A tragedy, not a treatment

TO PUT INTO LAW THAT ASSISTED DEATH IS AN OPTION FOR MENTAL ILLNESSES IS, IN A WAY, A DE FACTO CONCESSION THAT PSYCHIATRY CAN’T HELP.

There’s a dark joke just waiting to be made about the prospect that doctor- assisted dying will likely soon be an option for the mentally ill in Canada. I’ll give it a shot:

A man walks into a doctor’s office and says, “Help me doctor. For years, I’ve been achingly, debilitatingly depressed. I’ve lost my family, my friends and my job. I need to do something.”

“Don’t worry, sir,” the doctor replies. “There are several things we can do. I can start you on anti- depressants today and you might start to feel a whole lot better soon. Or I can send you to a psychologist who will work intensively with you using cognitive behavioural therapy. Or if that doesn’t work, there’s always assisted suicide.”

“Hmm,” the man says. “I really don’t know. How much will all of this cost?”

“Well,” the doctor says, “since you don’t have a job and probably don’t have insurance, you’ll have to pay out- of- pocket. The anti- depressants will cost you anywhere from $100 to $300 per month. The psychologist I’d send you to charges $150 an hour.”

“And assisted suicide?” the man asks.

“Oh, that’s covered by provincial insurance,” the doctor says.

“I’ ll make my arrangements,” the man replies.

Obviously the conversation would go somewhat differently in the real world, but it nevertheless invites valid questions about how we will perceive, treat and talk about mental illness if and when it is written into Canada’s new assisted dying law. And indeed, there’s every reason to believe it will be: when the Supreme Court of Canada struck down Canada’s ban on assisted suicide, it specifically referred to competent adults enduring “physical or psychological” suffering caused by a “grievous and irredeemable” illness.

I suppose the question, thus, is not whether mental illness causes profound psychological suffering — which most people would agree it does — but whether there are any mental illnesses that could be decisively called “irredeemable.” To make that inference is no small thing, and it would be to undermine the fundamental principles on which contemporary schools of psychology are based: that is, that mental illnesses can be treated and managed though a combination of therapies and medications.

But to write into law that death can be an option for those suffering from certain mental illnesses is, in a way, a de facto concession that psychiatry can’t help them. While I have no doubt that for some people that might very well be true, I’m just not sure the government of Canada should be enshrining that notion in law.

John Moore put it well in his Friday column in drawing a distinction between assisted death and assisted suicide. And like him, I support the i dea of helping those with terminal illnesses accelerate the inevitable in order to avoid prolonged suffering. But death is not an inevitable consequence of mental illness — or at least, it shouldn’t be. To compel a physician to help a mentally ill patient end his or her life is truly to help the patient commit suicide, not to help him or accelerate a process that is already underway. There might be a case here for decriminalizing assisted suicide for the mentally ill — I’m not sure. But to write it into law that a physician shall offer assisted suicide for the mentally ill is to ask medical professionals to betray the driving principle behind psychological treatment, which is that people with mental illnesses can still live productive lives.

There’s another problematic aspect of offering assisted dying to the mentally ill, and that is that the affected brain is known to often lie to its host. A woman in labour will beg for drugs to alleviate her pain even though she swore beforehand not to get an epidural, and a man swallowed in the pits of depression will seek just about anything to end his suffering. But how can the state sanction death for someone when the decision is made under duress? Particularly in cases of chronic mental illness, how can anyone — including the patient — be sure his or her decision is a lucid one?

None of this is to minimize the profound suffering that those with mental illnesses are forced to ensure. It’s only to suggest that as far as the state is concerned, the government shouldn’t be offering suicide as an option. If we agree, as we should, that a suicide due to mental illness is a tragedy, we shouldn’t also make it a sanctioned medical treatment.

rurback@nationalpost.com Twitter.com/RobynUrback Robyn Urback is a member of the National Post editorial board.