Establishing a global ethical principle that mentally ill patients cannot be euthanized

By Dave Andrusko

Back in August Washington Post columnist Charles Lane wrote eloquently in opposition to the euthanasia movement’s “mission creep,” specifically killing patients who are not terminally ill and more specifically yet patients who are chronically depressed or mentally incompetent.

As NRL News Today has written, this is becoming customary in places such as Belgium and the Netherlands where the physician administers the lethal dose. Alas, the plague threatens to metastasize and spread to other nations.

Today Lane wrote an add-on to his August 19 column, revealing information that I suspect most people, including me, did not know.

First, the background to something that happened over the weekend:

The troubling implications of physicians, especially psychiatrists, extinguishing life based on the supposed volition of mentally ill people who are, by definition, less capable of expressing clear intention — whose diseases are often manifest by a diminished grasp of reality — have stirred increasing concern both within Belgium and the Netherlands and beyond.

Lane’s point is that the psychiatric profession has pussyfooted around by failing to establish a forthright position of opposition. “But now that may be changing,” Lane wrote today. “This past weekend, the American Psychiatric Association gave final approval to statement declaring its ethical opposition to psychiatric participation in assisted suicide or euthanasia for a non-terminal patient.”

The statement read:

The American Psychiatric Association, in concert with the American Medical Association’s position on Medical Euthanasia, holds that a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.

There needs to be a couple of points of clarification. This opposition is to euthanasia–where a physician directly administers something that kills the patient–and specifically to cases of non-terminally ill patients.

This separate from the pro-death contingent within the American Medical Association which is trying to persuade the AMA to go neutral on physician-assisted suicide. Typically, physician-assisted suicide means the physician prescribes the lethal concoction which the patient takes on his or her own, or with the assistance of someone other than the physician.

Back to the statement by the American Psychiatric Association. Lane writes

Obviously, this is of little immediate practical effect in the United States, because non-terminal cases are not eligible for assisted death — but given the potential slippery slope in this area, the APA statement lays down an important marker for the future.

Yes and no. Technically, the patient is supposed to be terminal–usually diagnosed to die within six months. But as we have reported in dozens of stories, empirically these kinds of predictions are nearly impossible to make with certainty and there are statistics that show that patients who are living with serious but non terminal conditions are receiving lethal prescription where legal.

But Lane is right: it is somewhat of a deterrent to the “slippery slope” to have a policy statement that the patient must be terminally ill. Lane concludes his column

Also, the APA’s stand may help influence the debate in next-door Canada, where physician-assisted suicide has recently been legalized for physical illness — and the government is going to make a formal study of extending it to “requests made by individuals with mental illness as their sole underlying condition.”

Most important, the statement implies the basis for a possible direct organizational protest by American psychiatrists to their Belgian and Dutch colleagues, the logical next step in the APA’s welcome assertion of what should be a global ethical principle.