Mental health oriented right to die movements?
March 6, 2008 1:23 PM   Subscribe

Are there any mental health oriented right to die movements?
posted by By The Grace of God to Human Relations (26 answers total) 7 users marked this as a favorite
As in "I'm so depressed I wish I could die"?

That seems very counter to the notion of rational choice that pervades most organizations in that field.
posted by Oktober at 1:31 PM on March 6, 2008

In addition to Oktober's point, depression is treatable, not terminal.
posted by ibmcginty at 1:39 PM on March 6, 2008

I think the issue, BTGOG, is that only Oregon has a right-to-die system in place. This system has held up in the Supreme Court, but its opponent are often disabled people who think the program will encourage people to end their lives. While that is bunk, you still need to have consent from two doctors and prove your condition is causing extreme physical pain and treatment is no longer an option for life transformation. Often patients to seek euthanasia are already in hospice. Doctors will make a prescription of a high powered barbiturate. The suicide attempt can backfire if the drugs, which must be administered by the patient only, are taken wrong. They could just end up sleeping for 36 hours.

People with mental health problems who are in extreme pain and terminally ill or in hospice care would probably qualify for the plan, but would need to probably additionally prove they are of right mind to take the drugs themselves.
posted by parmanparman at 1:54 PM on March 6, 2008

OP asked for movements, not existing legal systems.
posted by Melismata at 2:04 PM on March 6, 2008

I do not know of (and cannot find) any movements, but I do know of this article from the British Medical Journal, a publication which is held in high esteem in these parts:

BMA Article

Perhaps it might lead you to something.
posted by Blacksun at 2:25 PM on March 6, 2008

Some things aren't really "treatable" in any average sense of the word.

One thing that comes to mind is someone with a disorder that leaves one with two options: strong antipsychotics, locked up for life, or death. It wouldn't be much of a life. I don't want to make this a "Is the right to die a real right" argument, but are there any organizations that propose right-to-die in some circumstances?

But, yes, depression, even if it's completely physiologically based, IS treatable and, damn, I'd want to be sure I couldn't have a life before I went down that road. Of course, my history here would suggest I'd off myself if the right situation came up. :-( I sincerely doubt it...
posted by tcv at 2:36 PM on March 6, 2008

The other thing that jumps to my mind is Alzheimer or other dementia-like conditions. If it's a choice between putting my family through that hell or just not waking up one morning, I don't really think that's a choice I'd have to deliberate on.

Naturally a few years later they'd come up with a cure and Bones would be tormented over it, but them's the breaks.
posted by Skorgu at 2:41 PM on March 6, 2008

i think some people are missing the question here, its not a debate over the ethics of it but he is looking for any movements involved in this.

i'm sorry but i don't know of any either :(
posted by Jack Feschuk at 2:54 PM on March 6, 2008

I believe By the Grace of God identifies as a female, Jack.
posted by muddgirl at 3:24 PM on March 6, 2008

identifies herself as a female, I mean. As in she is a woman.
posted by muddgirl at 3:25 PM on March 6, 2008

The Hemlock Society and their sister organization, Compassion and Choices, come to mind.

You can't approach this issue in a sensible way without thinking about mental health - of the person who wishes to die, but also of that patient's caregivers, family, friends and relations.
posted by ikkyu2 at 5:07 PM on March 6, 2008

The right-to-die movement exists outside of the ethical boundaries of the American Psychological Association (APA). This is due to the first rule, "Do No Harm." Individuals that advocate for the movement must do so without their professional credentials.
posted by mynameismandab at 8:53 PM on March 6, 2008

I am in various communities that have various viewpoints on "right to die." (I myself am ambivalent.) The women's rights world tends to be pro. The disability rights world tends to be very anti. The mental health disability world tends to be mixed.

A friend of mine who is considered a leader in the mental health disability world is decidedly pro-"right to die," and is frustrated with the disability rights movement's position. She views her own position as based party in her experiences as a person with a psychiatric condition. Here's an article she posted on a discussion board.
posted by ClaudiaCenter at 9:08 PM on March 6, 2008 [1 favorite]

Mynameismandab, "First do no harm" is part of the Hippocratic oath, and applies only to doctors. Even ignoring the obvious position that a life of extreme agony constitutes more "harm" than the nothingness of death, doctors may advocate for a right to die without administrating that death. Much like they can advocate for the right to drink liquor, even though booze is harmful.
posted by explosion at 8:03 AM on March 7, 2008

The APA is pretty much a fringe wacko group, these days.
posted by ikkyu2 at 8:06 AM on March 7, 2008

Explosion, please see this.

Principle A: Beneficence and Nonmaleficence
Psychologists strive to benefit those with whom they work and take care to do no harm. In their professional actions, psychologists seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons, and the welfare of animal subjects of research. When conflicts occur among psychologists' obligations or concerns, they attempt to resolve these conflicts in a responsible fashion that avoids or minimizes harm. Because psychologists' scientific and professional judgments and actions may affect the lives of others, they are alert to and guard against personal, financial, social, organizational, or political factors that might lead to misuse of their influence. Psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work.

Say what you want, but I'm in the profession and I can never advocate that a client end his or her own life, no matter how much I may disagree in my personal values.
posted by mynameismandab at 6:32 PM on March 8, 2008

Say what you want, but I'm in the profession and I can never advocate that a client end his or her own life

Aren't you lucky to have such cherry-picked clients, then. Nurse an elderly lady with severe Guillain-Barré syndrome - total tetraparesis, no muscle function anywhere in the body other than the eye movements- through 2 months on a ventilator with no recovery and no reasonable prognosis for recovery and then see what you say. See, indeed, whether your capacity to inflict wilful cruelty - and watch the wretched suffering that results - is in fact as powerful as you state that it is. Communicate with her via her eye movements, if you think you have the stomach for it - look up for yes, down for no - and ask her if she wishes to be allowed to die.

Maybe you'd be surprised to learn that someone can beg for death using only their eye movements.

I bet you're not so tough as you say you are. I bet you don't do any of your work in intensive care units, either. Where you're most needed, where the deepest suffering is, you're not going - for your own convenience, probably; ICUs smell bad and they are depressing - yet you feel free to make your authoritarian pronouncements about all people. How do you feel about that? Good? Glad to know it.

American Academy of Neurology Position Statement on such patients, incidentally. A most humane document, written in the face of injustice and suffering so grave that most who have no experience cannot comprehend it.
posted by ikkyu2 at 8:36 PM on March 8, 2008 [4 favorites]

ikkyu2, I might be reading mynameismandab's post incorrectly, but I think she's saying she legally can't do it, even when she wants to.
posted by small_ruminant at 10:07 AM on March 9, 2008

Really? That actually hadn't occurred to me, s_r. I thought mandab's point was that she won't do it because that's how she interpreted the APA ethical guideline she posted. Professional organization guidelines aren't binding, anyway - the worst they can do is kick you out.

Looking back at it with that in mind, I guess maybe that was her point? It's not clear. The guideline itself is weasel-worded to the point of uninterpretability anyway.

After posting the above I thought about it for a while and I realized I've never seen a psychiatrist or a psychologist in an intensive care unit (apart from a couple patients who happened to hold those qualifications and were critically ill.) What's up with that, anyway? It seems like a dumb policy.
posted by ikkyu2 at 10:31 PM on March 9, 2008

Hmm. No, you're probably right, and I was misreading. She seems to have a different definition of harm than a lot of people, as you've already pointed out very effectively.

I have no idea why psychologists and psychiatrists aren't in the ICU. I'd have thought they'd be standard procedure.
posted by small_ruminant at 10:00 AM on March 10, 2008

Okay everybody, to clarify my statement:

A Personal Anecdote:
My great grandfather is 100 years old. He lives in a nursing home people rarely visit; his wife has been dead for 20 years; 3 of his 5 children have already died. He is lonely without his wife and children, he's depressed, and even his once razor-sharp wit and memory is starting to fade. I sense that he feels there is nothing here for him anymore; he's just waiting for his turn to die.

My Beliefs:
My grandfather's personal convictions prohibit suicide, but I can't help but thinking that at his age and in his circumstances, he (or anybody in the same kind of situation) has earned the right to make that decision for himself, rather than being forced by the government to continue a life that he may not want.

So in my personal life, I am somewhat of an advocate for the right of people of a certain age plus relevant circumstances, or with various degenerative illnesses to have a say in how or if they choose to continue their lives.

Professional Responsiblity:
But the APA ethical codes aren't just a good idea or a guideline. For practitioners, they're the Law. We have required coursework in Psychological Ethics and Accountability; our licensing exams test our knowledge of professional ethics and accountability; and we take a written oath to uphold those ethical codes, on penalty of losing our licenses. Mental health workers are highly litigated. It's hard enough when it's a frivolous or unfounded lawsuit, but if it's true, there could/will be hell to pay.

So according to my training, because I am duty-bound to the ethical codes, I am unable to suggest or help clients find ways to end their own lives. To do so would constitute serious professional misconduct. I could lose my license. I Would Lose My License. For Good. And that means that even if the professional code changed in the future and was more in line with my personal beliefs and values, I Still Wouldn't Be Able to Practice.

Call me crazy, but I am simply not willing to jeopardize my whole calling and life's work for a few fleeting patients. It's a boundary issue, and it's as serious as having a sexual relationship with someone entrusted to my care. In the world of psychological ethics, any life is better than no life, no matter how much it (the ethical principle or your life) may suck.
posted by mynameismandab at 10:22 PM on March 12, 2008

But the APA ethical codes aren't just a good idea or a guideline. For practitioners, they're the Law.

All right. But they don't say anywhere that patients can't be allowed to choose to die with dignity if that is part of the natural course of their life path. Your interpretation of nonmaleficence that you've expressed is way outside the norm in the medical community that I belong to, and I think it's probably outside the norm even for the APA.
posted by ikkyu2 at 12:24 AM on March 13, 2008

I'm not going to argue with you about this.

You're right that patients are responsible for their own actions, but if I am knowingly complicit in an act that defies the ethical code, I can be held legally and professionally libel for any resulting harm. In this case, advocating to my clients about my personal belief in their right to die, helping them contemplate possible methods, or helping them implement a death plan defies the code because it could lead to obvious, measurable "harm," namely, the loss of their life. It's not an opinion. It's a fact.

We in the mental health field are accountable not only to our clients, but to the professional community. If a colleague observes an unethical act on my part or receives a complaint about unethical behavior from a client, s/he has a responsibility to address it with me and my supervisor, and ultimately the state and national boards of professional licensure if necessary.

How can I be so convinced about this?
Remember my great-grandpa-- during the course of my graduate coursework I interviewed him and wrote a paper about it. In my conclusion I briefly mentioned that I believed some people should be able to choose if/how to continue living, and that I would be willing to discuss with them their options for achieving that goal. My supervisors called me out on it. I sought feedback from a second and a third source, and they all said the same thing. It's not allowed.

I'm not crazy about the fact that I have to censor myself any more than anybody else, but the truth is, it's not about me. It's not about you. It's about them and putting their needs above my own. And in this profession their need for safety supercedes my need to evangelize my personal values in my workplace. That's what it means to be a professional.
posted by mynameismandab at 3:47 PM on March 13, 2008

One more thing, other than suicide prevention, right-to-die politics just isn't something that comes up very often. And even if it did, we are still bound to that pesky ethical statute.
posted by mynameismandab at 6:04 PM on March 13, 2008

[derail removed - take this to email if it becomes a back and forth not about the topic at hand, thanks.]
posted by jessamyn (staff) at 8:05 PM on March 15, 2008

If anyone's reading this, I'd like to point out that

a) mandab retracted her dogmatic stance over the course of a few MefiMails with me;

b) as a board-certified neurologist, I deal with these issues frequently on a professional basis;

c) if anyone's still left with questions, feel free to Mefimail me; there's a lot left to say, but when I tried it got nuked.
posted by ikkyu2 at 10:18 PM on May 25, 2008 [1 favorite]

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