The following article originally appeared in the Winter 2016 issue of the MCFL News magazine, a perk of membership mailed out quarterly to all members.
Research reveals something unexpected about suicidal behavior. The end-of-life concerns most often given for choosing legalized doctor-prescribed suicide (DPS) in Oregon, are not physical pain and suffering; rather they are psychological and emotional: losing autonomy, feeling like a burden on family and friends, loneliness, and a loss of enjoyment of life. These are the very same reasons given by persons contemplating suicide who are not suffering from a terminal illness.
Nancy Valko, R.N., ALNC, a spokesperson for the National Association of Prolife Nurses, spent her nursing career working in critical care, hospice, home health, oncology, dialysis and other specialties. "Personally and professionally as a nurse for 45 years, I have encountered many suicidal people," says Valko. "Some were terminally ill, but I found that even the few who were insistent about killing themselves revealed great fear and ambivalence. The will to live is so strong, but these suicidal people were being overwhelmed with desperation, even when they were physically healthy."
A recent study published in JAMA Psychiatry, "Euthanasia and Assisted Suicide of Patients With Psychiatric Disorders in the Netherlands 2011 to 2014," confirms fears that feelings of depression and isolation drive requests for lethal prescriptions. The objective of the study was to "describe the characteristics of patients receiving EAS (euthanasia or assisted suicide) for psychiatric conditions and how the practice is regulated in the Netherlands." The study, led by National Institutes of Health psychiatrist and bioethicist Dr. Scott Y. H. Kim, found a troubling correlation between depressive illness and the request for DPS.
Among the findings of those requesting either euthanasia or assisted-suicide: 80 percent had previously been hospitalized for psychiatric reasons, 52 percent had previously attempted suicide (non-assisted), 58 percent had at least one other medical condition, 55 percent had depressive disorders as the primary psychiatric issue, 56 percent of the physician reports mentioned the patients’ social isolation or loneliness, and 56 percent had refused some treatment. An astounding 70 percent were women.
Genevieve Plaster, writing for the Charlotte Lozier Institute commented, "One cannot highlight enough that most of these individuals were vulnerable to suicide due to depression and feeling alone. That more than half of these patients had tried to commit suicide on their own previously, and then succeeded by way of a legal process involving healthcare providers, is alarming." Plaster noted that Oregon’s law and state legalization bills pending for 2016 do not require that mental health screening be given after a person requests doctor-prescribed suicide.
These concerns become more important as "end-of-life options" or "aid-in-dying" bills have succeeded in Colorado and Washington, D.C. In Massachusetts, where doctor-prescribed suicide has previously been defeated both at the polls and in the legislature, the Suffolk Superior Court will hear a case brought by two physicians claiming that DPS is not prohibited by state law. The doctors are asking the court to declare that terminally ill patients have the constitutional right to choose death through the use of lethal medication. "Plaintiffs seek a declaration that Medical Aid in Dying is not a criminal offense under the laws of the Commonwealth of Massachusetts,” the suit states.
In California, the End of Life Options Act allows terminally ill patients in mental hospitals to request doctor-prescribed suicide. Under the Act, a lethal drug may be prescribed "only if the patient is not suffering from impaired judgment due to a mental disorder." However, regulations allow a terminally ill patient to "petition the superior court to participate in the End of Life Options Act by requesting release from the custody of the Department of State Hospitals." If the court orders release from the custody of the hospital, the patient is released to a person or other entity. If the person is too dangerous to be released, the state hospital must make DPS available in the hospital.
Bioethicist Wesley Smith notes the absurdity of a situation where people are hospitalized as a protection against suicide, only being released to commit suicide because they have a terminal illness. Smith writes, "These are people denied their very freedom due to diagnosed severe mental disease. They are undoubtedly being treated with powerful psychotropic medications. In what universe could they possibly be deemed 'not to be suffering from impaired judgment due to a mental disorder?'"
Nancy Valko says suicide prevention and treatment must be made available to all, not just the young and physically healthy. A story in Valko's blog, "A Nurse’s Perspective on Life, Healthcare and Ethics" tells of a cancer patient whose struggles with the disease left her planning to take her own life or have the help of a doctor before she became mentally diminished or physically dependent on others. Valko notified her doctor and spent time talking with her.
"With treatment and especially by addressing her fears and the ramifications of a suicide decision, I was elated when Eleanor changed not only her mind but her attitude," writes Valko. "Once she decided against suicide she embraced life fully and with gusto. She eventually died comfortably and naturally.
"However, after Eleanor changed her mind about suicide and mentioned me, her friends tracked me down and threatened to get me fired because I was unjustly interfering with her 'right to die.' Instead of being relieved for Eleanor, these friends were instead outraged that we took the usual measures we would take with anyone to prevent suicide."
Valko also commented on the recent legalization of DPS in Colorado. "When we allow medical/legal protections and standards to be suspended for some suicidal people considered expendable based on an estimated prognosis and personal fear of even potential pain and/or dependence, we will inevitably see the pool of potential victims of medical termination expand and lethal injections accepted,” Valko said. “This is already happening in Canada, the Netherlands, Belgium and Switzerland.”