Opinion | Medical Assistance in Dying Should Not Exclude Mental … – The New York Times

My first attempt to kill myself was when I was a child. I tried again as a teenager; as an adult, Ive attempted suicide repeatedly and in a variety of ways. And yet, as a 55-year-old white man (a member of one of the groups at the highest risk for suicide in America) and the happily married father of five children, I am thankful that I am incompetent at killing myself.

I believe that almost every suicide can be prevented, including my own, with access to good behavioral health systems. I have talked many, many people off the ledge.

I am a Canadian, where eligible adults have had the legal right to request medical assistance in dying (MAID) since June 2016. Acceptance of MAID has been spreading, and it is now legal in almost a dozen countries and 10 U.S. states and Washington, D.C. To my mind, this is moral progress: When a person is in unbearable physical agony, suffering from a terminal disease, and death is near, surely it is compassionate to help end the pain, if the person so chooses.

But a debate has arisen in Canada because the law was written to include those living with severe, incurable mental illness. This part of the law was meant to take effect this year but was recently postponed until 2024.

Many people who want to end their lives because of intense mental suffering find themselves grateful for their lives once the suicidal moment or attempt has passed. As Ken Baldwin, who survived a suicide attempt by leaping off the Golden Gate Bridge, famously remarked, I instantly realized that everything in my life that Id thought was unfixable was totally fixable except for having just jumped.

One might expect that as someone who has repeatedly attempted suicide and yet is happy to be alive, I am opposed to euthanasia on psychiatric grounds. But it is because of my intimacy with suicide that I believe people must have this right.

Its true that policymakers, psychiatrists and medical ethicists must treat requests for euthanasia on psychiatric grounds with particular care, because we dont understand mental illness as well as we do physical illness. However, the difficulty of understanding extreme psychological suffering is in fact a reason to endorse a prudent policy of assisted suicide for at least some psychiatric cases. When people are desperate for relief from torment that we do not understand well enough to effectively treat, giving them the right and the expert medical assistance to end that misery is caring for them.

Canadas MAID law recognizes that people suffering from extreme depression, for example, may find no other means to end their agony. Approximately one-third of people coping with major depressive disorder have symptoms that do not reliably respond to available treatments. If you know there is no medically sanctioned way out of your mental pain, you may be likely to take matters into your own hands. Major depression is one of the psychiatric diagnoses most common to suicidal people, and approximately two-thirds of people who die by suicide are depressed at the time of their death. Yet any of us can commit suicide and currently it is an epidemic.

A panel of experts has recommended safeguards and protocols for requests for aid in dying made by people with mental illness. Should MAIDs extension to those suffering acute mental pain follow the Canadian model, patients will be able to make their case to two health care practitioners, who must agree that their illness is grievous and irremediable. This is far preferable to the messy, difficult, terrifying job of trying to do it yourself. The suicidal persons involvement in a behavioral health setting that can give a variety of kinds of help might result in rethinking the desire to die. Suicidal ideation can consume the lives of those who live with it. By interrupting or complicating the habitual patterns of chronic suicidal ideation, the prospect of relief through MAID could, paradoxically, ease the need for ending ones own life.

As DeseRae L. Stage, a therapist and suicide-awareness advocate, told me, This is one time that bureaucracy might actually save lives. While the Canadian application for physician-assisted suicide is being reviewed, treatment and reflection can take place. Also, the knowledge that there is a way out may alleviate the terrifying claustrophobia so common to suicidal people like me and to people in acute suffering more generally. Pain can make anyone panic.

When people are granted the right to end their lives with medical help, they may opt not to use it. People should be granted the right to this assistance. It does not follow they will exercise that right.

I agree entirely with Andrew Solomon when he writes, It is up to each man to set limits on his own tortures. That is the compassionate wisdom informing every law permitting medical assistance in dying. If we are willing to help people end their physical suffering by assisting their death, can we in good conscience deny them that help for their mental suffering? As psychiatrists like Dr. Justine Dembo of the University of Toronto have argued, excluding mental suffering from MAID would discriminate against individuals suffering intolerably from mental illness.

Yes, we need wise regulation; we need expert advice; we need the best medical information: This is precisely why physicians who specialize in this must be involved, and Canada has these experts. Must Canada, and other countries with similar policies permitting MAID on psychiatric grounds, like Belgium and the Netherlands, continue to proceed with the utmost care, with the advice of appropriate behavioral health and ethical experts? Of course. Should we be especially cautious when it comes to cases involving anyone about whose informed consent we have concerns, such as minors or the disabled? Of course. But this is how any enlightened health care policy must proceed.

Suicidal people suffering from psychological torture should have the right to consult a medical expert about medical assistance in taking their own lives and be given that assistance if their need is justified. Having terrified or anguished people in acute mental suffering ending their pain by the many means available to them, often resulting not in death but in terrible physical injury, is much worse, and its happening every day.

If you are having thoughts of suicide, call or text 988 to reach the National Suicide Prevention Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources.

Clancy Martin is professor of philosophy at the University of Missouri in Kansas City and Ashoka University in New Delhi. His latest book is How Not to Kill Yourself.

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Opinion | Medical Assistance in Dying Should Not Exclude Mental ... - The New York Times