{"id":2998,"date":"2016-03-05T09:46:48","date_gmt":"2016-03-05T08:46:48","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=2998"},"modified":"2016-03-05T10:46:12","modified_gmt":"2016-03-05T09:46:12","slug":"autism-mental-illness-euthanasia-and-the-wapo","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2016\/03\/05\/autism-mental-illness-euthanasia-and-the-wapo\/","title":{"rendered":"Autism, Mental Illness, Euthanasia and the WaPo"},"content":{"rendered":"

There was a piece in the\u00a0Washington Post<\/em> the other day with a striking headline:<\/a>\u00a0Where the Prescription for Autism can be Death<\/strong>.<\/p>\n

Normally, if we’re saying that the prescription for\u00a0x<\/em> is\u00a0y<\/em>, we mean to say that\u00a0y<\/em> is being suggested as a treatment for\u00a0x<\/em>. \u00a0Painkillers are the prescription for a bad back, a steroid cream the prescription for eczema, and so on. \u00a0Even if you find that phrasing a bit clunky, “prescription” implies the recommendation of a medical expert. \u00a0On that basis, the implication here is that somewhere in the world, doctors are seeing patients, diagnosing autism, and saying, “I wonder if the best thing would be to kill you”. \u00a0That would be uiruite a Big Deal.<\/p>\n

The place in question is Holland. \u00a0But a quick look at the article shows – surprise, surprise – nothing of what’s hinted at in the headline. \u00a0Here’s the opening few sentences, edited slightly for formatting:<\/p>\n

\n

In early childhood, the Dutch psychiatric patient known\u00a0as 2014-77<\/a>\u00a0suffered neglect and abuse. \u00a0When he was about 10, doctors diagnosed him with autism. \u00a0For approximately two decades thereafter, he was in and out of treatment and made repeated suicide attempts. \u00a0He suffered terribly, doctors later observed, from his inability to form relationships: \u201cHe responded to matters in a spontaneous and intense, sometimes even extreme, way. This led to problems.\u201d<\/p>\n

A few years ago, 2014-77 asked a psychiatrist to end his life. \u00a0In the Netherlands, doctors may perform euthanasia \u2014 not only for terminal physical illness but also upon the \u201cvoluntary and well-considered\u201d request of those suffering \u201cunbearably\u201d from incurable mental conditions.
\nThe doctor declined, citing his belief that the case was treatable, as well as his own moral qualms. \u00a0But he did transmit the request to colleagues, as Dutch norms require. \u00a0They treated 2014-77 for one more year, determined his case was, indeed, hopeless and, in due course, administered a fatal dose of drugs. \u00a0Thus did a man in his 30s whose only diagnosis was autism become one of 110\u2009people to be euthanized for mental disorders in the Netherlands between 2011 and 2014.<\/p><\/blockquote>\n

So, then, it’s a story about a man, who happened to be autistic, and who asked a psychiatrist for euthanasia. \u00a0After a little to-ing and fro-ing, that request was granted. \u00a0There is no reason to believe that this was a case of death being prescribed\u00a0for<\/em> autism. \u00a0It’s just that he happened to be autistic and to want to die, and a prescription for assistance was provided. \u00a0Phrasing is important.<\/p>\n

Dutch law on assisted dying is famously liberal; in considering the permissibility of euthanasia for psychiatric as well as somatic illnesses, it is in the minority\u00a0of the minority of jurisdictions that consider the permissibility of any euthanasia. \u00a0I have addressed the question of psychological suffering in relation to euthanasia elsewhere<\/a>, and shan’t rehearse the details here; suffice it to say, I don’t see any reason in particular to think that mental illness and physical illness should be treated all that differently in principle:<\/p>\n

[T]he arguments about physical distress [as a reason to seek assisted dying] seem to me to rely \u2013 to at least some extent \u2013 on a notion of psychological distress anyway.\u00a0 After all, a person who was terminally ill but unmoved by that fact would \u2013 presumably \u2013 be less likely to seek assistance than someone for whom it did make some kind of emotional impact.\u00a0 There\u2019s likely to be more to it in real life; but I think that, all the same, some kind of psychological distress is reasonably likely to be found in people who seek assistance to die for ostensibly physical reasons.\u00a0 That being the case, it\u2019s not clear why psychological distress mightn\u2019t be a reason to seek assistance in its own right.<\/p><\/blockquote>\n

For sure, we might be a bit more worries about the authenticity of a desire to die in the case of mental illness; but so long as we are satisfied that the desire to be dead is genuine, then I don’t really see why mental illness should be a special case when it comes to euthanasia. \u00a0In fact, I don’t see why illness should be a criterion at all. \u00a0If a\u00a0Smith wants to be dead, and would prefer assistance, and someone is willing to allow it, then – subject to fairly straightforward regulations about who that someone is – for as long as we take seriously individuals’ rights to run their lives as they see fit, the moral case seems to be there to be made.<\/p>\n

And this is how we can answer he case of Tine Nys, also cited in the WaPo<\/em> article. \u00a0Nys, who has a history of mental illness, sought assistance to die after a romantic breakup. \u00a0It might be that, after all, the medics who helped in this particular case were too easily persuaded – I don’t know enough about her or the case – and it might even be that virtue would count against assisting in\u00a0every<\/em> actual similar case; but that won’t make the principled argument, which is that mental distress need not be any worse a cause for assisted dying than anything else, not least\u00a0because – as I suggested above – it’s implicit in wanting to die in response to physical illness as well. \u00a0That procedures can be ignored is evidence that there are procedures; and there’s no reason to believe that such procedures have to be sinister. \u00a0exceptio probat regulam in casibus non exceptis<\/em>, and all that.<\/p>\n

Back to the main thrust of the\u00a0WaPo<\/em> piece, though. \u00a0It’s claimed that<\/p>\n

In 37\u2009cases, patients refused possibly beneficial treatment, and doctors proceeded anyway.<\/p><\/blockquote>\n

But it’s not clear why that should matter. \u00a0If a person refuses treatment, then that’s fine. \u00a0(Imagine that\u00a0someone is seeking an abortion, and is told not to worry because the pain of childbirth can be nullified with drugs. \u00a0That might, I suppose, make a difference where fear of pain is at the root of the desire for termination; but it’d be strange to treat it as an all-things-considered knockdown argument against providing any abortions at all. \u00a0Or someone who refuses intubation, even though it isn’t going to be forever – again, we’d take that seriously, and Ms B<\/a><\/em> showed that the law would be on the refuser’s side. \u00a0The same sort of reasoning would seem to apply here.)<\/p>\n

Contrary to the tone in the\u00a0WaPo<\/em> article, there is no reason to suppose that someone with a mental illness or who has a disorder\u00a0like autism is by definition especially vulnerable in this sort of situation. \u00a0They might be vulnerable, of course; and there might even be a higher chance of that than there is for most people. \u00a0But they might not be. \u00a0It strikes me as rather patronising to assert otherwise.<\/p>\n

The article continues, to report that<\/p>\n

[a]mong the obvious risks [of providing euthanasia to psychiatric patients], Columbia University psychiatrist Paul S. Appelbaum\u00a0writes<\/a>\u00a0[…], is \u201cinducing hopelessness among other individuals with similar conditions and removing pressure for an improvement in psychiatric and social services.\u201d<\/p>\n

\u201cWill psychiatrists conclude from the legalization of assisted death that it is acceptable to give up on treating some patients?\u201d Appelbaum asks.<\/p><\/blockquote>\n

A perennial warning I have to give to my students is against rhetorical questions: someone might answer them, and not as you expect. \u00a0Instead of answering head-on, though (and at risk of falling foul of my own exhortations), I shall respond to this one with a couple of my own: \u00a0Why should it? \u00a0Why should the possibility of doing\u00a0A<\/em> at someone’s request make it less likely that standard practice\u00a0B<\/em> would be rejected in circumstances when\u00a0A<\/em> is\u00a0not<\/em> requested?<\/p>\n

The problem with this article is not that it’s just poorly argued, but that it’s actually dangerous. \u00a0Why? \u00a0Because between the tendentious headline and the leading rhetorical questions, patients are at risk of being made more worried than they need to be; and, at the outside, this might mean that they’re less likely to seek treatment for mental or neurological disturbances out of an unwarranted fear that the prescription will be for a lethal injection.<\/p>\n

That strikes me as being a bad thing.<\/p>\n","protected":false},"excerpt":{"rendered":"

There was a piece in the\u00a0Washington Post the other day with a striking headline:\u00a0Where the Prescription for Autism can be Death. Normally, if we’re saying that the prescription for\u00a0x is\u00a0y, we mean to say that\u00a0y is being suggested as a treatment for\u00a0x. \u00a0Painkillers are the prescription for a bad back, a steroid cream the prescription […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[511,443,563,2148,591,2152,328,475,1266,1241],"tags":[],"class_list":["post-2998","post","type-post","status-publish","format-standard","hentry","category-in-the-news","category-jme","category-language","category-law","category-life-and-death","category-mental-health","category-philosophy","category-politics","category-shameless-self-publicity","category-tinfoil-hat"],"yoast_head":"\nAutism, Mental Illness, Euthanasia and the WaPo - 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\/2016\/03\/05\/autism-mental-illness-euthanasia-and-the-wapo\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Autism, Mental Illness, Euthanasia and the WaPo - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"There was a piece in the\u00a0Washington Post the other day with a striking headline:\u00a0Where the Prescription for Autism can be Death. 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