Gaind, a past president of the Canadian Psychiatric Association, is chief of psychiatry at Humber River Hospital in Toronto and is the physician chair of the medical assisted suicide team.
“There’s no doubt that mental illnesses lead to grievous suffering, as grievous, even more grievous in some cases than other illnesses,” Gaind told the National Post. “It’s the irremediability part that our framework also requires and that scientifically cannot be met. That we cannot do. That’s the problem.”
Depression, he noted affects a patient’s outlook on the future.
“You don’t think about the future the same way. You see nothing. And there’s that hopelessness,” he said.
Gaind said isolation and poverty could play a role in assisted suicide requests. People seeking assisted suicide due to the prospect of foreseeable death do so out of concerns about their autonomy and dignity and tend to come from a higher socioeconomic standing.
Those seeking euthanasia or assisted suicide solely for mental illness, however, tend to be disproportionately women. In the Netherlands, women outnumber men by two-to-one among such patients. Gaind voiced concern that this parallels the ratio of suicide attempts. Most who attempt suicide and fail do not do so again, he noted.
“So, the concern is, are we then shifting this transient suicidality into a permanent death?” he asked.
The Netherlands has allowed assisted suicide for those with “irredeemable” mental suffering since 2002. At the same time, 90% of initial requests do not end in assisted suicide, with most request denied by psychiatrists and some requests withdrawn by the patients.
The Canadian Medical Association on April 4 published a study that surveyed Netherlands psychiatrists about assisted suicide for the mentally ill, the U.K. newspaper The Independent reports. The study summarized their views: “making meaningful prognostic claims about psychiatric suffering is challenging or, some feared, impossible.”
Guidelines for euthanasia and assisted suicide could emphasize a retrospective view of a patient’s history of failed treatments rather than ask psychiatrists to evaluate prospects for improvement.
Jocelyn Downie, a professor of law and medicine at Dalhousie University, said those who seek assisted suicide are generally not forced to undergo other kinds of treatment, such as chemotherapy for cancer patients, out of respect for autonomy. At the same time, she told the National Post that if a patient refuses basic treatments, “that to me is a red flag about their decision-making capacity” that merits deeper scrutiny from an advising doctor even though the patient might still have that capacity.
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Dr. Jennifer Gaudiani, a Denver, Colo.-based internal medicine doctor who is an eating disorders specialist, made the news for co-authoring academic paper advocating assisted suicide for patients with severe anorexia nervosa.
Gaudiani, who does not endorse assisted suicide for other psychiatric conditions, told the National Post “an exceptionally tiny fraction of people” suffer from anorexia so severe that they could quality for a terminal diagnosis. She cited the dangers the condition causes to patients including malnutrition and bone damage.
Her stand drew criticism and concern from those who said the condition is treatable. A patient who is starving or severely malnourished may lack the mental capacity to consent. Several doctors told the Colorado Sun that her paper is dangerous to patients.
Dr. Blake Woodside, a professor in the University of Toronto’s psychiatry department and former director of Toronto General Hospital’s eating disorders program, said offering medical assisted suicide to those with anorexia nervosa would be “complicated beyond belief.”
“Most people with anorexia nervosa do not want to die, and most people with severe anorexia nervosa do not see themselves at risk of death. The majority of people with bad anorexia nervosa have significant denial about how severe their illness is,” Woodside told the National Post.
Dr. Angela Guarda, a psychiatrist who is director of the eating disorders program at John Hopkins University in Baltimore, told the Colorado Sun that assisted suicide medication for people with anorexia is “alarming” and “fraught with problems.”