Euthanasia in psychiatry: ethically?

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chewybrian
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Re: Euthanasia in psychiatry: ethically?

Post by chewybrian »

Greta wrote: October 22nd, 2019, 5:52 am People want to die gently, if possible.

Families don't want to blow all of their savings on keeping relatives alive in pain against their will.

Yet people keep on dying horribly without need and family finances continue to be strained by what is effectively the cost of torture. The art of ancient torturers was the ability to keep their victims alive and conscious. Today, treatment provided in kindness becomes an unwitting instrument of torture.

Many hope that legal systems around the world adjust to this reality.
What you say rings true for euthanasia in response to certain terminal medical conditions. Everyone including the patient and the doctor knows that only a miracle will result in a cure, and there is little chance for any reasonable quality of life in the short time left. As you say, cost can be brought into the picture, too, though I don't like the idea of putting a price on life.

But, this topic is about euthanasia as a response to psychiatric problems. These too can be painful. Yet, there is unlikely to be broad agreement that there is no hope of recovery for the patient. And, a symptom of mental problems is the desire to commit suicide. There is a great risk of blurring the line between suicide and euthanasia, if we can even justify euthanasia in any case of mental problems. The very desire for death is perhaps a sign that the patient is not fully competent to make such a decision. This process would seem to rubber stamp suicide in the mind of the patient. Having tried cure, A, B, C and D, they would become a 'candidate' for euthanasia.

I believe few mental health issues can not be resolved with the right therapy to help the patient change their opinions of the world and the resulting perceptions that they are suffering or that there is no hope. People can tolerate just about anything if they have the right opinion about it, if it has meaning for them. Finding meaning is often difficult, and perhaps a unique approach is needed for every patient. But, should we really be ready to say there is no hope for someone, because we have yet to find it?

In the case of someone with terminal, inoperable cancer, we may say there is effectively no hope. Can we say the same about someone who is severely depressed? Aren't there many cases of people with similar symptoms who did recover, and are happy to be alive? Certainly this is true of many people who tried to commit suicide.
Bauman was overwhelmed with stress. During his suicide attempt, he remembers feeling at peace for the first time in a year. “I didn’t have to worry about the stress of what I was going through, the stress of what was going on at work, the stress of my family trying to figure out what was going on with me that I couldn’t tell them.”

“My experience wasn’t necessarily that I wanted to die, I just didn’t want to continue living with the amount of pain I was living with, especially because it was pain nobody could see,” Gay says. “You start feeling … like there’s no other options.”

“I didn’t want to die, I actually wanted to live, but not with the same pain I was going through,” Cortez Yanez says. “That made suicide an option for me.”
https://www.health.com/condition/depres ... -survivors
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Re: Euthanasia in psychiatry: ethically?

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chewybrian wrote: October 22nd, 2019, 4:25 pm
Greta wrote: October 22nd, 2019, 5:52 am People want to die gently, if possible.

Families don't want to blow all of their savings on keeping relatives alive in pain against their will.

Yet people keep on dying horribly without need and family finances continue to be strained by what is effectively the cost of torture. The art of ancient torturers was the ability to keep their victims alive and conscious. Today, treatment provided in kindness becomes an unwitting instrument of torture.

Many hope that legal systems around the world adjust to this reality.
What you say rings true for euthanasia in response to certain terminal medical conditions. Everyone including the patient and the doctor knows that only a miracle will result in a cure, and there is little chance for any reasonable quality of life in the short time left. As you say, cost can be brought into the picture, too, though I don't like the idea of putting a price on life.

But, this topic is about euthanasia as a response to psychiatric problems. These too can be painful. Yet, there is unlikely to be broad agreement that there is no hope of recovery for the patient. And, a symptom of mental problems is the desire to commit suicide. There is a great risk of blurring the line between suicide and euthanasia, if we can even justify euthanasia in any case of mental problems. The very desire for death is perhaps a sign that the patient is not fully competent to make such a decision. This process would seem to rubber stamp suicide in the mind of the patient. Having tried cure, A, B, C and D, they would become a 'candidate' for euthanasia.

I believe few mental health issues can not be resolved with the right therapy to help the patient change their opinions of the world and the resulting perceptions that they are suffering or that there is no hope. People can tolerate just about anything if they have the right opinion about it, if it has meaning for them. Finding meaning is often difficult, and perhaps a unique approach is needed for every patient. But, should we really be ready to say there is no hope for someone, because we have yet to find it?

In the case of someone with terminal, inoperable cancer, we may say there is effectively no hope. Can we say the same about someone who is severely depressed? Aren't there many cases of people with similar symptoms who did recover, and are happy to be alive? Certainly this is true of many people who tried to commit suicide.
Fair points, Brian. Alas, a price is already on life. Many who die could have been saved if they had the treatment options available to the few.

I see no reason why we can accept physical problems as incurable and not mental ones. The issue is lack of tangible evidence that casts doubt in people's minds. However, our prison system makes crystal clear that incurable mental problems are quite common. Still, a fair percentage of the mental problems of prison inmates are probably curable. The question I put to you is: why are these people not being cured?

It's the same answer as the mental health/euthanasia question.
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Re: Euthanasia in psychiatry: ethically?

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Greta wrote: October 22nd, 2019, 6:12 pm I see no reason why we can accept physical problems as incurable and not mental ones. The issue is lack of tangible evidence that casts doubt in people's minds.
There is hard evidence that certain conditions, like Lou Gehrig's disease, are progressive and incurable, and the quality of life, by any reasonable measure, declines as the disease progresses. You might say this about Alzheimer's disease, but that is a mechanical problem, and I am talking about mental illness that is based on attitude and perception, like depression and anxiety. Those problems require particular solutions tailored to each patient. Cognitive behavioral therapy and existential psychotherapy offer solutions. These solutions are highly effective...
Although it is far from a cure for all psychological conditions, CBT has a fairly impressive success rate of 50-75 percent for reducing symptoms of anxiety and depression, although estimates do vary somewhat.
https://www.healthcentral.com/article/1 ... nsider-cbt

...and further, since the cure is unique in each case, there is reason to think that the success rate could be higher if we worked harder to find the right solution for each patient. There is sound evidence to have hope that many or most such mental health problems can be cured, and sadly, little reason for hope, for the moment, in the cases of physical ailments that would justify euthanasia.
Greta wrote: October 22nd, 2019, 6:12 pm However, our prison system makes crystal clear that incurable mental problems are quite common. Still, a fair percentage of the mental problems of prison inmates are probably curable. The question I put to you is: why are these people not being cured?

It's the same answer as the mental health/euthanasia question.
The answer is the same, indeed. The primary causes of anxiety and depression are existential. We run from the fear of death, meaninglessness, freedom or isolation in many ways by distracting ourselves with work or drugs or whatever. These distractions are secondary causes of anxiety, which we often try to treat while ignoring the primary cause, just as we might try to treat high blood pressure with drugs without expecting the patient to exercise or lose weight. Existential therapy tells us we are all ultimately alone and responsible for our own well being. But, hard work in therapy can break down people's walls and enable them to care for themselves by allowing them to see the world around them more clearly.

Why are people not being cured? Some are perhaps afraid to allow anyone to help, for fear of facing up to the real world. But many are simply unaware of their own habits and misconceptions that hold them back, perhaps leading all the way back to their childhood. And, they need information and a little kick start to set off on the right path. Ultimately, most people have the tools inside them to cure their own mental problems, just as most people could solve their high blood pressure by eating right and exercising. Why don't they cure themselves? The answer is as unique as the individual, and you will never get all the way inside their mind to know for sure. Yet, I do think most can. But, I don't think anyone can cure their own Lou Gehrig's disease at the moment.
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Re: Euthanasia in psychiatry: ethically?

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chewybrian wrote: October 22nd, 2019, 7:55 pmWhy are people not being cured? Some are perhaps afraid to allow anyone to help, for fear of facing up to the real world. But many are simply unaware of their own habits and misconceptions that hold them back, perhaps leading all the way back to their childhood. And, they need information and a little kick start to set off on the right path. Ultimately, most people have the tools inside them to cure their own mental problems, just as most people could solve their high blood pressure by eating right and exercising. Why don't they cure themselves? The answer is as unique as the individual, and you will never get all the way inside their mind to know for sure. Yet, I do think most can. But, I don't think anyone can cure their own Lou Gehrig's disease at the moment.
Dr. Detlef Petry mentions that 80% of the "given up" patients in his clinic recovered using an innovative approach that he called "rehistorization" or "biographical developmental thinking".

A problem may be that there has been a long term suppression of non-pharmaceutical innovation. The method of Dr. Petry for example has been to rely less on drugs.
Long-stay patients belong to the group that has been written off. The long-stay departments house chronic mentally ill for whom, according to classical psychiatry, no future is left. It gave Dr. Petry the name of "psychiatrist of the craziest". But the patients are not written off in the eyes of psychiatrist Detlef Petry. When chronic patients have degenerated into houseplants, people who come to nothing and do nothing anymore, it is the fault of psychiatry and not of the patient or his illness, he argues in his book "The Unmasking".

In Petry's eyes, "being given up" only means that the practitioner has given up the courage, yes, that he is forsaking his duty.

Petry: "I have seen that patients who were written off became human again, received hope, picked up things that they had done in the past."
I've noticed many professors and specialists who created innovative treatments but they often were suppressed. The psychotherapy of US professor Loren Mosher (a former director of research at NIMH) achieved better recovery for psychosis than anti-psychotic drugs in hospitals. Upon it's success, the finance for his research was cancelled and he felt obligated to resign from the APA in disgust for what he called "a pharmaceutical swindle that unnecessarily squanders the lives of young people".

Medical journalist Robert Whitaker (Mad in America, Pulitzer price finalist) wrote the following about the therapy:
But the difference was that Soteria patients remained healthy for longer. The relapse rates were much lower for the Soteria group in both one and two year follup-up studies. The Soteria patients also functioned much better socially. They were better able to keep their job or to attend school.
Professor Mosher's life's work was wasted. He needed to resign as a psychiatrist only to make a point to the public. It was a total waste of time with regard to "helping people recover from mental health problems". Professor Mosher was one of the most powerful people in psychiatry in his time. Thousands of other caregivers are simply not heard of. They will choose a different career and keep silent out of fear for retaliation.

The decades long suppression of non-pharmaceutical innovation in mental health care is a factor to consider. Potential successful treatments may have been suppressed.

The Dutch psychotherapy professor J. Derksen states the following about modern education of psychiatrists:
With the help of the famous DSM (Diagnostic and Statistical Manual of mental disorders), psychodiagnostics and psychopathology have been degenerated into classification, organization of the outside without any significance for in-depth treatment and without any insight into the mechanisms of action of psychological problems. The same scientific developments have fabricated treatment protocols that reduce the practitioner to a technician rather than a clinician. Adding DSM labels and following a protocol is the adage, if one protocol does not work then one tries the other. The complexity inherent in psychological problems and treatment has completely disappeared from the table and hardly gets a chance even in the training of psychiatrists.
According to the professor, psychiatrists are essentially educated to give pills.

Dr Detlef Petry: "If I ever reincarnate, I'll come back as a psychiatrist and get rid of all those pills. (laughs) That takes a lot of time, but it would be a good thing."

The evidence shows that psychiatric care is controversial and may be biased toward pharmaceutical profits.

It is not to be expected from patients turned houseplants to speak for themselves. It is a vulnerable group of people who it concerns.

If euthanasia is applied based on their mental wish (or the wish of their family), that does not seem ethical.
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Re: Euthanasia in psychiatry: ethically?

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chewybrian wrote: October 22nd, 2019, 7:55 pm
Greta wrote: October 22nd, 2019, 6:12 pm I see no reason why we can accept physical problems as incurable and not mental ones. The issue is lack of tangible evidence that casts doubt in people's minds.
There is hard evidence that certain conditions, like Lou Gehrig's disease, are progressive and incurable, and the quality of life, by any reasonable measure, declines as the disease progresses. You might say this about Alzheimer's disease, but that is a mechanical problem, and I am talking about mental illness that is based on attitude and perception, like depression and anxiety. Those problems require particular solutions tailored to each patient. Cognitive behavioral therapy and existential psychotherapy offer solutions. These solutions are highly effective...
Accepted. Still, you noted (fairly) that cognitive therapy isn't failsafe, in which some people's paradigms may not be fixable. The way I see, the law of averages suggests that some belief systems will be easier to change than others. Also note that, especially in these post-modern/post-truth days, cognitive therapy tends to be seen as "system brainwashing".

Whatever, clearly some will slip through the cracks. Those whose paradigms are stuck and society lacks the resources to help. Can we devise a system that is sophisticated enough to not create problematic precedents and loopholes, but still allow for the fact that we "can't save everyone"? Must such fringe cases always be chewed up by utilitarian machinery?

chewybrian wrote: October 22nd, 2019, 7:55 pm
Greta wrote: October 22nd, 2019, 6:12 pm However, our prison system makes crystal clear that incurable mental problems are quite common. Still, a fair percentage of the mental problems of prison inmates are probably curable. The question I put to you is: why are these people not being cured?

It's the same answer as the mental health/euthanasia question.
The answer is the same, indeed. The primary causes of anxiety and depression are existential. We run from the fear of death, meaninglessness, freedom or isolation in many ways by distracting ourselves with work or drugs or whatever. These distractions are secondary causes of anxiety, which we often try to treat while ignoring the primary cause, just as we might try to treat high blood pressure with drugs without expecting the patient to exercise or lose weight. Existential therapy tells us we are all ultimately alone and responsible for our own well being. But, hard work in therapy can break down people's walls and enable them to care for themselves by allowing them to see the world around them more clearly.

Why are people not being cured?
May I suggest a lack of resources and a relatively low level of political and media prioritisation for mental health? Then there is a commercial system where people need to mask symptoms of illness to keep earning money, leading to quick and easy drug-based "solutions" that are more about handling a bout of trouble than getting to the root of the problem (which is too expensive and results in too much downtime from work).

Then there are questionable relationships between doctors and drug companies, the latter no doubt having a fair bit of influence in medicine, being amongst its biggest players.
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Re: Euthanasia in psychiatry: ethically?

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I've wondered what could explain the 'depression epidemic'. In the US, 13% of all people take anti-depressants. It is a growth of 65% in 15 years time. The pills generate a revenue of $17 billion USD per year.

I understand that it is part of culture. Combined with an open door for euthanasia however, it may become dangerous for some people.

Some hope may be with NASA. How will astronauts cope with depression in space while considering that they may be in greater risk for depression?

It is unlikely that NASA would want to waste precious cargo space for anti-depressant drugs.

NASA has been developing an artificial intelligent psychotherapist with $1.2 billion USD funding. Considering the application, it may be intended to efficiently 'solve the problem'.

Virtual Therapist Offers Out-of-This-World Depression Treatment
https://spinoff.nasa.gov/Spinoff2018/hm_5.html
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Re: Euthanasia in psychiatry: ethically?

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I've published a more extensive article on the subject and the background story of the political extortion that was used to enforce the right to apply euthanasia to psychiatric patients.

(2022) Ethical concerns against euthanasia in psychiatry
Dutch psychiatrists used political extortion in 2010 to obtain the right to euthanize psychiatric patients. Since then euthanization numbers in psychiatry have skyrocketed.
https://en.zielenknijper.com/archive/et ... nasia.html

An excerpt that might be of interest for discussion:

Antidepressant treatment controversial

Antidepressants have suspicious side effects while a fake pill with a side effect (active placebo) that gives users the feeling that something is happening in the body, is proven to be just as effective as antidepressants in patients with a clinical major depression.

(2008) Effectiveness of antidepressants: an evidence myth constructed from a thousand randomized trials?
https://philpapers.org/rec/JOHEOA-2 (Stanford professor John P. A. Ioannidis)

Antidepressants double to tenfold the risk of suicide and hundreds of professors raised the alarm that antidepressants can have extreme violence as a side effect. Some magazines even published covers with the title “Killer Pills”.

2009, Pills of the Devil (magazine REVU)
2009, Pills of the Devil (magazine REVU)
revu-killer-pills.jpg (47.53 KiB) Viewed 1351 times

Some references from around 2010:

(2010) A criminal side effect
There is no hard scientific evidence that antidepressants can be the cause of extremely violent behavior, but the evidence is piling up.
https://en.zielenknijper.com/pdf/trouw- ... erking.pdf

(2008) Cheating with suicide rates: Miracle pill, fake pill, suicide pill
https://www.youtube.com/watch?v=c8jtgDMSLjQ

While it is almost impossible to prove why someone decides to do something and thus to prove whether antidepressants were a 'cause' for a suicide wish, that would be irrelevant. What can be concluded is that antidepressant treatment is controversial and may promote suicide in patients. If that would be the case, it would create 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 or her wish.

What do you think about euthanasia on the basis of a mere mental 'wish'?
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