According to Dr. Michael H. Sacks, professor of psychiatry at Cornell University’s Weill Medical College, “when patients kill themselves, it is a very painful and humbling experience for psychiatrists. A patient’s suicide punctures our therapeutic omnipotence and reminds us that we can’t cure or even help all patients. Psychiatrists commonly harbor a sense of personal failure and inadequacy at not having prevented a patient’s suicide.”
According to the Centers for Disease Control, more than 41,000 in the U.S. died by suicide in 2013. More than 90 percent had depression or another diagnosable mental or substance abuse disorder- with the prevalence of suicidal thoughts, suicidal planning and suicide attempts being significantly higher among adults 18-29 versus those 30 and older. Suicide is the tenth leading cause of death in the U.S and the second leading cause of death among 15-24 year-olds. Many cite depression as their “intractable and unbearable pain.”
How do mental health professionals square their role to treat mental illness with the physician-assisted suicide movement? If the law and certain physicians support suicide for those who choose not to endure the hand they have been dealt, then what is the profession’s end game?
Five states allow physicians to write lethal prescriptions for dying patients to self-administer. For a patient to qualify, the physician’s diagnosis must include a terminal illness, with six months or less to live. A consulting physician must then certify the patient as mentally competent to make and communicate care decisions. If either physician determines that the patient’s judgment is impaired, the patient must be referred for a psychological examination.
The physician-assisted suicide movement is a call to action for serious dialogue about how we define our society.
Judgment is typically impaired when a young adult suffers protracted severe depression. When asked to provide a psychological evaluation, would a mental health professional recommend treatment or death by suicide? Is the profession’s ethical responsibility to treat and relieve suffering up to a point, just as with physical illness, and then deign the condition to be terminal?
Doctors in Belgium are granting the right to die to a 24 year-old otherwise healthy woman suffering from depression. She qualifies for euthanasia under Belgian law, even though she does not have a terminal or life-threatening illness. The woman has received the green light by physicians to receive a lethal injection after she spent both her childhood and young adult life suffering from “suicidal thoughts.”
Many psychiatrists say they feel a sense of personal failure after a patient commits suicide, but 80 to 90 percent of those seeking treatment for depression are treated successfully using therapy and/or medication. Is it okay for the other ten to 20 percent to opt out of life with the blessing of public policy and the medical community? Those with a diagnosed terminal physical illness can. Why not the same for those with untreatable mental illness? How is the imminence of death of a 15-24 year-old determined when one is severely depressed? Is the individual’s life good for six minutes or 60 years?
The physician-assisted suicide movement is a call to action for serious dialogue about how we define our society. The U.S. is known worldwide for our humanitarian culture. We have opened Pandora’s box with assisted suicide when asking physicians to put aside their Hippocratic oath of “doing no harm” and “administering no poison.”
The explosion of healthcare costs has already required policy makers to shift financial responsibilities to individuals, instead of being borne by taxpayers or private companies. According to Robert Glover, executive director of the National Association of State Mental Health Program Directors, states cut five billion dollars in mental health services from 2009 to 2012. These cuts have left a population either without services or bearing individual burdens.
The combination of states sanctioning a physician’s ability to prescribe lethal medication and the squeeze on state budgets has the potential to drive public policy toward measuring the value of a human life through actuarial calculations. This is the basis for rationing.
Mental illness is one of the major drivers of U.S. health care costs in the US, costing the nation more than four hundred billion dollars in medical, pharmaceutical, disability and lost productivity each year. According to ResearchAmerica.org, for each suicide prevented, the U.S. could save an average of more than two million dollars yearly in medical expenses and lost productivity.
Will our rationing policy include greater efforts toward suicide prevention through treatment? Or, will it expand the scope of assisted suicide to include those with mental illness-whether they be in their 20s or 80s? Will psychiatrists consider suicide a failure or an option? How will our nation be defined? Will the U.S. be a leader in respecting life? Or, will our country incrementally slip toward Belgium’s solution?