Depression

The legalisation of EAS in the Oregon, the Netherlands and Belgium has seen people suffering from treatable depression assisted to die.
  • Suicide amongst elderly people is usually associated with ill health, social isolation and exclusion.
  • 93-94% of those committing suicide suffer from some identifiable mental disorder.
  • People with disabilities already face discrimination from society that could be fatal with legalisation of EAS.
  • Doctors may not always be able to distinguish between the 'normal' distress and more severe psychological distress.
  • Studies show that 71-95% of elderly people who completed suicide had a psychiatric illness, most commonly depression.
Facelifts, exercise, dieting...we live in a society that is seemingly obsessed with youth or at least having the appearance of youth.

Today’s elderly may often feel that they have no place left to fit in a culture where age is often seen as a “problem”. 

Elderly people have a higher risk of completed suicide than any other age group worldwide. 1

The same is true of people who have become disabled or diagnosed with a disabling disease and can't accept the thought of living with it in the years ahead. Suddenly their life has lost all meaning for them.

Euthanasia and Assisted Suicide (EAS) laws in Oregon, the Netherlands and Belgium are supposed to prohibit EAS for people suffering from depression. In reality, people with treatable depression are being legally killed and given assistance to kill themselves despite safeguards written into the laws.

EAS advocates  suggest that people whose disabilities or illnesses become so severe that life holds no promise of pleasure should be able to end their lives as painlessly and with as much dignity as possible.

Opponents say that legalisation of EAS would mean that people with disabilities or illness, who suffered depression and sought death, would be less likely to receive medication and psychological help to overcome their depression.

Studies have indicated that 93-94% of those committing suicide suffer from some identifiable mental disorder. 2

The Elizabeth Bouvia Case
This excerpt is from an article in the American Bar Association Publication written by Diane Coleman of the US disability group Not Dead Yet.

"I don't want to live like this one more day," she said firmly. "I've had enough." 

She had been forced, at 26, to leave her masters program. Her car had been repossessed. Following a miscarriage, her marriage had broken up. Her brother had drowned. And now her mother had been diagnosed with cancer.

One night, she turned up in a hospital, moaning that she just wanted to die. She was a competent adult, and her reasons for living were gone, so the hospital should not interfere.

In fact, the doctor should cooperate, so she would not have to worry about botching her suicide and making things worse. She had lost more than most could bear. She just wanted the suffering to end. So she called a lawyer to sue the hospital to help her end it all.

But it is not a hypothetical. It is a real case. Elizabeth Bouvia sought the right to starve herself in a hospital while receiving morphine and comfort care.

There are facts are missing from the above synopsis above The chief missing fact is that Bouvia was born with cerebral palsy, and she used a wheelchair to get around. 

In Coleman's opinion, this case shows there is one law for the disabled and one law for everyone else. In Elizabeth Bouvia’s case what she was suffering from was not her disability but extreme distress caused by the loss of all she held dear.

With proper emotional and psychological counselling this set of circumstances could have been navigated around and an alternative future could have been secured for her. Disability activists gathered to monitor the proceedings and talk to the Press. 

Disability activist. Paul Longmore, said:

"When society gave disabled the right to live with dignity, then, and only then, might we might talk about the right to die! Society had no business talking about a disabled person's right to die before it had given them a right to live!"

Coleman points out that this case highlights the discrimination that exists towards people with disabilities. 

Read the Elizabeth Bouvia story

Disability and depression
Alison Davis, National Co-ordinator for the UK group 'No Less Human' has spina bifida, emphysema and osteoporosis, and has used a wheelchair full time for the last nineteen years.

She suffers severe spinal pain on a daily basis. She was committed to ending her life for the first ten years of illness and made serious suicide attempts but was saved by friends who not only administered treatment against her will but gave her hope.

Davis asks "Would any doctor really wait (10 years) if euthanasia were legal and the patient qualified for it?" She also states "what has changed is not my medical condition, but my outlook on life."

Asserting that it is fundamentally wrong to kill vulnerable people, whether or not they have requested death, Davis says:

"People use the principle of autonomy as a justification for voluntary euthanasia. However, such freedom to make decisions entails a responsibility to act ethically, and euthanasia is deeply unethical. Compassion does not mean simply giving people what they want, or say they want, or what others think they ought to want."
Most ill or disabled people suffering clinical depression, who have been prevented from committing suicide, are later glad that they were unable to carry out their intention. In many cases, patient response depends upon the manner in which information about their illness or disability is presented to them.

In some cases, people with disabilities or illnesses choose to die because there are no reasonable economic, residential, vocational, social, or educational alternatives. Those opposes to EAS say that offering people death with dignity while denying access to a life with dignity is no choice at all. 

Doctors, lacking clinical knowledge and skills, may not always be able to distinguish between the 'normal' distress, which is inevitable, and more severe psychological distress. 

"Psychological distress impairs the patient's capacity for pleasure, meaning, and connection; erodes quality of life; amplifies pain and other symptoms; reduces the patient's ability to do the emotional work of separating and saying good-bye; and causes anguish and worry in family members and friends.

Finally, psychological distress, particularly depression, is a major risk factor for suicide and for requests to hasten death." 3 

The elderly and depression
According to a comprehensive review of psychological autopsy studies, 71-95% of elderly people who completed suicide had a psychiatric illness, most commonly depression. 4

An attempt at suicide is often a challenge to see if anyone out there really cares. 5

When elderly people request assisted suicide rather than acting to kill themselves, there is some reason to believe this may well be a subconscious manifestation of precisely that challenge.

EAS opponents are concerned that, following legalisation, if this challenge is made to a doctor who agrees to provide physician-assisted suicide, the recipient will receive the message from society "we don't care if you live or die."

Read more about Suicide and the Elderly

References:
  1. BMJ  2004;329:895-899 (16 October), doi:10.1136/bmj.329.7471.895
  2. Barraclough, Bunch, Nelson, & Salisbury, A Hundred Cases of Suicide: Clinical Aspects, 125 BRIT. J. PSYCHIATRY 355, 356 (1976) and E. Robins, THE FINAL MONTHS 12 (1981).
  3. Susan D. Block, MD Assessing and Managing Depression in the Terminally Ill Patient
  4. Conwell Y, Duberstein PR, Caine ED. Risk factors for suicide in later life. Biol Psychiatry 2002;52: 193-204
  5. Stengel, Suicide and Attempted Suicide 113 (1964).