{"id":2907,"date":"2015-05-18T20:09:10","date_gmt":"2015-05-18T19:09:10","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=2907"},"modified":"2015-05-18T20:09:10","modified_gmt":"2015-05-18T19:09:10","slug":"we-should-not-prevent-some-depressed-people-from-access-to-assisted-dying","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2015\/05\/18\/we-should-not-prevent-some-depressed-people-from-access-to-assisted-dying\/","title":{"rendered":"We should not Prevent Some Depressed People from Access to Assisted Dying"},"content":{"rendered":"<p><em><strong>Guest post by Udo Schuklenk<\/strong><\/em><\/p>\n<p>We should not prevent some depressed people from access to assisted dying.<\/p>\n<p>Deborah E Gray, whose depression is (according to her account) successfully managed today, describes vividly on her\u00a0<span style=\"text-decoration: underline\"><span style=\"color: #0000ff\"><a style=\"color: #0000ff;text-decoration: underline\" href=\"http:\/\/www.wingofmadness.com\/what-does-depression-feel-like\/\">website<\/a><\/span><\/span>\u00a0the impact depression had on her. \u00a0She writes:<\/p>\n<blockquote><p>you don\u2019t feel hopeful or happy about anything in your life. \u00a0You\u2019re crying a lot for no apparent reason, either at nothing, or something that normally would be insignificant. \u00a0You feel like you\u2019re moving (and thinking) in slow motion. \u00a0Getting up in the morning requires a lot of effort. \u00a0Carrying on a normal conversation is a struggle. \u00a0You can\u2019t seem to express yourself. \u00a0You\u2019re having trouble making simple decisions. \u00a0Your friends and family really irritate you. \u00a0You\u2019re not sure if you still love your spouse\/significant other. \u00a0Smiling feels stiff and awkward. \u00a0It\u2019s like your smiling muscles are frozen. \u00a0It seems like there\u2019s a glass wall between you and the rest of the world. \u00a0You\u2019re forgetful, and it\u2019s very difficult to concentrate on anything. \u00a0You\u2019re anxious and worried a lot. \u00a0Everything seems hopeless. \u00a0You feel like you can\u2019t do anything right. \u00a0You have recurring thoughts of death and\/or suicidal impulses. \u00a0Suicide seems like a welcome relief. \u00a0Even on sunny days, it seems cloudy and gray. \u00a0You feel as though you\u2019re drowning or suffocating. \u00a0Your senses seem dulled; food tastes bland and uninteresting, music doesn\u2019t seem to affect you, you don\u2019t bother smelling flowers anymore.<\/p><\/blockquote>\n<p>In many jurisdictions where the decriminalisation of assisted dying is debated, proponents of decriminalisation hasten to add that they would, of course, exclude patients that suffer from depression. \u00a0This may be a political move aimed at increasing the societal acceptability of assisted dying, but it is unjust towards patients suffering from treatment-resistant depression. \u00a0Many lay-people, and even doctors and nurses, fail to acknowledge the severe suffering that comes with depression. \u00a0Patients who suffer from long-term treatment resistant depression are not just \u2018feeling a bit low\u2019. \u00a0As the quotation above shows, these people really suffer existentially, and because their depression has proven to be untreatable (often over the course of decades) there is no relief for their suffering.<!--more--><\/p>\n<p>Treatment-resistant depressed people\u2019s suffering is in some sense even worse than that of the patients who suffers from end-stage cancer, or other uncontroversially somatic ailment, since these patients know that they will die soon even if their request for assisted dying is not granted. \u00a0Often the only way out for treatment-resistant depressed patients is to end their suffering by means of committing suicide, often in a gruesome manner, if no humane alternatives are offered. \u00a0Major depressive disorder and bipolar mood disorder are <span style=\"text-decoration: underline\"><span style=\"color: #0000ff\"><a style=\"color: #0000ff;text-decoration: underline\" href=\"http:\/\/www.who.int\/mental_health\/prevention\/suicide\/suicideprevent\/en\/\">reportedly<\/a><\/span><\/span> the main drivers underlying about 60% of the estimated 800,000 annual suicides globally. \u00a0In addition to the hopelessness depressed patients feel, they often encounter a resistance from their psychiatrist to discuss the options of a death as a way out of their suffering. \u00a0This impossibility to discuss possible ways to achieve a good death, only adds to their loneliness and desperation.<\/p>\n<p>We argue <span style=\"text-decoration: underline\"><span style=\"color: #0000ff\"><a style=\"color: #0000ff;text-decoration: underline\" href=\"http:\/\/jme.bmj.com\/content\/early\/2015\/05\/02\/medethics-2014-102458.full.pdf\">in our paper<\/a><\/span><\/span> that assisted dying should be made available as an option to patients with treatment resistant depression, as much as it ought to be available to other patients that suffer unbearably and hopelessly. \u00a0We propose competence as a threshold criterion, this would exclude patients in a psychotic state.<\/p>\n<p>We expect that being able to discuss the possibility of a humane end-of\u2013life with their doctors will help these patients to cope better with their depression. \u00a0The knowledge that they will no longer have to bear it, once they decide it is too much, may in itself be therapeutic. \u00a0This in turn may well prevent violent deaths that leave their relatives, friends and even completely random bystanders distraught. \u00a0At the same time a public discussion about mental illness, including depression will contribute toward misperceptions of psychiatric diseases as something &#8220;not real&#8221;. \u00a0Suffering from psychiatric disease is very real, and should be acknowledged as such. \u00a0For some patients this suffering will be so severe, so debilitating, that not-to-live is the better alternative. \u00a0It is unjust to deny them the peaceful death we are willing to grant other competent patients whose lives have become not worth living to them, in their best considered judgment.<\/p>\n<p><em>Read the full paper <span style=\"text-decoration: underline\"><span style=\"color: #0000ff\"><a style=\"color: #0000ff;text-decoration: underline\" href=\"http:\/\/jme.bmj.com\/content\/early\/2015\/05\/02\/medethics-2014-102458.full.pdf\">here<\/a><\/span><\/span>.<\/em><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Guest post by Udo Schuklenk We should not prevent some depressed people from access to assisted dying. Deborah E Gray, whose depression is (according to her account) successfully managed today, describes vividly on her\u00a0website\u00a0the impact depression had on her. \u00a0She writes: you don\u2019t feel hopeful or happy about anything in your life. \u00a0You\u2019re crying a [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2015\/05\/18\/we-should-not-prevent-some-depressed-people-from-access-to-assisted-dying\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2153,1542,443,591],"tags":[],"class_list":["post-2907","post","type-post","status-publish","format-standard","hentry","category-guest-post","category-in-the-journals","category-jme","category-life-and-death"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>We should not Prevent Some Depressed People from Access to Assisted Dying - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2015\/05\/18\/we-should-not-prevent-some-depressed-people-from-access-to-assisted-dying\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"We should not Prevent Some Depressed People from Access to Assisted Dying - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"Guest post by Udo Schuklenk We should not prevent some depressed people from access to assisted dying. 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