When “Medical Assistance In Dying” Comes After You

Canada’s “Medical Assistance in Dying” program is in the disability news as “mental illness” has been added to the list of rationales for state-approved suicide — despite the acknowledged difficulty of distinguishing the suicidal patients from the ones who just want suicide.

I’d like to back up today and talk very frankly about the temptation to suicide when experiencing any of the conditions, physical or mental, that Canada’s euthanasia policies cover. Proponents of assisted suicide make it sound as if state-sanctioned suicide is there only as a rescue from extraordinary suffering in the rarest of cases. This is not at all the reality.

The reality is that death-ideation is an extremely common experience, and that the availability of medically-assisted suicide creates a disastrous pressure towards suicide among patients who do not want to be suicidal.

So let’s talk about that pressure.

Suicide Prevention is a Normal, Healthy Philosophy

Before we continue, since this is the Catholic Channel let’s dispense with a few points about the Catholic faith:

There is no requirement to take extraordinary measures to prolong life. It’s immoral to withhold nutrition and hydration from a patient capable of receiving it (at the end of life the digestive system may shut down), but it is not required that the patient seek out expensive or burdensome treatments.
We should seek to relieve suffering, using whatever moral means are at our disposal. I’m going to discuss that a bit more below.
It is acceptable to use pain medications (or other treatments) to relieve suffering, even if that treatment comes with a known risk of shortening lifespan.

And while the Catholic opposition to suicide does have a religious basis, it is not a uniquely-Catholic philosophical position.

For the remainder of this discussion, though, I’m going to be looking at what I think is an even more common moral belief: People should not be pressured into suicide.

If you think people should be pressured into suicide, please go away. Everyone else, keep reading.

My Dog in this Fight

Regular readers know that I have some kind of brain disease, fairly mild at the moment, precise diagnosis still TBD. We don’t even know if it’s strictly a neurological disorder or if it’s something else, but which happens to be provoking neurological symptoms.

What’s new is that as of last Friday night I picked up an intermittent movement disorder. Looks like a chorea, and if you click that link you’ll see that most of the possible causes are horrifying chronic and/or terminal illnesses that definitely put you on Canada’s suicide-eligible list.

(I have many gates to pass through before I am likely to know where exactly I fall on the charts. My GP and I have been wondering for a decade if something like this would eventually pop up to assist with a more definitive diagnosis than “Yeah, something’s wrong, but we can’t really tell what yet.”)

Fortunately for me, I do not live in a state where assisted suicide is legal.

Deadly Suffering

Let’s talk about suffering.

In my own experience, fatigue is one of the most disabling features of chronic illness. With persistence you can out-engineer all kinds of other problems, but you have to be awake and mentally functional in order to do so.

Obviously therefore dementia would be even more disabling; addiction and psychological disorders will each wreck you in their own nasty manner; and of course there are no end of physical ailments, many of which sound more like sci-fi until you hear from someone who actually has that thing.

You the reader probably have some top most-worst disability that completely blows you away.

I’m convinced, though, that the soul-crushing power twins are chronic pain and severe sleep-deprivation. It only takes one or the other, but of course they often work as a team.

Any of these, or any other catastrophic illness or disability, can easily push you to the brink of despair.

The Consequences of Inadequate Treatment

Severe chronic pain and sleep-deprivation bring on despair of their own accord. I would hazard it’s almost a biological fact.

–> For this reason, refusing to offer adequate pain control is tantamount to murder. Plain and simple. It is torture that pushes the sufferer to insanity. To then dangle suicide as a “choice” is a mockery.

I say this as someone who doesn’t use prescription pain meds, uses very little in the way of OTC pain meds, and who delivered four children unmedicated (by choice). I’m not speaking as a med-seeking, pain-fearing person. I’m just telling you what reality is.

Therefore, you cannot speak of choice about suicide unless both pain and sleep deprivation have been dealt with.

The Emotional Fallout of Disabling Illness

The emotional toll of disabling chronic or terminal illness (any physical condition known to the government of Canada to be justification for suicide) comes in various guises, depending on the situation:

Fear of being a burden on loved ones who have to either personally care for you or pay someone else to do so.
Feeling “useless” because you cannot do what you think you ought to be doing.
Social isolation from being unable to maintain relationships or community involvement due to your limitations, or because needed assistive technology is not available to you.
Ostracizing because your condition makes you socially-unacceptable, or your condition requires assistance that community members (including your doctor’s office and your church) don’t care to accommodate.
Awareness of not “pulling your weight” if you can’t financially support yourself, even if you don’t require significant care otherwise.
Outright destitution if there is not a support network (public or personal) that can provide for you when you are incapable of supporting yourself.

Poverty has been specifically cited in numerous cases of requests for legally-sanctioned assisted suicide. Again, here, what is the “choice” being offered? It’s no choice. Governments that swear they offer a social safety net are now declining to provide necessary material support to indigent citizens, and instead are offering suicide.

Emotionally, however, feelings of intensely lacking in self-worth and of being a “net negative” on friends and family members are very common, and this is true even among religious people, and even when the sufferer has supportive family members.

Surfing the Waves of Despair

If the “choice” of suicide is off the table, feelings of despair and worthlessness can be dealt with.

If initial efforts at treating pain and sleep deprivation don’t succeed, alternatives can be tried. You the person feeling isolated and overwhelmed can continue to pursue strategies for building relationships, coping with physical limitations, or seeking financial and practical supports.

Serious illness and disability put pressure on family relationships, bringing to light problems that were previously covered-over when things were going well. With time, these conflicts can be resolved.

Furthermore, it is common for waves of despair to be part of the chronic or terminal illness experience. Even if you know better, even if overall your situation is remarkably supportive, the emotions are likely to show up.

When the “choice” of suicide is not offered, then those emotions can be dealt with for what they are: Temporary feelings that will pass either on their own or by addressing the underlying issue that is fueling them.

The Death-Dealers

In contrast, in a climate where physicians, public-aid agencies, and unsupportive family members are touting suicide as a means of escaping suffering, it is impossible to speak of a free “choice” to kill oneself.

The offer is the pressure. In the midst of a wave of despair, it is already difficult to not succumb. The supposed “compassion” of asking whether someone might like to step off the ledge isn’t the offering of a choice at all. It’s a nudge unto death.