Can Mad People Access State Assisted Suicide?

Suisse, H. (2012). SUICIDE ASSISTANCE FOR MENTALLY DISORDERED INDIVIDUALS IN SWITZERLAND AND THE STATE’S POSITIVE OBLIGATION TO FACILITATE DIGNIFIED SUICIDE Medical Law Review DOI: 10.1093/medlaw/fwr033

Can a mentally disordered citizen call upon the State to medically assist her or his suicide?

The simple answer to that question is ‘no’, since even in liberated Switzerland a callous distinction is made between who and who cannot access legal euthanasia on the basis of their presumed capacity…

‘The applicant in Haas had suffered from severe bipolar disorder for some 20 years, during which time he had twice attempted suicide, and spent several periods in psychiatric institutions. In 2004, he became a member of Dignitas, subsequently soliciting its assistance to commit suicide. However, unable to find a psychiatrist willing to prescribe a lethal dose of sodium pentobarbital, the applicant’s plans were frustrated’ (2012, n.pag.).

As is noted in this article (2012), the stumbling block for this gentleman was capacity, that is, the presumption made by the State that to be mad is to lack capacity to make such a critical decision. The impossible dilemma posed is that State expects that if one wants to check out prematurely, one must not be severely mentally unwell, since that is seen to be analogous with incapacity and yet, it is only when one who is ordinarily mentally unwell is severely so affected that she or he would be likely to contemplate a speedy exit from life. What was at large in the Haas decision was that nasty, ancient overhang by which the law washes itself of the factual evidence regarding mental health and instead defers sheepishly to psychiatry, to do its thinking for it…

‘The members of the medical profession have long and anxiously endeavoured to frame a definition of insanity, which is an attempt in a few words to exhibit the essential character of this disorder; so that it may be recognised when it exists; – these efforts have been hitherto fruitless, nor is there any rational expectation that this desideratum will be speedily accomplished. The Lawyer has taken a different view of the subject: he has been little solicitous to become acquainted with the physiological distinctions of disordered intellect, or the causes producing such state:- these he has confided to the medical evidence to explain…’ (Haslam, 1817).

My interest in this topic is far from purely academic. The product of a wrongful life, where the State proactively intervened to prevent my mother from actioning her considered choice to terminate an unwanted pregnancy, for my entire childhood and adolescence, I was knowingly left for dead by the State in a hellish home environment, where I was forced to spend every waking moment in sheer terror of anticipated abuse. From that abuse, I was left with the pervasive symptoms of complex trauma that have persisted to the present and will undoubtedly haunt me for the rest of my life. At many points across my troubled life I have been pushed to the precipice of suicide, fulfilling the first element in Haas, that is, that I was being caused suffering that led to me believing that my life was no longer worth living (2012).

For one, I am forever ‘stuck’ with the traumatic memories of that fateful night on 1 May 1998, when at the launch of the Human Rights Centre for Mental Health that I had developed with Kon Karapanagiotidis in Fitzroy, Melbourne, I was bashed by a trusted friend and colleague. That assault triggered in me the most extraordinary, overwhelming wave of torment that led me to later that same night beg my perpetrator to actually finish off what he had begun, that was, to kill me. As my life quickly unravelled after that vicious assault the same State that had forced my birth denied me the therapeutic support that would have facilitated my recovery. To the present, in fact, Catherine Branson, President of the Australian Human Rights Commission, has concluded that the State owes me no duty whatsoever to provide me with essential, psychological counselling.

The unfinished business of Haas is that it seemingly affords citizens who are mentally unwell the right to State assisted suicide but then, renders that practice all but impossible by invoking a raft of intervening checks and balances that militate against individual agency…

‘…the procedure developed in Haas is problematic insofar as mentally disordered individuals are subject to measures not imposed on individuals with somatic conditions. Individuals with somatic illness are not required to demonstrate that the wish to die is authentic – no distinction is made between the individual and the condition. Moreover, unlike individuals with somatic conditions, mentally disordered individuals may not decline alternatives, viz, treatment. However, if the underlying assumption with regard to mentally disordered individuals holds true for those with somatic conditions (that a wish to die is only authentic when the source of suffering is incurable), it would be illegitimate to allow any refusal of treatment with a greater than de minimis chance of extending life. Alternatively, the underlying assumption may be false – and the link between incurability and authenticity artificial’ (2012)…

See also: MacLeod, S. (2012). Assisted dying in liberalised jurisdictions and the role of psychiatry: A clinician’s view Australian and New Zealand Journal of Psychiatry DOI: 10.1177/0004867411434714