Euthanasia in psychiatry: ethically?

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arjand
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Euthanasia in psychiatry: ethically?

Post by arjand » August 15th, 2019, 8:07 pm

I am new on this forum. I hope that this forum is the right place for my question.

Two tiny countries in Europe were the first in the world to allow euthanasia. In most other countries, including the UK and the US, it is illegal for doctors to kill their patients.

My first question is: why are doctors not allowed to euthanize their patients? Is it because of a political ideology or are there ethical arguments against such a practice?

My second question is: would it be ethically responsible for doctors to euthanize patients with a completely healthy body on the basis of a psychiatric diagnosis, i.e. a purely mental wish?

Background:

Initially, psychiatry was excluded from the right to euthanize patients. In 2010 however, Dutch psychiatrists successfully obtained the right to euthanize their patients. They obtained that right using what appeared to have been political extortion.

In 2010, the Dutch version of the APA (NVvP) released an official guideline that instructed institutions to release their patients with a suicide wish, so that they could commit suicide. [1]

The head of the Dutch union for railway personnel responded with the following:
"This is a bad signal. Every year 200 people in the Netherlands jump in front of a train. These are horrific experiences for drivers and also for conductors. Some never come back to work. That is why suicide on the railways must be reduced as much as possible. When institutions let patients go to commit suicide, a number of them always ends before a train, because it is simply a certain path to death."
In a poll with psychiatrists in The Netherlands, 75% of psychiatrists responded to approve of euthanasia as a treatment option and 43% responded that they would be willing to apply it. [2]

Soon after the guideline, Dutch politics provided psychiatrists with the right to euthanize their patients and the numbers have been growing rapidly since. In 2010, the year of the guideline, 2 patients were euthanized. In 2011 the number grew to 13 patients and in 2013 the number had grown to more than 50 patients.

It is almost 10 years later and it is estimated that more than 2,000 people have been euthanized by a psychiatrist in The Netherlands and Belgium. The two countries are tiny. 2,000 people in 10 years time is a big number. Translated to the US population it would correspond with 40,000 people.

Ethically responsible?

There are situations in which psychiatric care could have had a devastating effect on the life of a person. And while it is debatable if such care is justifiable or should be changed, the fact remains that there simply are situations in which psychiatry may reduce or destroy the will to live in a person.

Some medications such as anti-depressants are proven to increase the risk of suicide while others may have severe side effects by which life may become unbearable.

Further, unlike other branches of the medical profession, psychiatry forces some treatments onto patients against their will. It includes forced electroshock treatment and years of isolation cell imprisonment that could have devastating effects on a persons will to live.

Blackmailing to hide wrongdoing

The years leading up to the guideline had seen a lot of mainstream media attention for scandals in psychiatry and it was often cited that psychiatry turned to blackmailing to hide their wrongdoing.

When the mother of a 22-year old University student suspected that the problems of her daughter were caused by a nutrient deficit, she was ignored by the psychiatrists. [6] Her daughter received several (invalid) diagnosis including schizophrenia and when the psychiatrists demanded forced electroshock (ECT), she raised the alarm via a blog. The story was given national attention by celebrity psychiatrist Dr. Bram Bakker and soon after, the mother was blackmailed to take her blog offline under the threat that she was not allowed to see her daughter. The mother wasn"t allowed to see her daughter for 7 weeks.
"They pay € 24,000 every month for her, unbelievable, for that money someone is drugged and placed in a smelly room."
As a sort of retaliation, Dr. Bram Bakker was "ex-communicated" by psychiatry. He wrote the following in his Volkskrant column:
"I was dismissed from psychiatry. Call it academic inquisition." "They actually excommunicated me." [7]
Robert Whitaker, medical investigative reporter and best seller author (madinamerica-com) once wrote the following in an email to me which shows that it is a widely known fact that psychiatry attempts to hide it"s wrongdoing by hurting people.
As for the rest of the medical profession, well, doctors basically belong to a big tribe, and part of the tribal rules are that those in one discipline don"t publicly criticize the doctors in another discipline. This keeps non-psychiatrist doctors from weighing in on the matter, and as far as criticism that arises from within psychiatry, psychiatry as a field has been very successful in letting its members know that they will be ex-communicated and their careers will suffer if they speak too critically. Psychiatrists are allowed to make minor concessions, such as saying that pharmaceutical money has become too influential, but they are not allowed to say that the drugs don"t really work."
Dr. Bram Bakker was punished for standing up for a mother and her daughter. Despite his strong position as a celebrity psychiatrist, he had to endure damaging influence to his professional career.

The blackmailing weren't incidents.

In 2010, shortly before psychiatrists were given the right to euthanize their patients, politician Halbe Zijlstra (from the then ruling party) raised the alarm about a measure demanded by the mental health organizations to hide their wrongdoing from the public. The demand was a response to the many scandals that had hit the news and as such it became evident that psychiatry intended to hide their wrongdoing and resorted to political blackmailing to meet their ends. [8]

This fact is important for context. It is seen here that in 2010, politicians seek public media attention for “blackmailing” by psychiatry and that same fact came to light in the political extortion used to obtain the right to apply euthanasia.

Why did psychiatry receive the right to euthanize patients at that specific time?

With euthanasia, psychiatry is much stronger in hiding potential wrongdoing.

It doesn’t seem logical that politicians would have ‘given in’ to extortion at that time, considering the public shout out about the occurrence of such practices by a ruling party politician several months before. But if political extortion wouldn’t have been required to get euthanasia legalized, why would the Dutch APA have used such a tactic? If anything, it shows a lack of care for their patients and for society by essentially letting patients jump in front of a train.

The end result is simple however. Psychiatrists obtained and used their right. Patients were being euthanized and it reached the international news. [9]

I must rely on the numbers communicated by the media, but there is no reason to doubt it. Who were the 2,000 people who were euthanized by a psychiatrist in the past 10 years?

There are patients who are called “given up”. I know of many psychiatrists and mental health specialists who cannot accept the term “given up”, especially with youngsters, and some claim that psychiatry could have been the cause of the chronicity of the problems in those patients. [10] [11] But would they have been able to protect those thousands of people from being lured / forced into euthanasia?

A recent blog by Bonnie Burstow, PhD on MadInAmerica-com about the fact that the eugenics movement originated from within psychiatry, started with the following quote:
“Those who cannot remember the past are condemned to repeat it.” (George Santayana)
Considering the history, some patients are likely to be at risk when psychiatrists can advise euthanasia as a treatment option. Why wouldn’t they advise it when they see no way out after years of failed treatments?

Conclusion

Chronicizing of mental health problems starts with the fundamental idea on which psychiatry is based: the idea that the human mind and emotions are the result of accidental chemistry in the brain. That idea implies " with vulnerable people in a crisis " that life is meaningless. As a person who has to learn to fight to overcome complex mental problems, you are not served by such an idea. If you experience life as a coincidence or as meaningless, you can wish for feelings of happiness as much as you want but the chance that you will achieve them would be small.

There are strong indications that psychiatry exacerbates problems and makes them chronic. That makes it ethically irresponsible to allow psychiatrists to euthanize their patients, even though there may be situations in which people can genuinely choose to end their lives while there is nothing wrong with their body. The fact that " in view of the fierce criticism of psychiatry by many scholars" it cannot be excluded that psychiatry has provided inadequate care or even had a detrimental influence on the opinion and decision-making of an individual, makes it ethically irresponsible to allow psychiatrists to euthanize their patients.

Sources

[1] "Doctors release their patients for suicide" (newspaper)

[2] 43% of psychiatrists willing to apply euthanasia to their patients, 75% approves

[3] Mother raises the alarm about forced ECT threat to daughter

[4] NOVA TV report: innocent depressed girls locked in a isolation cell for more than 1 year
youtube: i5IWFDY_oNo

[5] Nicole on national TV (official news): "I was locked in a isolation cell for 1.5 years"

[6] "Emergency Call for my Daughter": psychiatrist keeps pressing for forced electroshock

[7] Dr. Bram Bakker: "I have been dismissed from psychiatry, call it academic inquisition"

[8] Halbe Zijlstra (politician): "Psychiatry blackmails to keep scandals hidden"

[9] BBC-com: /news/stories-45117163

[10] Dr. Detlef Petry: ""Given up" patients are often made chronically ill by treatment" ISBN 9026323344

[11] Dr. Detlef Petry: "Written off but not "given up": a psychiatrist's fight for his patients

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h_k_s
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Re: Euthanasia in psychiatry: ethically?

Post by h_k_s » August 18th, 2019, 3:33 pm

@arjand it is a political issue in most places.

There are States in the USA that do allow it now. Oregon is one of them.

https://statelaws.findlaw.com/oregon-la ... -laws.html

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arjand
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Re: Euthanasia in psychiatry: ethically?

Post by arjand » August 18th, 2019, 4:47 pm

Thank you for your comment! From a quick search it appears that the practice is recognized in the US as "the Dutch way".

I was in the assumption that there was a strong code of ethics that prevented doctors from killing their patients. Allowing euthanasia on the basis of a psychiatric diagnosis doesn't just affect individual people but it also communicates an idea. The question would be: is that a sound idea and would it have a good effect?

I understand that some people may truly want to commit suicide, but there may also be people at risk.

Patients may be more easily "given up" by their doctor when euthanasia is available as a treatment option. It may be that some people need protection.

Why does life has meaning? The fact that people have big problems with such questions has lead to religions with several excesses.

There have been cults in which people collectively committed suicide. People are easy to manipulate and are capable of a lot for a belief or idea.

What effect could there be for people in general when doctors give up their patients purely on the basis of their mental will? It may promote the idea in insecure people that life is meaningless, resulting a escalation of mental problems and instability and a lack of compassion for fellow human beings (increase of violent crime).

The second argument, and the reason why I personally have become involved, is that there have been hundreds of professors (possibly thousands) who raised the alarm that psychiatric treatment does more harm than good.

For example, in The Netherlands, there has been a lot of main stream media coverage for the claim that antidepressants double the risk of suicide and can cause violent crimes.

Some sources around 2009-2010:

Trouw: Anti-depressants make more aggressive than expected, 2010
Prof. Trudy Dehue and Prof. Kees van Grootheest: Pill against depression can lead to murder. NRC Handelsblad. [Online] 2009.
Pills of the devil. REVU. [Online] 2009.
Prof. Evelien Tonkens: Antidepressants cause (self-) murder behavior, transparency does not help. Volkskrant. [Online] 2009.
Prof. Ivan Wolffers: Three professors in court disagree on the role of antidepressants in the 2009 bloodbath.
Prof. Corine de Ruiter: Dutch judges do not take side effects of antidepressants seriously. Trouw. [Online] 2009.
A criminal side effect. Trouw. [Online] 2009.

As can be seen, around 2009/2010 a lot of attention was given to the alarming messages by professors that antidepressants increase the risk of suicide and of violent crimes. The cover of one big magazine stated boldly "Killer Pills".

Of course it is almost impossible to prove why someone decides to do something and thus if antidepressants were a 'cause', but that's irrelevant. What can be concluded is that psychiatric treatment is controversial and may promote suicide in patients. If that would be the case, it creates a very strange situation when the doctor who prescribes a possible suicide wish increasing treatment ends the life of that patient on the basis of his/her wish.

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Re: Euthanasia in psychiatry: ethically?

Post by LuckyR » August 19th, 2019, 1:59 am

arjand wrote:
August 18th, 2019, 4:47 pm
Thank you for your comment! From a quick search it appears that the practice is recognized in the US as "the Dutch way".

I was in the assumption that there was a strong code of ethics that prevented doctors from killing their patients. Allowing euthanasia on the basis of a psychiatric diagnosis doesn't just affect individual people but it also communicates an idea. The question would be: is that a sound idea and would it have a good effect?

I understand that some people may truly want to commit suicide, but there may also be people at risk.

Patients may be more easily "given up" by their doctor when euthanasia is available as a treatment option. It may be that some people need protection.

Why does life has meaning? The fact that people have big problems with such questions has lead to religions with several excesses.

There have been cults in which people collectively committed suicide. People are easy to manipulate and are capable of a lot for a belief or idea.

What effect could there be for people in general when doctors give up their patients purely on the basis of their mental will? It may promote the idea in insecure people that life is meaningless, resulting a escalation of mental problems and instability and a lack of compassion for fellow human beings (increase of violent crime).

The second argument, and the reason why I personally have become involved, is that there have been hundreds of professors (possibly thousands) who raised the alarm that psychiatric treatment does more harm than good.

For example, in The Netherlands, there has been a lot of main stream media coverage for the claim that antidepressants double the risk of suicide and can cause violent crimes.

Some sources around 2009-2010:

Trouw: Anti-depressants make more aggressive than expected, 2010
Prof. Trudy Dehue and Prof. Kees van Grootheest: Pill against depression can lead to murder. NRC Handelsblad. [Online] 2009.
Pills of the devil. REVU. [Online] 2009.
Prof. Evelien Tonkens: Antidepressants cause (self-) murder behavior, transparency does not help. Volkskrant. [Online] 2009.
Prof. Ivan Wolffers: Three professors in court disagree on the role of antidepressants in the 2009 bloodbath.
Prof. Corine de Ruiter: Dutch judges do not take side effects of antidepressants seriously. Trouw. [Online] 2009.
A criminal side effect. Trouw. [Online] 2009.

As can be seen, around 2009/2010 a lot of attention was given to the alarming messages by professors that antidepressants increase the risk of suicide and of violent crimes. The cover of one big magazine stated boldly "Killer Pills".

Of course it is almost impossible to prove why someone decides to do something and thus if antidepressants were a 'cause', but that's irrelevant. What can be concluded is that psychiatric treatment is controversial and may promote suicide in patients. If that would be the case, it creates a very strange situation when the doctor who prescribes a possible suicide wish increasing treatment ends the life of that patient on the basis of his/her wish.
As a resident of Oregon and a physician, I can tell you that it is called Physician Assisted Suicide (not the Dutch way). In addition most of your questions were posed before the referendum was voted upon, yet have not materialized in real life.
"As usual... it depends."

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Re: Euthanasia in psychiatry: ethically?

Post by detail » August 20th, 2019, 1:02 pm

Euthanasia is at least for psychatry the biggest hoax i ever heard of . To use psychological diagnostics for aid of something for euthanasia is disgusting. Psychological deseases cannot be compared to painful cancer or ebola where death may seem secure and super painful.

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Re: Euthanasia in psychiatry: ethically?

Post by chewybrian » August 20th, 2019, 6:53 pm

Am I wrong to assume an element necessary for physician assisted suicide to go forward is that the patient must give consent, and be competent to give such consent? So, if the problem is strictly mental, does that allow room for competency? How can I argue that my mind is so broken that I can't be allowed to go on living, while at the same time saying that I am competent to decide to end my life?
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Re: Euthanasia in psychiatry: ethically?

Post by Felix » August 21st, 2019, 1:49 am

chewybrian: Am I wrong to assume an element necessary for physician assisted suicide to go forward is that the patient must give consent, and be competent to give such consent?
Yes (no, your assumption is not incorrect).
So, if the problem is strictly mental, does that allow room for competency?
No, someone who is non compos mentis cannot legally give consent.

This thread is based on hearsay, and without seeing the text of the Dutch law, this is a pointless discussion.
"We do not see things as they are; we see things as we are." - Anaïs Nin

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Re: Euthanasia in psychiatry: ethically?

Post by LuckyR » August 21st, 2019, 2:28 am

chewybrian wrote:
August 20th, 2019, 6:53 pm
Am I wrong to assume an element necessary for physician assisted suicide to go forward is that the patient must give consent, and be competent to give such consent? So, if the problem is strictly mental, does that allow room for competency? How can I argue that my mind is so broken that I can't be allowed to go on living, while at the same time saying that I am competent to decide to end my life?
Mind broken? What are you referring to?
"As usual... it depends."

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Re: Euthanasia in psychiatry: ethically?

Post by chewybrian » August 21st, 2019, 12:58 pm

LuckyR wrote:
August 21st, 2019, 2:28 am
chewybrian wrote:
August 20th, 2019, 6:53 pm
Am I wrong to assume an element necessary for physician assisted suicide to go forward is that the patient must give consent, and be competent to give such consent? So, if the problem is strictly mental, does that allow room for competency? How can I argue that my mind is so broken that I can't be allowed to go on living, while at the same time saying that I am competent to decide to end my life?
Mind broken? What are you referring to?
I'll agree that I did not pick my words carefully enough, but it's hard to think you did not get my meaning. If I am suffering so badly from mental illness that I think suicide is the answer, how can I also be competent to give consent?

Let's say I had Lou Gehrig's disease. So, I might be able to give consent for physician assisted suicide, right? But, I would probably be denied if I made the request in a straight jacket due to unrelated mental problems. I would have to show I was competent to give the consent. Yet, if I make the request based only on my suffering from a mental illness, don't I also need to give consent? My question is whether or not the request itself, or the notion that I am suffering horribly due to mental illness, raise competency issues. Can the request be denied on the basis of the request?

I don't want to see others making the choice to end a life based on the perception of mental suffering. But, if the suffering is bad enough to consider suicide, I also question the competency of the sufferer. I can agree with the availability of the choice to competent folks suffering from serious physical problems, but I am struggling to see the acceptable scenario for suicide based on mental problems.
"If determinism holds, then past events have conspired to cause me to hold this view--it is out of my control. Either I am right about free will, or it is not my fault that I am wrong."

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Re: Euthanasia in psychiatry: ethically?

Post by Sculptor1 » August 21st, 2019, 1:56 pm

In a free society I see no reason why euthanasia could be proscribed. The only stipulation should be consent.

Since it would be possible to define mental incompetence in ANYONE wanting to end their lives there is a real danger of imposing a Catch-22 situation in which no one would have the competency to give permission to end their lives, by definition.

I think this would be a great mistake.
When i want to die, I want to be able to buy the equipment to make it painless and easy, regardless of what someone else says about my competency.
Whose life is it anyway?

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Re: Euthanasia in psychiatry: ethically?

Post by Felix » August 21st, 2019, 3:42 pm

I did a search re: the Dutch law, found a lot of propaganda about it, but here's the Royal Dutch Medical Association website with a summary of it -- https://bit.ly/2NtrqPn
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Re: Euthanasia in psychiatry: ethically?

Post by Jklint » August 21st, 2019, 4:06 pm

It should be mandatory that any request to be euthanized - especially by those in a certain age - be performed by the medical profession without their dubious morality coming into play. Considered as a Last Expense, it's a service paid for by the person who requests it and like any other prepaid service there exists the obligation for its fulfillment.

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Re: Euthanasia in psychiatry: ethically?

Post by LuckyR » August 21st, 2019, 5:48 pm

chewybrian wrote:
August 21st, 2019, 12:58 pm
LuckyR wrote:
August 21st, 2019, 2:28 am


Mind broken? What are you referring to?
I'll agree that I did not pick my words carefully enough, but it's hard to think you did not get my meaning. If I am suffering so badly from mental illness that I think suicide is the answer, how can I also be competent to give consent?

Let's say I had Lou Gehrig's disease. So, I might be able to give consent for physician assisted suicide, right? But, I would probably be denied if I made the request in a straight jacket due to unrelated mental problems. I would have to show I was competent to give the consent. Yet, if I make the request based only on my suffering from a mental illness, don't I also need to give consent? My question is whether or not the request itself, or the notion that I am suffering horribly due to mental illness, raise competency issues. Can the request be denied on the basis of the request?

I don't want to see others making the choice to end a life based on the perception of mental suffering. But, if the suffering is bad enough to consider suicide, I also question the competency of the sufferer. I can agree with the availability of the choice to competent folks suffering from serious physical problems, but I am struggling to see the acceptable scenario for suicide based on mental problems.
Ah so. Well from a Physician Assisted Suicide perspective (what we do here in Oregon), you wouldn't qualify as there has to be a terminal illness, not merely suffering, physical or emotional/mental.
"As usual... it depends."

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Re: Euthanasia in psychiatry: ethically?

Post by arjand » August 23rd, 2019, 8:07 am

Thank you for the valuable perspectives! I want to share that I am not politically or religiously motivated. I joined this forum mostly to learn and not to pose an idea.

The reporting about the political activity was simply part of a more basic quest: "what is psychiatry's good intent for humanity?" This quest was based on facts such as that in The Netherlands over 1.2 million people were using anti-depressants while studies had shown that an 'active placebo' (a pill that gives the feeling that something happens in the body) enabled almost 100% of the patients to recover just as well, which proved that the belief in a pill could make people recover from depression. On a personal level, I would argue that it would be essential for human evolution to learn to make use of that potential. It would not just serve to overcome problems, but also to take humans further than what can be imagined today. So the question arose: what does psychiatry intend to achieve by treating the brains of 1.2 million people? What is their 'good intent' for humanity? I never found an answer, not even a plausible theory. It did worry me that anti-depressants proved to affect fertility by causing DNA damage in sperm or by directly damaging the fetus to cause babies to be born with a weakened heart. How could that be explained when patients were proven to recover just as well with an active placebo? If it were just about misleading people for good, such side effects are suspicious.

In conversations with psychiatrists and many professors over the years, the excuse had generally been "we cannot do better", "we have to do something". The scope was: psychiatrists simply focused on treating a disease and didn't think much further. There wasn't a motive behind it in regards to treating the brains of 1.2 million people.

In regards to euthanasia in psychiatry. I have seen people change in psychiatric care, from happy and energetic human beings into zombies in which life appeared to have disappeared. There are people who are being broken in psychiatry.

I find it dangerous that psychiatrists have received the ability to apply euthanasia. I can imagine situations in which people could become victim after years of ‘torture’ and the most scary is that it will be even more unlikely that they could have received help from media attention, politics or reporting, because it is very difficult for outsiders such as politicians or reporters to interfere and assess a situation when it comes to someones personal choice to commit suicide.

Maybe it is a subject that belongs to philosophy.

I thereby continue by reading instead of positing replies.

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Re: Euthanasia in psychiatry: ethically?

Post by arjand » August 24th, 2019, 7:20 pm

detail wrote:
August 20th, 2019, 1:02 pm
Psychological deseases cannot be compared to painful cancer or ebola where death may seem secure and super painful.
In the OT I shared references of psychiatrist Dr. Detlef Petry who has to deal with "abandoned" patients whose problems are considered hopeless. He is convinced that the problems are not hopeless and claims that psychiatry can be the cause of the hopeless nature of problems. There are many others who share his vision. That makes the situation different than with a terminal illness.

Furthermore, with regard to the 'choice' to end life. If, after a few years, patients with a suicide wish are told by their trusted doctor that euthanasia is an option, it makes sense that they will make that choice, if only to prove that their problems are real. It could also be a kind of social stamp for many people to prove that their problems are the most serious.

If euthanasia is not possible, then people may unknowingly be forced to consider that there must be a way out somehow, giving specialists options to lead someone to recovery.

It may also be about the mentality that is created when you either let people fall or convince them by culture that life is not something to throw away.

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