Canada and assisted suicide for mental illness?

The institutions that were closed down were largely the District Lunatic Asylums. They were founded in the 1800s i believe and served to house and care for those with serious psychiatric conditions who were incapable of independent living, or who were dangerous. However, the system was also abused and was used as a hiding place for those who didn't fit neatly into society....

Eccentric character - INSANE! ...lock him up

Suffering from autism or downs syndrome - INSANE! Lock him up.

Homosexual - INSANE! lock him up

A challenger of society - INSANE! lock him up.

Unmarried mother - INSANE! Lock her up.

Opinionated and outspoken woman - INSANE! Lock her up.

Anybody who shamed or had the potential to shame a well to do or noteworthy family - INSANE! lock him up and pretend he never even existed.

They were also ridled with endemic sexual exploitation and every other type of abuse imaginable as the people in them had no voice, no recourse to justice and besides, no authorities wanted to know nor would even listen anyway. Afterall, these people were all locked up for being "insane"!

Whatever about the rights and wrongs of the DA system, one thing is for sure it was a massively expensive system to run. So around the 1950s a process of Deinstitutionalisation was started, whereby the asylums were shut down one by one in favour of the so called "care in the community" model. The latter was obviously not a success as it was underresourced and patients could just drop off the radar and deteriorate further and this manifests itself even today as we can see that a huge fraction of the homeless are mentally ill. However, this doesn't suit the agenda of the "but de homeless, joe" brigade.

No not at all. I'm sure many could and do go for it of their own free and informed will. However, there is huge potential for some people to be groomed into it. This is obviously a life ending event - if one person is wrongly euthanized because of being slowly groomed into believing it is the best thing, then that is one too many. Grooming being what it is, they won't even realise that they basically are being bumped off to suit someone elses ulterior motive.

We must remember, people in these situations where euthanasia is a viable option are already in a highly vulnerable state and might have their mind swayed more readily than someone who is fully healthy and able bodied.

And rest assured, there are plenty people in ireland, especially rural ireland, who would only be too happy to see an elderly relative voluntarily pop their cloggs if they knew they were in line for something in the will, land or whatever.

Just look at the recent cases - murders have been committed over land and dsiputed wills to do with farms.

All of that can be legislated for- however, even today, respect for the elderly of our society is fading- the value and the contribution they can still make to society is acknowledged less and less and more and more are treated and seen as an inconvenience - if that I agree with you. But that just means a rigorous process to ensure the chance of manipulation is limited - for example, if introduced, I’d propose the elderly today should actually be excluded and only those say under 65 could make this decision for either now or later in their lives if the need arose.

There’s ways to protect people and still introduce assisted dying - but right now, there are definately cases of elder abuse and manipulation taking place up and down the country - I’ve seen one example of manipulation of a Will wording- very hard to prove in a court of law though.

Nobody should have power to tell anyone else whether they're allowed to die or not.

That’s precisely what Canada is doing though, by regulating assisted suicide and indeed deciding whether or not a person is a candidate for assisted suicide based upon the degree to which their mental condition is sufficient to qualify them to be permitted to avail of assisted suicide -

In order to be eligible for medical assistance in dying, you must meet all of the following criteria. You must:

• be eligible for health services funded by the federal government, or a province or territory (or during the applicable minimum period of residence or waiting period for eligibility)
  • generally, visitors to Canada are not eligible for medical assistance in dying
• be at least 18 years old and mentally competent. This means being capable of making health care decisions for yourself.
• have a grievous and irremediable medical condition
• make a voluntary request for MAID that is not the result of outside pressure or influence
• give informed consent to receive MAID

https://www.canada.ca/en/health-canada/services/medical-assistance-dying.html

The Canadian attitude to suicide and assisted suicide isn’t all that different from Ireland’s attitude to suicide and assisted suicide. The only difference is in Canada, assisted suicide is permissible in law under certain conditions, whereas here, assisted suicide is prohibited in Irish law. The stigma regarding suicide and assisted suicide is as prevalent in Canada as it is here, with it paradoxically being recognised as a protective factor in suicide prevention (which in itself is quite distinct from medically assisted suicide).

It’s no small irony of course that you refer to it as disgusting when people attempt to shame others for their desire to die, that people don’t talk about these issues because of the stigma, etc, and when people ARE talking about it and expressing their opinions, you attempt to condemn them because their opinions don’t align with yours. If that’s your idea of maturity, it’s easy understand why you think people don’t talk about these issues - they’re not any more likely to talk about them around you either, knowing your opinion of people who don’t share your opinions.

I haven't decided for someone else, I've stated I don't think assisted suicide (having someone else kill you) should be legal in cases like this.

I'm not stigmatizing suicide, simply stating that assisted suicide needs to be very closely monitored and should only be available in very specific circumstances as it becomes a very slippery slope if you allow people with mental health issues (who generally don't have proper perspective) make a decision to get someone else to end their life.

My dad is in state care with rapidly degenerating dementia, it's too late for him to give informed consent, but I know, because he told me years ago, that he'd prefer to be dead than live out his days in such a place, not recognising my mam, his own siblings or me and my siblings.

When we first started noticing his issues, he was too angry and confused to give consent, in fact he was in denial the whole time he was able to think even slightly rationally.

If this is in my own future I want to sign a letter now giving my loved ones and medical professionals the consent and instruction to end my life before I get committed to an institution such as the one my dad is in.

The level of care he receives is second to none, he's comfortable - but what's the point? He knows nobody, he doesn't understand or know what's going on around him. He's not my dad anymore.

First it starts with killing unborn babies, now the disabled.

It’ll become mandatory. Slippery slope.

I think the first thing we need to do is to separate the term assisted dying from suicide - certainly in the early years of legislation being introduced, assisted dying will only be performed in very limited circumstances, most likely for very serious terminal illnesses that strip all dignity from the individual, but where the person remains of sound mind.

Assisted dying will likely involve decisions communicated to the family in advance and they will be part of the process not excluded from it, which doesn’t happen with suicide in the main.

With more countries introducing this legislation and Irish people opting to travel to avail of this process, there will come a time where pressure will bear on the government of the day to provide their own assisted dying services.

However I’m not sure Ireland will become a trailblazer for such legislation as it did for same sex marriage - I think we’re still too constrained by traditional thinking as a culture on this topic.

I’ve a lot of experience with dementia in my family so I can totally relate- denial, not just with the person but often with people closest to them such as their spouse is very common when the first signs of dementia appear.

I have to say, even at this early stage of debate on the topic, that “of sound mind” might be my own red line, even if consent was previously given by the person themselves.

Whilst you and I and countless others have seen the devastating affects of dementia on a person and wouldn’t wish it on anyone, who decides when the assisted dying process commences?

My current thinking is -The power of attorney is one thing but I don’t think handing the decision to a loved one as to when you pass away is something I’d like to do. So, if it were placed in the hands of doctors, how would that work? If I met a level and number of symptoms and signed some legal document in advance, would they have the power to end my life regardless of how family members felt? Again this troubles me. That’s why I would only be in favour of assisted dying where the person is of sound mind- they would have a certain window of opportunity as a result of say a dementia or Alzheimer’s diagnosis but once that limited window has gone, they could no longer avail of assisted dying.

I wonder how the Canadian legislation works on this example- I must research it a bit more.

Whilst you and I and countless others have seen the devastating affects of dementia on a person and wouldn’t wish it on anyone, who decides when the assisted dying process commences?

It’d depend on the circumstances in each individual case as to when the process would commence. Like with the current safeguards in place in the Canadian system, the development of a neurological disease alone wouldn’t necessarily meet the criteria to be considered eligible for MAID, there’s no way to determine the applicants natural death is reasonably foreseeable. Further assessment would have to take place -

https://www.justice.gc.ca/eng/csj-sjc/pl/ad-am/c7/p4.html#s3-4

My current thinking is -The power of attorney is one thing but I don’t think handing the decision to a loved one as to when you pass away is something I’d like to do. So, if it were placed in the hands of doctors, how would that work? If I met a level and number of symptoms and signed some legal document in advance, would they have the power to end my life regardless of how family members felt?

It would help if there was an advance healthcare directive in place which specified your wishes in the event you lacked the capacity to be able to make decisions about your healthcare at that time. However, as the law currently stands in Ireland, it still wouldn’t permit physicians to end a life -

It is a criminal offence to aid, help, encourage or procure the suicide of another person. This crime is usually called assisted suicide. The maximum penalty for assisted suicide is 14 years imprisonment. If you help someone to die by suicide, you may be charged with murder, manslaughter or assisted suicide depending on the circumstances. You could be charged if you help another person to end their life, even if the other person is terminally ill or wants to end their life.

This applies to medical professionals in the same way as to other people. However, pain killing drugs which may also shorten life may be given if the intention is to deal with pain and not to end life.

https://www.citizensinformation.ie/en/health/legal_matters_and_health/advance_care_directives.html

Essentially if you’ve given your informed consent and physicians are aware of your wishes, they can proceed in those circumstances in accordance with Irish law. I wouldn’t say regardless of how family members felt, it’s better if they are consulted and everyone is in agreement. But with something as complex as assisted suicide, it can be a bit of a mixed bag, based upon this review of Dutch practices -

https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-019-0361-2

The checks and balances and safeguards involved in eligibility for assisted suicide are likely to be able to discover that sort of coercive control at an individual level. I’m sure it goes on, but it would be at best a handful of anecdotal examples, similar to the scenario you presented above.

Far more likely however, in contrast to the argument that legislating for assisted suicide would reduce suicide rates, the opposite effect is observed in US states at least where assisted suicide is permitted in law -

Richard Posner argued that legalising assisted suicide may have the counter-intuitive effect of reducing unassisted and possibly even total suicide rates. This column examines the empirical evidence for this idea using data from ten US states that implemented an assisted suicide law up to the end of 2019. In contrast to Posner’s hypothesis, the real-world data suggest that assisted suicide laws lead to a substantial increase in total suicide rates and, if anything, are associated with an increase even in unassisted suicides. This effect is most pronounced amongst women.

https://cepr.org/voxeu/columns/assisted-suicide-laws-increase-suicide-rates-especially-among-women

…indeed all of this needs careful consideration debate and discussion - I know you’re just talking off the top of your head, as I am to a large degree at this point, but even then, I don’t feel at all comfortable with those conditions you’ve listed- the thought of essentially killing someone, who has dementia, even if this was their intended wish, doesn’t sit well with me- and as for finding a doctor who will do it:

As much as I’d hate to be in that position myself (advanced dementia) I just can’t get my head around someone making a decision about when I die- for me assisted dying is a fully conscious decision made by the person themselves, in that moment in time. What I would certainly subscribe to and plan in anticipation of it happening, is that no extraordinary means are used to keep me alive if I fell into an acoma or similar - I’ve no interest in being kept artificially alive for months or maybe even years.

a dreadful situation, i wish you and your family the best

....get the fcuk over yourself!

…as you say it’s a tricky topic but one worth debating. If it did come in, I’d like to see it done in very limited circumstances- I’m not a medical practitioner so I really couldn’t describe what those conditions or circumstances are- what I’ve learned from this thread so far is that stating certain scenarios is probably pointless because we’re going too broad and general .I.e chronic pain or dementia- if introduced it will likely be for a set of very narrow and extraordinary medical conditions and be open to only a handful of people as a result. But that in itself could be a good starting point and give us all time to get our heads around the concept.

I think Canada may have gone way too broad and way too quickly is my own view.