of Racial Policy of the Nazi Party), while they were in power; the magazine was founded in 1933. The poster says:
“60 000 RM is what this person suffering from hereditary illness costs the community in his lifetime. Fellow citizen, that is your money too. Read Neues Volk. The monthly magazine of the Office of Racial Policy of the NSDAP.”
Already out of control?
… “unfit for life,” which we have heard before, is being used based on opinions and interpretations.
Some 20 years of euthanasia of the mentally ill in the Benelux countries has at least given us some information – although the information is so scant as to already be concerning.
Research in Belgium points out that in 2013 more than 40% of general euthanasia in that country was not being reported. And that 1.7% of reported deaths “were hastened without explicit request” – no longer voluntary. That is over 1,000 deaths. 2 In The Netherlands, only half of the doctors report instances of euthanasia. 3
So with close to 50% or more of instances of euthanasia of any type being reported the situation is already out of control and factually unmanageable.
Even so, what statistics are reported, show in The Netherlands and Belgium, euthanasia instances of the mentally ill increasing year after year, until now between the two countries some 150 people are euthanised each year. 4 5 6 7
Reports are now filtering through from the press:
- Three Belgian doctors were sent to trial where, among other things, the euthanised patient had had no psychiatric treatment in 15 years prior to her death.
- A depressed patient whose treating psychiatrist of 20 years did not believe she met the Belgian legal requirements but was euthanised by an oncologist who had no psychiatric training at all.
- A Belgian dementia patient who made no request to die but was euthanised at the request of relatives.
- A depressed patient in The Netherlands was euthanised without consent as two physicians, in their opinion, stated he was “decisionally incompetent”
- Although the practice is illegal, Flemish doctors have extended the euthanasia principles to newborns based on their opinions of whether the child is capable of “bearable future”.
- In The Netherlands a patient who had only expressed a wish to die at the right time in a living will, was euthanised under her protest while her relatives held her down.
And so on. Already out of control and well down the slippery slope.
With a major concern that “unfit for life,” which we have heard before, is being used based on opinions and interpretations.
Is psychiatry ready?
…only four years of political, social and professional influences had moved many psychiatrists to support these measures that they originally thought as repugnant or dangerous.
In the case of Canada, psychiatrists weren’t so sure:
“This study found that most psychiatrists, despite supporting MAID in general, do not support the legalisation of MAID for the mentally ill. Objections appear based on concern for vulnerable patients (particularly those with persistent suicidal ideation), the nature of the psychiatric illness not being easily qualified as “irremediable,” personal moral objections, and concern for the effect it would have on the therapeutic alliance”.
Skye Rousseau, Sarah Turner, Harvey Max Chochinov, Murray W Enns, Jitender Sareen. A National Survey of Canadian Psychiatrists’ Attitudes toward Medical Assistance in Death 2017. 8
This 2016 study found only 29.4 % of Canadian psychiatrists supported medical assistance in dying for the mentally ill. This survey found reasons for not supporting “the belief that MAID for mental illness would change the psychiatrists’ commitment to their patients through enduring suffering, having a personal faith, and having had past patients who would have received MAID for mental illness were it legal but instead went on to recover.”
However, another survey commissioned by the Canadian Psychiatric Association a few years later found a different result.
“But in another survey of its members conducted last October, a plurality of respondents — 41 per cent — agreed that individuals suffering only from mental disorders should be considered eligible for medically assisted deaths. “Thirty-nine per cent disagreed, while 20 per cent were unsure.”
GLOBAL NEWS. Psychiatrists more open to assisted dying for people with mental illnesses: survey
Despite the original survey bringing up real concerns of moral responsibility to their patients, only four years of political, social and professional influences had moved many psychiatrists to support these measures that they originally thought as repugnant or dangerous.
Psychiatry fails, the patient dies
All of these things are psychiatry’s shortcomings. Does the patient then have to die for them?
The determination of life or death relies on ‘irremediability of suffering’ or ‘intolerable and untreatable.’ The patient, not being an expert, is taking the psychiatrist’s word that the condition is ‘irremediable’ or ‘untreatable’. That word is entirely based on a psychiatrist’s opinion, even when an additional opinion is obtained.
Looking at the Netherlands experience, an April 2022 study investigated what determined the psychiatrist’s opinions.
“Although irremediable psychiatric suffering is a prospective concept, most participants [psychiatrists] relied on retrospective dimensions to define it, such as a history of failed treatments, and expressed that uncertainty was inevitable in this process. When establishing irremediable psychiatric suffering, participants identified challenges related to diagnosis and treatment. The main diagnostic challenge identified was the frequent co-occurrence of more than 1 psychiatric diagnosis. Important challenges related to treatment included assessing the quality of past treatments, establishing when limits of treatment had been reached and managing “treatment fatigue.”
Sisco M.P. van Veen, Andrea M. Ruissen, Aartjan T.F. Beekman, Natalie Evans and Guy A.M. Widdershoven Establishing irremediable psychiatric suffering in the context of medical assistance in dying in the Netherlands: a qualitative study. 2022. 9
Simply put, if the diagnosis is difficult, if the ‘limits of treatment have been reached’ and ‘treatment fatigue’ sets in and the psychiatrist doesn’t know what to do, then he puts the patient in the “irremediable psychiatric suffering” category and a candidate for euthanasia.
The Benelux and Canadian laws have been written based on a myth that psychiatry is a precision science and yet this is very far indeed from the truth.
First, let’s emphasize the statement that most psychiatrists “expressed that uncertainty was inevitable in this process.” The Benelux and Canadian laws have been written based on a myth that psychiatry is a precision science and yet this is very far indeed from the truth.
There are no cures for any mental illness in psychiatry nor does psychiatry know the reason for any mental illness. All the psychiatrist can offer as treatment is a possible temporary alleviation of symptoms.
With the current (poor) state of technology in psychiatry, of course treatments fail. If the psychiatrist then grows tired of trying this and that, then he can recommend death.
What is astonishing is that none of this is the fault of the patient. All of these things are psychiatry’s shortcomings. Does the patient then have to die for them?
Psychiatry eminently unqualified
Every death is an admission of the failure of psychiatry and a betrayal of their patients.
Remember psychiatry cannot cure any mental illness and has not even found the cause of any mental illness. Psychiatric treatments are directed only toward suppressing symptoms and are often brutal in application and side effects.
Psychiatry as an activity is dominated by commercial interests who profit from more drugs prescriptions written, more treatments given and not cured patients.
Psychiatry is eminently unqualified to be the determiner of life or death, but here again, it has assumed that position.
These patients are being offered a choice between life and death only based on psychiatry’s incompetence and inability (and some would even say refusal) to cure them.
Every death is an admission of the failure of psychiatry and a betrayal of their patients.
Other references:
Aktion T4 – psychiatry’s eternal shame
Commercial interests have captured mental health
- Mark S. Komrad, MD First, Do No Harm: New Canadian Law Allows for Assisted Suicide for Patients with Psychiatric Disorders 2021. Psychiatric Times, Vol 38, Issue 6,
- European Institute of Bioethics. 2020. Euthanasia in Belgium: Analysis of the 2020 Commission Report
- Tony Sheldon Only half of Dutch doctors report euthanasia, report says BMJ. 2003
- Mark S. Komrad, MD First, Do No Harm: New Canadian Law Allows for Assisted Suicide for Patients with Psychiatric Disorders 2021. Psychiatric Times, Vol 38, Issue 6,
- Regional Euthanasia Review Committees. Annual Report 2019. [The Netherlands]
- Euthanasia in Belgium: Analysis of the 2020 Commission Report
- Robert Preston Death on demand? An analysis of physician-administered euthanasia in The Netherlands British Medical Bulletin, Volume 125, Issue 1, March 2018, Pages 145–155
- 2017. Skye Rousseau, Sarah Turner, Harvey Max Chochinov, Murray W Enns, Jitender Sareen. A National Survey of Canadian Psychiatrists’ Attitudes toward Medical Assistance in Death
- Sisco M.P. van Veen, Andrea M. Ruissen, Aartjan T.F. Beekman, Natalie Evans and Guy A.M. Widdershoven Establishing irremediable psychiatric suffering in the context of medical assistance in dying in the Netherlands: a qualitative study CMAJ April 04, 2022