It Doesn’t Get Bet­ter

The men­tally ill de­serve the right to die with dig­nity

The Walrus - - CONTENTS - By Graeme Bayliss

The men­tally ill de­serve the right to die with dig­nity

If you were go­ing to kill your­self, how would you do it? You could jump off a bridge, or leap in front of a sub­way, or shoot your­self in the head. You could tie a noose round your neck or take an over­dose of bar­bi­tu­rates. You could even swim out into the lake, too far to swim back.

I’ve con­sid­ered many of these ­meth­ods my­self and have even at­tempted to carry some of them out — as the scars on my left wrist can at­test. I was di­ag­nosed with de­pres­sion, var­i­ous forms of anx­i­ety, and ob­ses­sive-com­pul­sive dis­or­der at seven­teen, and, de­spite nearly a decade of ther­apy and a dozen med­i­ca­tions, have of­ten thought of off­ing my­self, to the ex­tent that I’ve al­ways sim­ply as­sumed that, when I even­tu­ally went, that’s how I’d go. You may un­der­stand­ably won­der why I’ve been un­suc­cess­ful in my pur­suit of the void.

As Dorothy Parker re­minds us, killing your­self is a tricky thing to do. Set­ting aside the ba­sic hu­man im­pulse to sur­vive, there are a great many prac­ti­cal com­pli­ca­tions that any at­tempt at sui­cide pre­sents. Guns can mis­fire, ropes can snap, drugs can ­in­duce vom­it­ing and leave you with lit­tle more than a sore stomach and a­dam­aged liver. Around 40 per­cent of sub­way jumpers sur­vive, man­gled into con­sid­er­ably worse shape than be­fore. Just 1 per­cent of wrist-cut­ters are suc­cess­ful.

Most sui­ci­dal peo­ple are aware that what­ever at­tempt they make on their own life is sta­tis­ti­cally likely to fail, caus­ing them greater pain and hu­mil­i­a­tion, com­pound­ing their sad­ness and anx­i­ety. (Once, on my lunch hour, I walked down to a ­frigid Lake On­tario, there tak­ing off my coat and shoes with the in­ten­tion of tak­ing a ter­mi­nal swim. I backed out in part be­cause, had I failed, I would’ve had to re­turn to work and tell my col­leagues why I was sop­ping wet.)

There’s also the mat­ter of the body. No one should have to stum­ble upon the still-swing­ing rope or the brain mat­ter on the wall, but, in­evitably, some­one does. That’s be­cause, in Canada, the sui­ci­dally de­pressed still don’t have the right to die.

Ra­zors pain you; Rivers are damp; Acids stain you; And drugs cause cramp. Guns aren’t law­ful; Nooses give; Gas smells aw­ful; You might as well live. — Dorothy Parker, “Re­sumé” (1925)

They still don’t have the right to end their suf­fer­ing with dig­nity; they still don’t have the right to spare the peo­ple they love the shock of los­ing them, of knowing that they died alone in ter­ri­ble pain.

In April, Justin­Trudeau’s gov­ern­ment ­un­veiled its new right-to-die ­leg­is­la­tion. It will give those suf­fer­ing from painful ­ter­mi­nal and ­de­gen­er­a­tive phys­i­cal ill­nesses — those for whom “nat­u­ral death has ­be­come rea­son­ably ­fore­see­able” — ac­cess to doc­tor-­as­sisted sui­cide. It will not give those suf­fer­ing from painful men­tal ill­nesses the same ac­cess, de­spite a par­lia­men­tary com­mit­tee’s rec­om­men­da­tion to the con­trary (the bill pro­poses only that an in­de­pen­dent body be es­tab­lished to ex­plore the is­sue). But that won’t stop thou­sands of Cana­di­ans from killing them­selves this year. Sui­cide will ­re­main one of the most com­mon causes of death in this ­coun­try (and the ­se­cond-most ­com­mon cause among young peo­ple), and it will ­re­main as ­grisly and undig­ni­fied as it ever was.

Crit­ics present the sui­ci­dally de­pressed with a Catch-22: if they don’t want to live, then that very fact means they can’t pos­si­bly con­sent to die.

The ar­gu­ments against le­gal­iz­ing doc­tor-as­sisted death for the clinically ­de­pressed are mostly spe­cious. Slip­perys­lope fal­la­cies (“What’s next? Eu­gen­ics?”) were pop­u­lar among news­pa­per colum­nists in the lead-up to the re­lease of the leg­is­la­tion, while con­cerned op­po­si­tion mem­bers of Par­lia­ment took to build­ing straw men, sug­gest­ing that the gov­ern­ment should help peo­ple in­stead of killing them. But coun­tries in which the men­tally ill have for years had the right to die — in­clud­ing Bel­gium and the Nether­lands — have not taken to ­eu­th­a­niz­ing un­de­sir­ables; and, of course, no one is sug­gest­ing that doc­tors stop pre­scrib­ing ther­apy and med­i­ca­tion and ­in­stead ­ad­vise their patients to take a long drop with a sud­den stop.

More dis­turb­ing is the no­tion that the men­tally ill are, by def­i­ni­tion, in­ca­pable of de­cid­ing ra­tio­nally to kill ­them­selves. As the Con­ser­va­tive MP Gérard ­Del­tell (who is not a med­i­cal ­pro­fes­sional) said in a ­re­cent in­ter­view, “At what point does some­one suf­fer­ing from a men­tal ill­ness of­fer his or her full and com­plete con­sent? It’s im­pos­si­ble.” Cer­tainly, ques­tions of con­sent are fraught when it comes to psy­chotic ill­nesses, but I have never ex­pe­ri­enced the breaks with re­al­ity that typ­ify them. ­Del­tell’s monochrome think­ing, there­fore, pre­sents me with a Catch-22: if I don’t want to live, then that very fact means I can’t pos­si­bly con­sent to die.

Ob­vi­ously, what­ever treat­ments are avail­able — the med­i­ca­tions now are num­ber­less, and their ef­fi­cacy can of­ten be im­proved through psy­chother­apy and cog­ni­tive be­havioural ther­apy — should be tried be­fore any de­ci­sion to die is made. And that de­ci­sion should be made by an adult, in con­sul­ta­tion with psy­chi­atric pro­fes­sion­als. (Eigh­teen-year-olds are al­lowed to pur­chase ci­garettes, so it would be tough for any gov­ern­ment to ar­gue that they don’t have the where­withal to kill them­selves by other means.) It needn’t be deemed a moral ca­pit­u­la­tion or chalked up to an ­in­suf­fi­ciently stiff up­per lip.

In my case, there’s al­ways a chance that the de­pres­sion and anx­i­ety and OCD will dis­solve bliss­fully away — or at least ­be­come man­age­able — and I will live

­longer than I’d ever thought pos­si­ble. But the gov­ern­ment will not, on the ba­sis that a cure might even­tu­ally be found, ban ALS ­patients from as­sisted sui­cide. So why should they stop the chron­i­cally de­pressed be­cause they have “good days and bad days”? Even on the good days, I know the bad days are com­ing.

And so, for those un­lucky few who have tried ev­ery­thing and de­cided that a life mired in op­pres­sive and un­remit­ting sad­ness is no life at all: rope, ra­zor blades, pills; bridges, sub­ways, ­sky­scrapers; an emis­sions-happy car and a length of hose. These are the choices that ­Trudeau has left us with.

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