In this episode of Euthanasia & Disability, Amy Hasbrouck, Christian Debray, and Taylor Hyatt discuss:
- United Nations draft comment on the right to life favours assisted suicide
- Canadian Mental Health Association opposes expanding AS/E to people with psychiatric disabilities
Please note that this text is only a script and that our webcast contains additional commentary.
UNITED NATIONS DRAFT COMMENT ON “RIGHT TO LIFE” FAVOURS ASSISTED SUICIDE
- In August, we found out that the United Nations Human Rights Committee was updating its general comment on the “right to life” section of the covenant on civil and political rights. The “General Comments” are the Human Rights Committee’s interpretation of Article 6 of the Covenant. This is the third time that an interpretation is being issued; the first since 1985. In the 10th paragraph, the update suggests that U.N. members should permit the legalization of assisted suicide. TVNDY will be submitting comments on this section (before the October 6 deadline) encouraging the U.N. to oppose AS/E. For more information, visit http://www.ohchr.org/EN/HRBodies/CCPR/Pages/GC36-Article6Righttolife.aspx.
- First, the U.N. statement recognizes that people think about suicide when in crisis and in a place of vulnerability. Therefore, the decision to end one’s life cannot be made freely, and member States should prevent people from acting on suicidal feelings. This is the one excellent point in the whole section.
- The next part proposes that countries should allow, or not prevent “medical professionals to provide medical treatment or the medical means in order to facilitate the termination of life.” In other words, countries should allow assisted suicide or euthanasia. As is usual in these discussions, the Committee starts sending mixed messages.
- The Committee’s description of the people who would “benefit” uses very ableist language. AS/E would be allowed for “[catastrophically] afflicted adults, such as the mortally wounded or terminally ill, who experience severe physical or mental pain and suffering and wish to die with dignity.”
- Taking this sentence apart, the U.N. is reserving AS/E for
- afflicted adults…
- who experience severe physical or mental pain and suffering, and
- [who] wish to die with dignity.
- Including a subset of people who are “mortally wounded or terminally ill.”
- What they’re really saying is that assisted suicide and euthanasia are acceptable for people with physical and psychiatric disabilities…and those who are dying. Mixed message indeed.
- The Committee doesn’t talk about the cause of the physical or mental pain and suffering. While everyone who is eligible for assisted suicide has some kind of disability, life with a disability is not as awful as it is made out to be! Most problems associated with disability come from discrimination, physical barriers, and a lack of supports for independent living. That is certainly the case in rich nations like Canada, but solving such problems is the goal of the Convention on the Rights of Persons with Disabilities, which Canada signed in 2010. It is much more of a problem in the developing countries that are members of the U.N.
- Even when someone has pain from a terminal illness or life-threatening injury, it can almost always be managed with effective palliative care. Unfortunately, palliative care is not available to many people who need it. Most doctors receive little training in pain relief. Again, if this is true of doctors in wealthy countries, imagine the struggles of poorer medical systems around the world.
- Doctors must ensure their patient’s decision is “free, informed, explicit, and unambiguous.” Multiple factors can make the “choice” to die anything but. Inequalities like the power imbalance between doctors and patients are made worse by stigma and discrimination. Depression and substance abuse may temporarily affect a person’s outlook on life and ability to make decisions – the “appeal” of assisted suicide might change over time in these cases.
- The Committee asks countries to “ensure the existence of robust legal and institutional safeguards” to “[protect] patients from pressure and abuse.” As we’ve seen in Canada, eligibility requirements and other limitations can be challenged and changed. Prognoses of terminal conditions might also be wrong. And when medical staff are involved in a death that dos not meet legal standards, of course they aren’t going to tell anyone.
- People with disabilities, including elders, are more likely than non-disabled people to be abused financially, emotionally and physically. The addition of assisted suicide can make a dangerous situation lethal. Doctors in the Netherlands and the Flanders region of Belgium have already killed hundreds of people without an explicit request. And consider Kate Cheney, an 85-year-old woman with dementia. Though Kate was found incompetent to choose assisted suicide and vulnerable to coercion, her daughter shopped for a doctor until she got the approval for Kate’s assisted suicide.
CANADIAN MENTAL HEALTH ASSOCIATION OPPOSES EXPANDING AS/E TO PEOPLE WITH PSYCHIATRIC DISABILITIES
- Last week, the Canadian Mental Health Association released a position paper opposing assisted suicide for people who only have psychological conditions.
- The short version of their statement reads “As a recovery-oriented organization, CMHA does not believe that mental illnesses are irremediable, … We recognize that people with mental illnesses can experience unbearable psychological suffering as a result of their illness, but there is always the hope of recovery. CMHA’s position on medical assistance in dying in Canada, is that people with a mental health problem or illness should be assisted to live and thrive.”
- The CMHA believes that, since mental illnesses are more likely to be “managed” than “cured,” and symptoms can respond to treatment, they do not cause “a state of irreversible decline in capacity”; nor would they result in a “reasonably foreseeable death.”
- The CMHA’s biggest concern was the ability to change one’s mind, as seen in a Belgian study where nearly half of the patients postponed or cancelled their request for assisted suicide. In a follow-up study done a year later of those still living, 84% of people were coping with the help of therapy or other means. This shows that, given time and support, the desire to die may change, especially if it is a symptom of a psychiatric disability.
- There were also concerns about shifting societal values as assisted suicide becomes more widely accepted, and other unaddressed social issues. The association cited a Dutch report that raised “red flags”; it showed that few people were seeking help, twice as many women as men were being euthanized for psychological reasons, and loneliness was a concern in half the requests.
- The three main points of the CMHA’s position are:
- belief in recovery (whether through coping strategies or relief of symptoms),
- the negative impact (loss of hope) of the health care provider’s acceptance of the AS/E request, and
- non-discrimination (people who qualify for AS/E based on a physical condition should not be excluded if they also have a mental illness).
- Finally, the CMHA called on the Canadian government to
- support centres that focus on recovery,
- invest in community mental health services,
- develop a national suicide prevention strategy, and
- invest in research to better understand the causes of psychological conditions.