Should people with mental health disorders have access to physician-assisted death?

Should someone with depression be assisted in ending their life? It’s a question that many in health care are currently wrestling with. And it’s not a hypothetical one.

The February 2015 Supreme Court of Canada ruling on physician-assisted death – known as the Carter decision – opens the door for people with mental health conditions to request physician-assisted death. The Court noted those with “grievous and irremediable” medical conditions that cause suffering that is “intolerable” and “enduring” should be able to access physician-assisted death. This suffering could be physical or psychological, according to the Carter decision. However, the individual must still be determined as cognitively “competent” to comprehend the numerous factors involved in a request to die.

Last week, the Court gave federal lawmakers a new deadline of June 6 after which the Criminal Code prohibitions on physician-assisted dying will no longer be in force when it comes to individuals who meet the Court’s criteria. The Court also made it clear that the Criminal Code prohibitions are already invalid in Quebec, as the province has already passed legislation to regulate “medical aid in dying.”

The possibility that psychiatrists – who make great efforts to prevent suicide among patients – could be called upon to essentially facilitate a psychiatric patient’s wish for death is leading to much concern, says Sonu Gaind, president of the Canadian Psychiatric Association. “Our members are wanting some guidance,” he says.

“Nobody [in the psychiatric community] has taken a serious run at the mental health questions,” says Phil Klassen, vice-president of medical affairs at Ontario Shores Centre for Mental Health Sciences.

Sandra Martin, a journalist at the Globe and Mail, has researched assisted death practices in countries around the world for a book that will be published in April. One of the key questions for Canada, she says, is how doctors and lawmakers define what is irremediable – or without remedy – when it comes to mental health conditions. “With cancer, you know there’s an end in sight. With a psychological condition, there’s always a thought that maybe a miracle cure will come along,” she says.

Physician-assisted death and mental health conditions: The international picture

Before wading into the ethically complicated questions, it’s important to mention that other countries – Belgium, The Netherlands, Switzerland and Luxembourg – allow access to physician-assisted death on mental health grounds.

Belgium is widely seen as the most permissive jurisdiction when it comes to assisted dying for people with mental health disorders, says Martin. One study followed 100 Belgian patients who made assisted dying requests as a result of mental suffering. The study found most had depression, followed by personality disorders. But patients with anxiety disorders, schizophrenia, Asperger’s and other conditions also applied. (The study noted that around half of the requests were granted, but the diagnoses involved in the accepted applications were not disclosed.)

Other countries have stricter procedures. In Switzerland, for example, a consulting psychiatrist must determine that the wish to end one’s life is not a result of perceptual changes that mental disorders can cause, but is “self-determined.”

In all jurisdictions that allow mental health diagnoses as grounds for assisted dying, very few patients with only psychological suffering die with physician assistance. They represent less than 1% of the successful applications, explains Jennifer Gibson, who examined international data as co-chair of the Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying. That could be because so few people with mental health issues request physician assistance in death or “because the psychiatric illness prevented the individual from being viewed as sufficiently competent to make the decision,” she says.

In other jurisdictions, including several U.S. states and the country of Colombia, psychological suffering doesn’t make one eligible for assisted suicide; there, people must have a terminal condition.

Doctors divided on the use of assisted death for psychological suffering

In her stakeholder meetings with psychiatrists as part of the Expert Advisory Group, Gibson says that while many in the psychiatric community are waiting for more legal clarification before adopting a position, some are already for or against assisted dying for their patients. “Some will be adamantly opposed to this and say, ‘Our job is to prevent suicide,’” she says. “On the other hand, I’ve heard from psychiatrists who say, ‘There are one or two cases in my years of clinical practice that have haunted me.’” For those extremely rare cases, the psychiatrists think that assisted death could be seen as reasoned to alleviate intolerable suffering, Gibson explains.

One of the key arguments for allowing assisted death for people with mental health disorders relates to fairness. The Supreme Court didn’t make ‘terminal’ a criteria for accessing physician-assisted death. So it would be discriminatory to allow physician-assisted death for those with non-terminal physical conditions but to bar it for those with non-terminal psychological conditions, the argument goes. As Martin puts it, “psychological suffering can be just as real as physical suffering.”

Gibson encapsulates this view. She doesn’t agree with an overt ban on assisted death for people with psychological suffering because “that’s saying a person with a mental health diagnosis doesn’t have the same right as a person with a physical health condition,” she explains.

Klassen adds that psychiatrists have been encouraged to adopt a care approach known as recovery – and this philosophy could be interpreted as suggesting it’s not the place of psychiatrists to prevent patients from accessing assisted death. “Recovery has words in it like hope and empowerment but at the end of day, it’s about patients determining their future, and that future being facilitated, not directed, by mental-health professionals.”

Others in the medical community are not comfortable with people with mental health disorders accessing physician assisted dying.

“There are often long waits for psychiatric referral and care,” says Romayne Gallagher, a palliative care doctor in Vancouver. “I would hate for someone to not get proper treatment and feel like there is really no other way to relieve themselves of the suffering but to consider physician-assisted death.”

One doctor who wished to remain anonymous argued doctors and patients can never be certain that a mental health condition won’t improve. “There are many cases of people being suicidal for months or even years, and they regret their suicidal thoughts,” he says.

Meanwhile, it’s psychiatrists’ jobs to prevent suicide in their patients in mental health crises. It doesn’t make sense to “admit one group of depressed patients who have attempted suicide to hospital against their will to stop them from harming themselves” while assisting another group of depressed patients in ending their lives, the doctor explains.

As chair of the Ontario Hospital Association’s Task Force on suicide prevention, psychiatrist Ian Dawe is acutely aware of the suicide prevention versus suicide facilitation conundrum. “The irony of working on suicide prevention while at the same time debating the appropriate approach to physician-assisted dying is not lost on me,” he says.

But Dawe sees a difference between “impulsive, aggressive” suicide, where people are responding to “acute episodes” of depression or substance dependence, for example, and wishes to end one’s life that are reasoned and consistent over time. “We don’t want to take a look at this from a sense of all or nothing,” says Dawe. “This isn’t a black and white issue.”

Of course, many concerns doctors have about physician-assisted death apply to both those with physical and psychological suffering alike, points out Gallagher. These include concerns about whether someone might be unduly influenced by family or whether someone is making a decision because they don’t have access to better care. Many doctors disagree with physician-assisted death in general.

Special considerations in assisted dying and psychiatric disorders

Currently, the CPA is preparing guidance for members on key issues that must be taken into account when considering what the legal terms like irremediable, intolerable, enduring, and capacity mean in the context of mental illness.

With regards to mental capacity, psychiatrists already decide whether patients with mental health conditions are cognitively aware of the implications of major decisions, such as refusing a treatment for cancer. And tools and processes are in place to help doctors when they’re unsure – in Ontario, doctors can refer a case to the Consent and Capacity board, for example.

In mental health conditions and assisted dying, the job of those deciding on consent will be to tease out an individual’s genuine thoughts from thoughts that may be a result of their disease. The “cognitive distortions” that come along with depression – “negative expectations of the future” and “loss of hope,” for example – could be seen as interfering with a patient’s autonomy, says Gaind, and could mean a person doesn’t have the capacity to decide to terminate their life. But Gaind is quick to add that there likely will be cases where patients with depression or other mental disorders are determined to have such capacity. “I wouldn’t want this to be misperceived as saying that the presence of mental illness alone means you can’t make this kind of decision. That’s not the case,” he says.

In some cases, however, “it would be virtually impossible to know for sure” whether a patient with a mental health condition is making decisions because of cognitive distortions caused by their disease or not, says Gaind. “We’d have to figure out what we do in that situation,” he says.

Dawe adds that it will be important that anyone who is making a request for assisted dying “show consistency with regards to that request over a reasonable period of time.” While Dawe was unwilling to attach a timeframe to what a reasonable period would be, he explained that if a person had depression that had changed in severity in the past, it would be prudent for doctors to ensure the patient had the same request when their depression was in an improved state.

When it comes to “irremediable,” meanwhile, there are many unanswered questions. “Will it be [the patient’s definition of] the end of the line or [the doctor’s definition of] end of line that wins the day?” asks Klassen.

Gaind thinks that “irremediable” should not simply be defined medically. Because many mental health conditions are influenced by societal factors, if a person’s condition could be helped with housing support or a path to employment, it shouldn’t be seen as irremediable, Gaind argues. “Society cannot wash its hands of that responsibility [to remedy a person’s suffering].”

However terms like “intolerable” and “irremediable” are further defined in the coming months, Martin hopes the debates lead to a better understanding of severe mental health disorders. “What would I do if I had unrelenting depression for 15 to 20 years?” she asks. “If you haven’t had a mental health illness like that, I think it must be very difficult to imagine it.”

Special thanks to Jocelyn Downie for her assistance in summarizing the Carter case.

Do you think people with depression and mental health conditions should be eligible for physician-assisted death?

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  1. Gerry Goldlist

    The answer to the question us too nuanced for a yes, no or even undecided answer. The answer for me is possibly.

  2. Danielle

    Wow, such difficult questions to ponder…thank you for tackling this challenging but necessary debate.

    “In mental health conditions and assisted dying, the job of those deciding on consent will be to tease out an individual’s genuine thoughts from thoughts that may be a result of their disease.”

    I wonder how it would even be possible to tease that out, since the reason they are seeking physician-assisted death is as a result of their disease. If they didn’t have the disease affecting their thoughts and feeling to such an extent, they wouldn’t be wanting to die.

    I also wonder whether in some cases mental health issues such as depression could be seen as terminal. No treatments are going to help, the end result will be death, whether physician-assisted or self-inflicted? Not all cancer is terminal – perhaps that same could be said of certain mental health issues? Sometimes treatment works, sometimes it doesn’t? I’m not sure.

    But %featured%a person essentially has the “right” to take their own life at any time, if they are capable of doing so. I think that them going through the physician-assisted death route could be preferable since at least there would be some discussion of other options, a waiting period to see if it is just a temporary mindset, etc.%featured% And if, ultimately, they decide to proceed with the physician-assisted death, they would be able to die with more dignity perhaps than other options, were they to attempt it themselves.

    Lots to think about…

    • Elizabeth Doyle

      “I wonder how it would even be possible to tease out [an individual’s genuine thoughts from thoughts that may be a result of their disease], since the reason they are seeking physician-assisted death is as a result of their disease. If they didn’t have the disease affecting their thoughts and feeling to such an extent, they wouldn’t be wanting to die.”

      Interesting point, Danielle.%featured% I would add that it’s questionable as to whether antidepressants sometimes leave an individual accepting conditions they would otherwise view as oppressive or intolerable.

      Sussing out the ‘genuine’ response from the ‘depressed’ response opens up all kinds of interesting questions about personhood.%featured%

    • Leigh

      Well said Danielle. I would like to caution the use of the word disease. As was also discussed in the article was say a mainstream acceptance of such distress as not only being attached to a person who may have continued distress because of an imposed, pervasive (diseased) model of mainstream society and stigmatization included in the word ‘disease’.

  3. S.M. Thomson

    We understand the pain of living with a broken leg, a severed muscle, a twisted spine because we can SEE the damage and empathize more easily. Assisted deaths should not be available upon first request for anyone, as we all have moments when we wish we didn’t have to face tomorrow, but after careful and caring screening, everyone should be helped IF THEY CANNOT PHYSICALLY MANAGE IT THEMSELVES.

    • Elizabeth Doyle

      “… after careful and caring screening, everyone should be helped IF THEY CANNOT PHYSICALLY MANAGE IT THEMSELVES.”

      Being able to “manage it” yourself doesn’t entail that your suicide will be pain-free or skillfully carried out. There have been tragic cases of failed attempts that call on us to reconsider what we mean by empathy and agency.

      • Val

        Thank you Ms Doyle, that is why someone who wants to die should have assistance, whether through fear of pain, of failing in attempt with possible horrible physical aftermath…it seems so easy to say if you want to die just do it yourself; if a person doesn’t travel in circles where guns and opiates are obtainable, all of the other options I’ve thought of cause too much pain or even potential to harm someone else in process.

  4. kathy kastner @kathykastner

    This debate embodies the sensibility I found resoundingly at the Toronto consult for implementation of Physician Assisted Dying (PAD): Everyone but the ‘person/patient/sufferer’ should/could/would have a say in how ‘intolerable’ their suffering is. ‘

    Whether it’s severe depression or psychosis, illness of the brain is every bit as debilitating and causing as much intolerable suffering as any physical condition. Ask anyone who’s experienced both, which they’re better able to ‘manage’.

    To Sandra Martin’s point – stating what some might seem obvious: “If you haven’t had a mental health illness like that, I think it must be very difficult to imagine it.”

    And, to Dr. Romayne Gallagher’s reality check: “There are often long waits for psychiatric referral and care”. Would that there were resources for those who cry out for, and/or seek help.

    So: ‘eligible for PAD’ Yes, absolutely.

    What became clear to me in that Toronto consult and what I believe applies here, too, is that the perception of ‘harm’ needs to evolve to meet the realities of resulting from medical advancements.– like the harms that can be caused by futile life-prolonging interventions.

    It wasn’t so long ago that those with mental illness were thought to be slackers, fakers, to just get on with it. For many, suffering under the burden of relentless mental illness, life itself seems a futile exercise.

    A new shift in perception of ‘harms’ paradigm, starting in Medical school, might also serve to ease the role of the conflicted healthcare professional.

    %featured%It seems impossible with the healthcare profession’s cure/fix/save mandate, to understand that sometimes staying alive can be the most painful, harmful thing.%featured%

    • Julia

      So instead of training more doctors to help cut the wait lists, we should offer that the mentally ill ask to be killed instead? This shift in perception you mention is horrifying to someone who has mentally ill family members.

      There is so much stigma around getting proper treatment and the positive struggle to live with mental illness. We are currently trying to help people feel supported for seeking treatment. This population already struggles with suicide – why hand it to them when the chemicals in their brain are already struggling to respond to medicine and cognitive behavior therapy and the like? Where would the generation inspired by Clara Hughes be if her doctor offered her assisted suicide? Where would my brothers be?

      I don’t think you understand that there can be joy even in the midst of suffering. For myself, I have a much greater appreciation of the good in my life because of the bad I have been through. This whole conversation on assisted death misses that.

      I don’t know what else to say – this whole philosophical landscape on death gives me the chills. It is like living in a dystopian nightmare where people hear cries for attention and love and think that the proper response is to grant lethal injections instead.

      • Miss NVJ

        Well said Julia. It seems that as individuals we often want to escape any incidence of suffering or pain we may face in life. Life is real and happening and there are REAL and TRAGIC circumstances that abound in our lives – illnesses both physical and mental, hurts and pains that we would rather do without but I don’t think the answer on any level is to consider facilitating the termination of life.

  5. Lulu Lu

    People are going to kill themselves.
    Without the option of death-with-dignity the only options are gruesome and horrible for families. There’s no goodbye

    hangings, CO2, gunshots, jumping in front of trains, car crashes..

    WHY? WHY? WHY? are those our only choices??

    • Julia

      There aren’t always good byes for families when the person is mentally ill with euthanasia either. Mental illnesses like depression often create distance in the family, the person themselves not wanting to be around anyone and therefore pushing themselves away from their family, or the family members not knowing how to respond to the loved one when their mental states are unpredictable and difficult. So we need more mental health education for the patient and the families.

      What we do not need it giving doctors the legal protection to offer a suicidal person lethal injection instead of medication, counselling and treatment to help them through the problem.

      Lethal injection is just as horrifying for families. No one wants to find out their depressed family member has killed themselves or requested a doctor kill them. It is an illness and there can still be joy amidst the pain. There can be post-traumatic growth even for someone with a chronic mental illness.

      This man wasn’t upset with the idea of euthanasia until he found out after his mother died of it.

      • Ashkan

        Julia, in your comments you generalize all mental illnesses as if all of them have “joy in midst of pain.” I believe not all of them do so and there are individuals with psychological conditions who have experienced post-mortem irreversible damage to their brain structures and have no hope in being cured. I think that there should still be a way for these individuals to get freed from the chronic pain and suffering. You can’t make generalizations in cases like these. Case-by-case, person-by-person, they need to be looked at independently and after thorough investigation, they should be granted the right to discontinue their life if no possible treatment currently exists. There is a difference between “hoping” for a magical treatment, and “actual” existing treatment.

        • Kimberly

          Very well said Ashkan, there are some people that have lived years of treatments and medications and still have no quality of life because of the suffering they endure every day. What right do any of us have, to demand that a person live in suffering instead of choosing to die with dignity. Do you make a person suffer because of your own ego or guilt or do you allow a person their right to choose? Nobody is saying it should be an immediate decision given before other options are explored but it should be an option available to human suffering if they so choose.

  6. Vera

    Carter vs Canada, clearly allows it. It’s actually the best possible thing that could happen for mental health, as well as chronic pain. It will look bad on the public stage if pain patients like Kathy Wardle with arthritis who went to Dignitas, and a whole bunch of untreated and undertreated mentally ill start demanding their rights. Maybe we will finally get access to timely treatment finally instead of shunted to the back of the health care bus as “unworthy”. All around me in my area I see elderly dementia patients getting priority care and stupid treatments like chemo, non compliant diabetics getting dialysis but the mentally ill get nothing.

  7. Karl Benzio, MD

    Anyone who gets a terminal diagnosis is experiencing a life and death traumatic event. WHen it devolves into anxieties and fears of dying or losing control or having insufferable pain, etc one could make a pretty easy case for PTSD. instead of going to a bottle to escape or self-medicate, they are contemplating suicide and need help. Help in living well, not help in dying quickly.

    Regardless of your take on what is really compassionate care, killing someone, or coming alongside until they natural die, the notion that a doctor needs to be involved is totally wrong and goes against what the healer’s role is. If suicide under the conditions most PAS legislation defines is truly noble and enhances autonomy, then they dont need a physician. As a psychiatrist of 25 years who has treated many people in US, Iraq, Uganda who have experienced unbelievable persecution and trauma, i have been trained to help and heal. Not abandon and kill.

    Many ways exist for a person to kill themselves – although i would never support anyone killing themselves – and a lot can be painless and they dont need a doctor to help. It is your decision, dont contaminate someone else by bringing them in and making them an accomplice to murder.

    • Joseph Jacek

      Very well put, Dr. Benzio. “Help in living well, not help in dying quickly.” “The notion that a doctor needs to be involved is totally wrong and goes against what the healer’s role is.” “They don’t need a physician.” “I have been trained to help and heal. Not abandon and kill.” “They don’t need a doctor to help. It is your decision, don’t contaminate someone else by bringing them in and making them an accomplice to murder.”

      This whole question, whether considering mental or physical health, has unfortunately been framed using a medical solution when it more properly calls for a legal solution involving lawyers and judges, with the power to call witnesses, including ‘expert witnesses’, who might be physicians. Why should the legal system, up to the Supreme Court, impose on the medical system?

      Yes, this may be seen as impractical with an already overburdened and expensive legal system, but is the life of a sick person any less important than the fate of an accused person?

    • Julia

      Very well said. Thank you for your work!

    • Ashkan

      Very well put, textbook answer to oppose physician-assisted death. True that there are many ways for someone to kill himself painlessly, but believe it or not, not many people are aware of those and often they are brought to hospital after their failed attempts where they suffer even more. The doctor is a healer of course not a killer, but remember there are conditions that cannot possibly be healed, what do you do? prescribe more analgesics? Can you not heal someone by freeing them of a diseased, hopeless life? Of course when a patient walks in your office you do your best to help them fight their illness and get better, but there are always those who cannot be treated, thats where you can help them. This right could be the last last option to relieve someone of chronic pain and suffering. And the important part of this is that if you help them do it, they die with dignity and at ease, knowing that their decision was the best they could make. Knowing that they died after a complete fight. A lonely death with suffering versus a death with feelings of compassion and support?

    • Val

      It would be very interesting to me to discover how an average person with no shady connections gets access to a painless way of dying without a doctor’s assistance. Please feel free to share this information as it certainly isn’t readily available.

  8. Johanna Mathieu

    No one should be contemplating suicide and people with depression do not have the mental capability to make a true judgement required in this important matter.

  9. isabelle

    ONLY GOD can give and take life, it is NOT our decision. If every Catholic would say their rosary, we would NOT be in this HUGE MESS.

    NEW WORLD ORDER has a PLAN, all we need to pray , penance against this evil,

    • Ray

      What a crock of shit your statement is. I’m sorry, but your lack of empathy says an awful lot.

    • Jackie

      My son was an Altar server, said the rosary and attended Mass every week. When the psychiatrists and the entire health care system took its time to diagnose him with his mental illness (schizophrenia) no one in Heaven or earth could prevent his suicide at age 21. I as a mother will only blame myself for not understanding the illness and taking better action in dealing with his type of illness, because my mind and body was and still is intact, and I could have done much more to save him. Euthanasia would be blissful if I could have offered him a painless, and not senseless way to go. Now we will never know, as he made his own choice and never got the easier option to die peacefully and not painfully and sneak away to take care of his suffering.

  10. Amy Hasbrouck

    Are we giving up on suicide prevention? Are we abandoning suicide prevention as a societal goal? How do we square assisted suicide with suicide prevention. They don’t square.

    • Ray

      It’s not suicide. It’s assisted dying.

  11. Jeremy

    Seems like a reasonably balanced article, but I’m not sure how anyone could even contemplate the idea of euthanising mental patients and not immediately think that our experiences with eugenics should immediately rule it out.

  12. Joseph Kokot

    As a society we do not allow a person with mental health to make decisions about simple things in their everyday lives, but somehow feel it is all right to let that person make a decision to end their own life.
    Then we believe it is right to force another person to “help” them to end their life…

    • Greg

      To correct you, it’s mental illness not mental health. Also, people suffering from mental illnesses aren’t mute, strapped to their bed with handcuffs; they make simple and important decisions on their own, daily. People suffering from mental illnesses are regular people with the inability to stop the constant over-analytical thoughts in their mind. These thoughts put a strain not only on their emotional health but their physical health, causing hindrance in their productivity and functionality. They work harder than the average person because they battle with their mind for majority of their day, just like the way a cancer patient battles with their physical health daily. Mental illness is cancer of the mind. These people do not deserve to suffer and if they wish to utilize the new assisted dying legislation, then it’s their decision, not yours.

      Side note: It’s so ironic to hear such an uproar when it comes to people objecting to someone’s wish in dying especially from physicians themselves. It takes almost half a year in some instances to book appointments with psychiatrists, specialists and surgeons and then the follow up takes just as long. Physicians have no right to object someone’s wish to die when there are such lengthy wait periods to see them and the visit is unsatisfactory. Many physicians display a lack of compassion, effort and knowledge. Physicians should be the last people to object such a legislation. And for those who are uneducated in the matter of mental illnesses, don’t give your unsolicited advice to those suffering from them.

  13. Julie Grimstad

    No one should be eligible for physician-assisted suicide or euthanasia. Doctors must not add killing to their list of specialties. A physician’s calling is to protect and preserve life, to cure and care for patients, not help people end their lives.

  14. Jim L. Sekerak

    Autonomy -if there even is such a condition- requires maturity, a fully developed cognitive state and occurs over a long period of time and living experience. To be “depressed” or identified as being in a “mental health condition” by definition precludes any such person from being fully self-directing much like being perfectly healthy yet going to a doctor to be ‘cured’ of some illness. To oppose this logic is really saying, anyone can chose i.e. have a right to have their life taken by a designated authority, at any time and for any reason, and we have to determine what is allowed, how performed and by whom it can be implemented, for now. As noted in the article, this will change over time in response to conditions which will arise but in all instances is irreversible. A wit noted that what one never wants to hear in an operating room is the expression “Oops!” and we as a society evolving into wise and compassionate people cannot afford to utter the same expression in the near future with respect to those who believe they should end their life before its natural course is completed, even if they require support during its final phase.

  15. Jule Koch

    You’re talking about killing people. It is impossible to kill someone without doing violence to them. Dressing up murder with words like “assisted” and “aid” doesn’t make it any less murder. Injecting someone with poisonous drugs to kill them is no less an act of violence than shooting, stabbing, beheading, hanging, drowning, asphyxiating, electrocuting, poisoning them with gas, or killing them by some other means. After undergoing chemotherapy twice in six years, I invite anyone who thinks being injected with poisonous drugs is fun to try chemotherapy.
    Once some people in society have the power to kill other people with impunity they can do anything to them – they can abuse them; they can kill them when and how they want because the killers always have the power. Believe it or not, they can even hurt their feelings. No one will investigate, and dead men tell no tales.
    (Oops, I should say “dead people” but the PC version of that saying doesn’t sound nearly as good)

    • Kimberly

      I’m curious how many opponents to assisted death are pro abortion?

  16. S. MacDonald

    Death is not the answer. Only God can give and take life. My mother lived for 30 years with bi-polar
    disease. She tried to commit suicide but thankfully was unsuccessful. It took years to find the right
    combination of medicines but it was eventually found. She was like her old self again.

    • Courtney

      The next sentence literally says the T4 program was NOT like modern PAD.

      From your same source:
      “Euthanasia typically means “mercy killing” and in the 1990’s in the United States and other western nations, it is synonymous with “physician-assisted suicide.” The kind of killing carried out through the T-4 program bears little resemblance to contemporary concepts of euthanasia.”

  17. Maureen Remus

    What false compassion! To propose to kill people who are mentally depressed! What cruelty and such a hypocritical culture. The fact is those who make these proposals do not want to suffer with those who suffer. They deem these people useless, unproductive. Therefore, kill them! This is the mentality Adolf Hitler had.
    Shame on anyone who supports this barbarism coming from the so called “educated” in the universities. Shame on anyone who supports the killing of innocent persons whether they be mentally ill, terminally ill, old, handicapped, etc. etc.

    Read: “Medical Science Under Dictatoship”, by Leo Alexander M.D. published in the New England Journal of Medicine:—_medical_science_under_dictatorship.pdf

    And: “Emotional and Psychological
    Effects of Physician-Assisted
    Suicide and Euthanasia on
    Participating Physicians” by Kenneth R. Stevens, Jr., M.D., FACR

  18. Norah Mallory

    The issue is that many people who are not receiving the care they should have in terms of palliation, pain control, support will be depressed and hopeless ad are likely to consider that death is their only option out of the circumstances they find themselves in.

    In those cases, we have failed them and their option to precipitate their own death is on all of the community’s hands.

    No aggressive legislation should be in place until we have established reasonable access to palliative care.

    Providing sufficient medication to eliminate pain is not euthanasia even if it hastens death – “res ipso facto”

  19. Daphne

    If we support this then how can we combat the epidemic of suicides among young people and other vulnerable communities? Saying no to suicide in one case and facilitating it in another makes no sense. Life can be a challenge to many people and the goal should be to help them live, not die. %featured%Death is not an improved state of being, it is no being at all, and it is illogical to claim that a person’s nonexistence is preferable to whatever condition they are in, when looking at that person alone. %featured% The only “benefit” of these measures is to rid the health care system of problematic cases in a cynical attempt to save money.

    • David Barry

      I have to agree with you unfortunately. Money may truly be the only reason why we are having this debate. We seem to be able to rationalize almost any behaviour.

  20. Jennifer Snell

    I have friends who are too many to count who would no longer be on earth if doctor assisted suicide had been legal during low points of their lives. They are now thriving citizens who contribute much to making this world a better place. Let us stop trying to play God by putting life and death decisions into the hands of human beings.

  21. Jean Clayton

    How did death ever become a good thing? Palliative care and good pain control and support are what a person in pain needs most, answers, not extermination. Most doctors enter the profession to heal people. We are crossing a very dangerous line in accepting euthanasia.

  22. John Wells

    “Society cannot wash its hands of that responsibility [to remedy a person’s suffering].”

    %featured%We must live up to our societal responsibility to do no harm, and permitting any euthanasia negates that duty. It just seems the easy way out to avoid health costs.%featured%

  23. Cecil Chabot

    We should treat people who suffer from depression and mental health. We should not confirm their fear that their lives are not worth living. Euthanasia might be the desire of a few strong individuals, but it makes the weak far more vulnerable. Demanding euthanasia as a right creates an obligation on the part of others to kill against their will. There may be some willing to do this, but if there are none, it will be imposed.

  24. Tom Koch

    In the writing I note the author spends little time on how to address the depression and despair of those with mental illness. She spends no time on what is needed, but often not available through local health ministries. And so physician-assisted or directed termination becomes an answer without attention to how these persons may be helped. As mr. Goldlist says, it’s “nuanced,” or should be. The question as posed as not. Let us help those who need it, giving social and psychiatric services the monies they need to do the job. Then ask … again.

  25. Brian McCarthy

    A depressed person is not in a position to make this life/death decision.

  26. Rev Dr Karl Csazar

    In my opinion, to ask anyone a question about wanting to end life is the wrong question!

    • Alfred

      How come many idiotic hospital personnel go asking that wrong question ?

      We are programmed to live. Are we programmed to suffer ?

  27. Rev Canon Keith Osborne

    Jesus Christ needs to be placed in the central position here in our determination on how to resolve this issue. We cannot be playing God by arbitrating over the taking of human life. That is God’s sphere and His along. He became incarnate in the person of Christ and so glorified humanity as something sacred. We have no right to preside over its demise. People who are suffering are not able to competantly decide on their fate. They need those who come alongside them to help them make decisions and to offer means of hope which could easily change their circumstances so as to avoid ending their lives in a tragic mistake.

  28. jane wright

    People need a hand up, not a hand out of existence. We have never lived in a time where more supports, medicines and social services have been available…and the best we can offer those with mental illness is a half-hour permanent exit from this life? We need to focus on and improve support, treatments and care. We need a system that truly HELPS the person, sometimes in spite of “individual rights” – to get the help they need.

    • Leigh

      how amazingly liberal agenda-ish of you. Perhaps all of us in a society can work toward assuring we all have the supports to facilitate each as individuals to help ourselves, direct, ourselves, and care for each other in an equitable way that is important to the individual and thus, over time, instill consistent sense of our human capacity toward general empathy for all (not for you and for others). That is enlightenment. Working as a community and a society to facilitate humans to be the best each human thinks they can be.

  29. Shirley Connor

    God gives life. It is a gift and should not be terminated wilfully by man.

  30. Erica McKirdy

    God is the giver of Life; it is precious. We have no mandate to terminate it because of illness. Anyone with depression or has a mental health condition needs extra loving prayerful support, help and encouragement to demonstrate they are still precious people with a lot to contribute to society.

  31. Herman MacDonald

    The sad reality is that these people are going to kill themselves anyway. It will either happen in some violent manner which puts others at risk (car crashes, falls off buildings, etc), or will be done in some incompetent manner such as a slashed wrist or drug overdose (both of which hardly ever work, are medically expensive to treat, and usually leave the person in worse shape than ever before, so it will happen again). I’m all in favour of spending scarce medical money where it will be effective, not on cases that are hopeless and are done only to make everyone else feel better, not the patient.

    • Kimberly

      The sad reality also is that when they do commit suicide, because they have not had the option to do it in a dignified way, they are left to die alone and found by someone who now needs mental health services to deal with the after math. Instead of having a process in place that helps each person come to terms with it before it happens.

  32. Kalie Gorman

    A poster left the comment ” Let us stop trying to play God by putting life and death decisions into the hands of human beings.” I agree. When someone is dying, leave them to it. We’re always trying to interfere with things. Let nature take it’s course.

  33. elizabeth crouchman

    Mental illness is treatable. It is not always permanent as in cases of depression.

    • Kimberly

      Not all mental illness is treatable just like not all medical conditions are treatable.

  34. J B Poulin

    Killing another human being is taking a life….a right we must never have.

  35. Jane Wagner

    So basically, what you are asking is this: If we see a man about to jump off a bridge, we should yell: “JUMP”, instead of offering our love and concern and real help to him. What a sick country we are becoming!

  36. Jack DeVries

    They should not be eligible.
    My family doctor claimed my wife had the beginnings of cognitive dementia and had her write a test, which she failed. The result was that she lost her drivers license.
    A year and a half later she wrote that test again by paying $ 550.00, She passed and is driving our family car again.
    How dangerous if someone else is given the authority and able to decide if you are eligible to die or not.

  37. Jim Church

    It all comes down to who makes the definitions and whether those same definitions would hold up for the same people the next day, or month, or year. No matter how one tries to tip toe around it it all sounds very much like a “final solution” with the lines being significantly blurred as time goes by until we wake up one day and wonder how in the world we got here. (Glaring example: abortion which we were assured would “NEVER” be used as a form of birth control. Only an absolute fool could argue that this is not exactly what it is today.)

  38. Gabrielle

    Life is a gift to be lived until its natural end.

    • Kimberly

      There is no natural end anymore with drugs that prolong life and in many cases suffering.

    • checking out soon

      To Gabrielle, life is a gift for those of us who are healthy, happy, socially acceptable, and fit in society. i am suffering from undiagnosed depression (its not fun), mental illness is in my family. i am almost 46 years old, i have been depressed almost constantly since i was a teenager. i have spent about half of my adult life unemployed, i am socially inept, which means i have never been in a relationship (nobody wants to be near me in that way). i am undiagnosed because without a medical plan, i can’t afford the medication, if i get cut off from it because of financial reasons, things will be worst because i will depend on it, i sometimes spend weeks without seeing other people at all (nice gift god, thanks) , my parents and siblings live about 10 minutes away. i am smarter than most people (analytically and technically, not socially), i have an extremely analytical brain which is both a curse and a blessing, when i do have a job (electrician) i can solve problems that can take other electricians hours or days to solve, often in just a few minutes, that skill has actually cost me two jobs (or my mental illness has cost me two jobs). the curse of such a brain is that i can see things differently (perception defines reality). when I do have a job, it is not as bad, but today, with more people than jobs, it is survival of the fittest. There is not enough room, i would volunteer for assisted suicide (would you give up your family income to save a suicidal persons life?). my reality is that of 25 to 30 years of loneliness and social rejection, first by society in general, then by myself, i have given up completely, i can’t smile, i am unable to get excited or feel joy, i am numb on the inside, and i look forward to dying, when both of my parents have passed on, i am checking out, if there is no assisted suicide, it could be death by police, drive into oncoming traffic, drowning, jump off a building or in front of a train, my method will have no chance of survival, It will rob me of my dignity, which is priceless and scar whoever finds me for live (i hate hurting people, when my desire to die exceeds my desire to not traumatize someone, i will die). none of those are good options because they negatively affect other people. Oh Gabrielle, if life is a gift, do you want to trade.

  39. Theresa

    Actually, no human being has the right to take their life and no human being has the right to help another human being take their life. God through his will gave you life and God will decide when you are to leave this world. No discussion is really needed.

  40. Catherine St. Pierre

    “Healthy Debate” is a bit of a misnomer, I think, because the Supreme Court has already decided the outcome, as it did in striking down the ban on abortionand same sex marriage. Real debate has died in this country because our legislators are skirting issues of concern for reasons of political correctness among others. Human rights tribunals (made up of unelected members like Supreme Court judges) among other groups, such as universities where one would expect all views to be heard, have all but killed free speech too because they have taken over the perogative of LEGISLATORS who are supposed to be the cornerstone of democracy. The low turnout of voters and the lack of faith in politicians is testimony to the waning of true debate in Canada.

    The airing of all opinions among freely elected REPRESENTATIVES OF THE PEOPLE is the only way forward

  41. Aaln Muzzerall

    I am reminded of one of the 10 universal principles mentioned by another Ph. D person. “Do no harm.” It’s called the silver rule. When this simple rule is cast aside, society gets things like slavery, civil war, abuse in residential schools, etc. Canada has done away with the death penalty for criminals. Why would we bring it back for sick people??

  42. Eileen

    Why not put the energy into assisting people with their living, instead of dying?

  43. Albert Lavigne

    I’d like to go back to an earlier time in this whole question: I’m concerned that 9 unelected people, who are not accountable to the public, should be able to decide what is good or not good for Canadian society. These unelected few are responding to the loudest voices, some of whom (the voices) have a financial interest in a culture of death. There is something fundamentally wrong where the leadership of a country is abdicated to an unelected body. This group of 9 seemed to have no problem as a group voting to allow killing by abortion and assisted suicide, using much the same euphemisms as the loud voices to justify the decision, but would any of them, individually, prove their belief in their decision by volunteering to push the lethal needle? That task has been downloaded to a third party, the physicians.
    I always thought the Supreme Court interpreted laws passed by parliament, the elected body, not that the Supreme Court made laws that governments would then have to implement.

  44. Helen

    To be mentally vulnerable is a time in a person’s life in need of great compassion (co-pain – i.e. empathy), support and attentive being (i.e. spending time with a person). To be left alone to the point that there appears to be no hope to go on and, not only to feel abandoned in such a way, but to even be encouraged to end one’s life due to socially endorsed means (i.e. assisted suicide), is horrific. Why should someone’s mental pain be a reason to abandon them, a reason to end their life, when it can be healed, improved, worked upon? Who know’s what good thing will happen tomorrow? In the midst of depression or mental illness, this does not necessarily seem likely, but life does get better. It is ever changing. It is not possible for it to remain constantly bad, something good will happen, even if it is only small. In addition to which, who knows what a person who has depression or a mental illness can do to touch the lives of others, to make a difference? As Thomas Grey wrote of the deceased poor, “Some mute inglorious Milton here may rest.” Without given the opportunity to shine, how much could be lost! Don’t give up hope. There is always, always hope. Don’t give in to the darkness. “I wish I could show you, when you are lonely or in darkness, the astonishing light of your own being.” – Hafiz

    • Leigh

      Have you experienced “only slightly better”? Never really ‘average’ better? What scale do you use to measure where better or tolerable is? Of course also there is the argument about what is depression? Moderate to mild malaise, (illness?) To what is often referred to in western modern medicine as pathologically depressed to the point of not moving much for weeks and in the clinician’s mind requiring intervention, usually in the form of drugs. Check the evidence for treatment vs no treatment along the spectrum. In some public health circles (WHO), depression is spreading worldwide and will be a public health concern very soon. Why? is it the Person? Is it the training? Is it “Globalization”?; moving from actual tangible communities of humans to large disaffected industrial information swapping…sort of like this forum. Is that what we need to do? Make sure someone who is ‘depressed’ “gets better”?

  45. Cecile F. LeBlanc

    Let compassion be the rule and guide for people with mental illness contemplating an end to their very difficult time in life. It passes with time. Trust in God and the people who can remedy this serious illness. I have experienced depression through many years and with time and trust in others and THE OTHER I now enjoy peace of mind and acceptance of whatever comes my way.

    Human life is meant to live eternally with God who is the one who decides when we die. Let us not play God and when we do play and anticipate the death of someone, its called killing the other and we kill our conscience. Let us not go there.

  46. JOYCE

    No I do not think people with the above problems should be eligible for physician assisted death.
    There is so much more for the care and comfort of these people. There is so much medical and doctor’s help for each person. Beside that we are given the examples of countries over seas that have the right to take lives and it has gone overboard on this both for the elderly and the babies and the young.. We are opening a can of problems allowing this to take place. There is so much that we can do to help people. I DO NOT BELEIVE THAT IT IS RIGHT TO EXPECT OUR GOOD DOCTORS AND NURSES TO HAVE TO TAKE ON THIS JOB OF SO CALLED MERCY KILLING.
    compassion for those who are ill if all we do is send them to their death?

  47. Robyn

    I had an anaphylactic reaction in a mental health facility. My husband was sad I didn’t die. It was hard to explain with a swollen mouth-get him away from me and help me breath. Now I am grateful for those who saved my life and remind me, although I am alone, God and prayer help with the loneliness that follows walking away from abuse.

  48. Josie Scott

    the supreme court ruling states should a person may request physician assisted death the physician who complies will not face legal charges. It does not say that physician assisted death is the right of all Canadians. This article – and many in the debate- speaks of “rights” of patients and appears to go beyond what the Carter decision is about.

  49. John Peter de Winter

    ear Alex keep on fighting for our funeral people in this world and let the Creator decide who dies or not These people are playing God and should be stopped with prayers and sacrefices thanks for doing this work Alex with love john Peter de Winter

  50. AK

    Discrimination. Steering. Abuse. Hidden agenda. Beneficiaries other than the dead. Lack of informed consent. Historical abuse and incidents. Overall attitude of society toward those who are seen as less than perfect. These are all reasons to say no. And before you say it, if a patient is ‘in pain’ and ‘suffering’ somewhere, that’s unethical on the face of it. So the lack of care should be addressed instead of offering death.

    • checking out soon

      Jeannine, what if my treatment is something as simple as getting a reasonable job (I am a skilled tradesman) and getting some friends and maybe a relationship, can you force someone to like me or give me a job? or give me a house and keep me fed and medicated into oblivion until i die naturally (who will pay?). not everything is cut and dry, i am not entitled to having a job, or being liked (people often avoid, dislike or bully mentally ill people). i am always alone, i have been all of my life, i will die alone, and i am not worth the expense of treatment.

  51. Nancy

    “People who are depressed and mentally ill are not in a position to rationally choose to end their life! They need help to manage these illnesses, not an invitation for a quick exit. In short they are very vulnerable people, precisely the kind of people that need to be most protected from medical murder!” Right to Life, N.B.
    I am one of those who suffer episodes of depression as part of bipolar disorder. Believe me, if there were an easy way out, I’d have opted for it years ago. Now that I’m in a joy filled state, I thank God for my life and the faith, family and friends who yet again have been there over the past 6 months of “hell”.

    • Sr Cécile

      Dear Nancy,

      I appreciated your input here and you have my sincee sympathy and prayers for your continued joyfill period. This illness is so difficult to endure but you have found the way and I admire you for your faith. Continue to be well and continue to trust in others who wish you well by praying for you and all others in the same condition. There are sooo many out there.

      Sr Cécile a member of NB Right to Life

  52. James

    God is the creator of life, He is the only one who can decide when it should end.

    God bless and guide all.


  53. Joan Munson

    I don’t agree with euthenasia, physician assisted death or suicide or whatever name you choose to call it.

  54. Diane

    Non, personne n’a le droit de s’enlever la vie et on n’a pas le droit d’encourager quiconque vie des moments dépressifs car ce sont des gens maladies et il faut plutôt les aider et donner des médicaments pour qu’il puissent passer à travers leur difficultés et ils ont plutôt besoin de counseling. Les médecins qui provoquent la mort de ces gens malades au lieu de les aider, commettent des meurtres gratuits et bouleversent la famille et méritent d’être en prison. Seul Dieu donne la vie et peut la reprendre.

  55. Jeannette of Nazareth

    Anyone who is perfect, may he/she raise his/her hand. Their are visible and invisible handicap in all of us. No one is perfect on this earth. Therefore, no one has the right to take someone’s life, including the person in question (patient). For, LIFE belong to our Creator (Creator of Heaven & earth). He’s the only one who has the right to decide when our earthly journey & mission come to an end. No one else has the right to take one’s Life including the physicians in all their branches of profession.

    Anyone who takes his/her own Life or others’ Life will have one day to face this crime before the God, Creator of Life in all humanity. During patient sickness, love, charity, and mercy are the answer. Family members and doctors have ethical and moral obligation to support the life of the sick without any compromise. And in time and place, the reward will come for all support during the period of the suffering of the patients.

    God bless all who protect and defend Life of Humanity in its diversity at all time and in all conditions without any exception!

    Jeannette of Nazareth

  56. Sylvain

    Pour une nation ( Ex.: le Canada, pays où il fait bon vivre) , le respect de la vie humaine devrait passer en premier : Le droit à la protection et la sauvegarde de la vie humaine et de la reconnaissance de sa valeur en société, incomparablement plus important que tout autre droit, incluant le choix . On devrait continuer de subordonner le droit de choisir à la valeur suprême , c’est à dire , à la valeur de la vie humaine. C’est la vie humaine qui est supérieure. Si on subordonne la vie au choix (placer à un échelon inférieur) , si c’est le choix qui est devenu la priorité, si c’est le choix qui est devenu la valeur suprême, à ce moment – là, le choix de n’importe quel acte, deviendrait précédent ou prendrait précédence sur n’importe quelle autre réalité , peu importe sa valeur. J’espère que le respect de la vie humaine jusqu’à sa fin naturelle est important comme valeur de société au Canada et qui demeurera protégée par rien de moins que de dire NON à l’euthanasie et au suicide assisté, donc NON à leur légalisation.

  57. Jan

    Death is not the end , so its not the answer either

    • A

      Idiot death is the end of life .

      define death.

      Happy and healthy is the end.

      Sad and sick is no life. Is harms way.

      You will know that just like everybody else.

  58. Françoise Gravel

    Sometimes we have to protect one person we love against himself. We have to help persons unhappy to find a way to get out of this bad moon. Whatever, when he will feel better, he will be grateful and appreciate what we did for him. (sorry for my bad english)

  59. Stéphane Gariépy

    My son took his own life in 2009. He was a 19 year old brilliant young man. He would have needed help, not to be terminated. People are not animals to consider “assisted-death” as a final solution for them when they are sick or when they feel bad. Where is it going to end? The difference between our society values and behaviours and these from the Nazis with regards to human life is getting thinner and thinner.

    • greg

      Why is human life valued above animal life? Life is life and you are wrong in your statement. People are animals. We function the same way. Our exterior is different but we have the same instincts and senses. This is a matter of individualized suffering so let the individual decide what they want to do their life. Your son was lucky to have a successful suicide, many are not and are left with permanent physical disabilities. Count your blessings.

  60. Frank Wagner

    Arnold Toynbee said that after every war the victors acquire the values of the vanquished. This is Nazi Germany all over again. Have we forgotten that Hitler, under pressure from the medical establishment allowed the German Psychiatrists to euthanize their patients “under the most restrictive conditions”? Have we forgotten that this resulted in 300 000 German euthanasia deaths? And let’s not forget what followed: 6 million Jewish deaths and roughly the same number of others who Hitler disagreed with.

  61. Emily Carroll

    No. There should be help available for people. And a good support system.

  62. Nancy Dugas

    Can’t believe this even needs to go to a vote. Why would a decision as final as life or death be left in the hands of those who are in a state of depression. Doesn’t the very word, I.e., depressed, suggest a feeling of hopelessness, that if treated effectively, can be reversed?

  63. Janet McDonough

    Anyone could change his or her mind after the suicide.

    But then it would be too late

  64. Jane Allen

    The only assistance any person needs is prayer and God’s love.

  65. Shamila Ramlal

    It’s not up to anyone to take a human’s life, however invaluable it seems. suicide is murder, not God’s option.

  66. Joanne Wanamaker

    No No No! This is not a form of Medical Treatment. That being said the law has passed to legally allow this, so given that, these are my suggestions in light of people requesting this.

    There are many people who expereince short term an situations depsression that can be treated and managed well over time. Never for peopel who have recently been diagnosed with depression. Sometimes it takes years for physicians to find the managable form of treatment for a patient. That needs to be explored first.

    There needs to be a clear set of assessments for all people requesting physician assisted suicide, and physicians should not be required by law to offer this assised suicide or medication for a patient to self impose suicide, as health option for treatment. Only if a patient requests this options should a physician be required to offer their patient to call or make an appointment for medical assessment to determine if the patient is a suitable candidate for this end of life option.

    Physicians need to have confedence in the Newly established board to thoroughly test and assess that this is the best course of action for the patient. This should not be a short process for patients.

    Patients need to be informed of all other forms of treatment and have time to really think and discuss options before making the decision to end their own life.

    There is a need for a medical assessment board to be established to review each individual case of patiences requesting this, and they need specific criteria to establish if an end of life solution is what is best for the patient or not, and that the patient is competent to make this decision.

  67. Kathy

    With proper treatment and a good dose of hope, people can make a turnaround and have a worthwhile life.

  68. Margaret Harris

    No “possiblies”. Our lives belong to God. If you have to debate the question, you’re missing the fundamental point of our existence.

  69. Kathy Fehr

    They need someone who cares and would walk alongside them.
    We all need someone who really cares.

  70. Louisa

    ANY assisted suicide is murder, there is always a healing for everyone, no matter how bad it looks.

  71. kathleen mccune

    I am a Christian and still I believe there is a place for assisted suicide if all else fails. How can we think we should force a person with severe schizophrenia for example, to keep living on in a very tormented body when they could be in Heaven where complete healing takes place? But if a person can live a fairly productive life with some happiness using medication then they need to be discouraged from suicide. But if nothing is working why make that person live in such a horrible way?

    • Jackie

      I think those are the words I was searching for. Thank you!

  72. John Ward

    Instead of spending on resources to help people die, we should be spending on resources to help people live . People with mental health disorders may need help living, but they never need help dying.

  73. john c. simpson

    Our daughter suffers from acute paranoid schizophrenia, and as a result of having been deprived of her insight frequently makes statements and commits acts which are completely foreign to her belief system. She desperately wants to live and recover her health, but might very easily be persuaded to end her life at a given moment.
    People who favor this proposal obviously have no understanding of mental illness. Only recently a world shaking scientific discovery has isolated the gene the malfunction of which in all probability brings about this crippling disease. If peer review and further investigation confirm this finding, the possibilities are limitless; an early screening procedure and appropriate gene modification could prevent the onset of the illness, and the discovery could quite possibly lead to sophisticated treatment strategies to lessen the impact upon those already afflicted.
    I pray that our daughter will be protected from those who would end her life simply because she is unable to manage herself or her affairs.

  74. Brenda Virtue

    I believe GOD HIMSELF is going to start healing mental illness like ever before bringing hope to the hopeless and LIFE to those in despair. It is crazy to kill people with problems. If we did that, we’d all be dead!

  75. Lorraine Watson

    Depression is a disease which can be cured. My brother committed suicide because he did not seek help for his depression.

  76. Vivian

    I do not agree with the debate as Doctors are there to help you with any type of mental health, not there to assist you to die!

    • greg

      These so called doctors don’t help. They prescribe drugs that are much more powerful than street drugs, which are prescribed for a lifetime.

  77. Grace McLean

    I think it’s disgusting that human beings should even be having this discussion. I was taught that “LIFE” is so precious and that we should strive to do all we can to protect this God given gift. Thank God there are still people with a conscience who will fight to protect the right to LIFE.

    • Greg

      Just like you were taught that life is precious and a gift, you will learn to accept that assisted dying is going to be the new law.
      It’s disgusting how human life is given more importance than any other life. Animal, aquatic and plant life are never considered when they are being harmed – don’t those lives matter? And because all LIFE is precious, shouldn’t ALL LIVES be advocated for?

      Your comment is hypocritical and is coming from a place of either innocence or ignorance. Instead of reading from the bible or religious literature, use your brain to formulate your thoughts.

      • Alfred

        I love your mature and very logical points of view regarding the end of life as we know it Greg.



    • Alfred

      Your’e going to die anyway. Its your choice how to die not mine. If you like life should every one else like life too. Your position is selfish and inconsiderate of other people’s circumstances.

  78. Teresa Sleep

    This euthanasia idea is totally unacceptable. Like abortion, first it was considered certain cases should be considered…then it was open season on the unborn and has been ever since. Once that became acceptable…then it would be open season on every and any other life. I’m not wrong on this…and Pro-Lifers were and are looking after your neck…join our membership so we have a stronger voice to prevent this impending insanity. And join the Euthanasia Prevention Asso. as well.

    • Greg

      Your comment is unacceptable. How dare you think that you have the right to make decisions for other people and such important decisions for that matter. It’s people like you who should be criminalized for dictating the way people should live their lives.

    • Alfred

      Nobody can prevent their death so why should we interfere with someone else’s life or death decision ?

  79. Phyllis Bate

    We should have an increased attention to palliative care, including infant palliative care. I don’t agree with assisted suicide in any case.

  80. Greg

    People suffering from mental illnesses are regular people with the inability to stop the constant over-analytical thoughts in their mind. These thoughts put a strain not only on their emotional health but their physical health, causing hindrance in their productivity and functionality. They work harder than the average person because they battle with their mind for majority of their day, just like the way a cancer patient battles with their physical health daily. Mental illness is cancer of the mind. These people do not deserve to suffer and if they wish to utilize the new assisted dying legislation, then it’s their decision, not ours.

    Side note: It’s so ironic to hear such an uproar when it comes to people objecting to someone’s wish in dying especially from physicians themselves. It takes almost half a year in some instances to book appointments with psychiatrists, specialists and surgeons and then the follow up takes just as long. Physicians have no right to object someone’s wish to die when there are such lengthy wait periods to see them and the visit is unsatisfactory. Many physicians display a lack of compassion, effort and knowledge. Physicians should be the last people to object such a legislation. And for those who are uneducated in the matter of mental illnesses, don’t give your unsolicited advice to those suffering from them.

    • alfred

      Not all people with mental illness are extreme emotional pain sufferers. Not all mentally ill people want to die either. Over analysis is not the root cause of suicidal feelings. Pain is the root cause.

      Do all people wanting to die have something in common ?

      Yes. Extreme pain, extreme fear, extreme need for relief.

      I agree with the rest of your statement.



  81. Mary McCarron

    we need to put more assistance in mental health and provide more resources for support of individuals who are suffering. Mental health is a disease like heart and cancer, our family has suffered losses in al of these but has provided comfort love and caring so that death takes its natural course .through community organizations and social systems we need to be the voice of the unspoken

  82. Dr. Benjamin Goldberg

    Although I have treated many patients with suicidal attempts and ideation, one patient, with a psychotic depression, had such painful hallucinations, he kept requesting for death. Despite consultation with other psychiatrists, and many trials of medication, this patient eventually drowned himself. If ever I encountered a patient, who deserved a gentle assisted dying , it was this individual.

  83. well

    well it is a very fragile topic
    but just the fact that you dont see them it doesnt mean they are not there do you think is good for a person to suffer day by day by his thought that are insane irrational not talking about the feeling i myself dont know where was the last time i felt good is like being trapped in a fire and feeling the burn 24for 7 sometimes even in your dream and i will sat to those who vote no they think that they re doing something good it shouldnt be considered think again it is better to die that way than to blow your brain with a gun dont you think so

  84. Aurelia Cotta

    You need to address the fact that evidence based treatments exist that treat all mental illnesses and relieve suffering.
    Except in Ontario, and Canada we refuse to pay for those treatments. We have many therapies like DBT for personality disorders, and personalized medications for picking the exact medications that will work. We know that supportive housing, as in a “housing first” method works for hmmm, about 100% of the homeless mentally ill, and addicts and actually gives them back their lives. Peer support networks have fabulous results. Incredible success rates.
    OHIP just refuses to pay for any of these treatments, even though they have the highest level of evidence behind them. (Refusing to fund proven treatment for illnesses with stigma is how we know for sure that Govt doesn’t give a damn about evidence based medicine or science.)
    And no, we do not need to build capacity. We just need to pay pre-existing private psychologists and private therapists, and our waiting lists end.
    We also have to accept that some brand-name medications are needed in psych due to special time release or delivery features. Trillium or the Ontario Drug Plan need to cover those, because generic manufacturers don’t make the same time release features.
    But that won’t happen, because now it’s so much cheaper to just let us kill ourselves.

    Sigh, does anyone here know how often people with depression and suicidal thoughts are TOLD explicitly to kill themselves by family, random strangers, and health care workers? Answer: all the freaking time.

    Or–how about the physically and developmentally Disabled? They and their caregivers are constantly pressured by HC Workers to sign DNRs, even when the only operation on the horizon is a tonsillectomy!
    People in wheelchairs, who go to work and have good lives were seriously asked by many co-workers, HCPs etc. “Now that it’s legal, I guess you’ll sign up for assisted suicide?” a question that I can assure you, they didn’t ask anyone at work who could walk.
    People who are terminally ill are in a different situation. They are at least starting to have access to palliative care. But to have the court expand the definition so broadly for treatable conditions and stigmatized groups is outrageous.

  85. joao monteiro

    I think we are all free of uor decisions in this world . So if some 1 wants to go. Wat is the problem ?

  86. Justine Dembo MD

    We should never assume that the pain of psychiatric suffering is any less severe or any more endurable than that of physical suffering. Furthermore, it is difficult to differentiate the two: individuals with terminal physical illness often describe their existential anguish to be more unbearable than their physical symptoms; and individuals with severe depression almost invariably describe accompanying physical pain, which is often agonizing in itself.
    Suffering is suffering, and it is an internal, subjective experience that no one other than the sufferer can truly understand. Therefore the sufferer’s opinions and desires are most relevant when it comes to a decision to die. If the decision meets the Supreme Court’s criteria (voluntary, non-coerced, capable, enduring, etc), it should be respected.
    I have great respect for this article, and for the psychiatrists who expressed their views, therein. It will certainly be challenging for us psychiatrists to navigate these new waters, and yet when our role as physicians is in large part to relieve suffering – not just to sustain life at all costs – we need to rise to that challenge.

    • dr. atwater

      I share your same perspective on pain doctor. In fact, the pharmaceutical companies have not come up with a med that controls psychological suffering. People can rely on alcohol and drugs to deal with their deep pains.

      Thank You,

      Dr. Atwater

  87. Michael

    I’m not surprised that over 80% of the people that participated in the poll voted no. The poll results and some of the comments in this topic are perfect examples of things that are responsible for my suicidal ideations. The majority of mental health professionals and the general public have been programmed to think about mental illnesses in a specific way. And there’s a general consensus that life or the current human condition is obviously good, and any person with a mental illness that wants to commit suicide is obviously incapable of thinking rationally. I think we should be using the words “societal” illness just as often as mental illness when we’re having discussions about suicide, anxiety, and depression. We’re living in culture that embraces and promotes misery. And it should be no surprise that some people want to escape it. My misanthropy or a lack of love for the current human condition is the source of my depression. I feel like I’m trapped and drowning in a sea of undesirable information, and the only practical way out is death. The other solutions (futuristic options like gene therapy and artificial intelligence with full immersion virtual reality during the coming decades) are highly improbable. Happiness or wellness is a measure of how well a person’s genetics and social programming is in alignment with their environment. It’s a specific fluctuation of biochemical / neurological states or an ebb and flow of hormones and neurotransmitters. Unfortunately, the environment that I’m living in is not conducive to my well-being. And I think the same thing could be said by a large percentage of the people that have been diagnosed with some type of depression.

    There are many people with depression and suicidal ideations that are capable of thinking and acting rationally. But it can be extremely difficult to argue for your perception of reality when most people have been programmed to think a certain way, and your cognitive functions are impaired because of stress hormones and a complete lack of joy in your life. I think the public’s aversion to physician assisted suicide for the mentally ill has little to do with rational thought and logic. It is mostly about the cultural and philosophical history of psychiatry, our fear of loss, and archaic interpretations of religious text. People have a problem with the idea of assisted suicide for the mentally ill because most people feel sad or scared when they think about it. Most people are only focusing on the so-called slippery sloop instead of focusing on the potential benefits. Think about the botched suicide attempts, or the thoughts of terror, hopelessness and despair as a person jumps of a building or a bridge. Think about the psychological distress of police officers that are forced to shoot suicidal individuals, or the people are inconvenienced because someone decided to jump in front of a train.

    Physician assisted suicide should be legal and easily accessible in any civilized society. Every person including minors, healthy adults, and the terminal and mentality ill should have the legal right to receive services that can provide a peaceful death. I think there should definitely be some restrictions and an evaluation process involving the approval from a social worker or psychologist and two physicians (at least one psychiatrist). Minors could be barred from using the service unless they’re dying from a terminal illness or suffering from an affliction that causes intolerable physical and psychological pain. Consent should have to be given by the child and all legal guardians. Having said that, I think some legal exceptions should be made by a judge and the evaluation panel if the child has reached a certain age. (Perhaps 12, 13, or 14)

    • Val

      Thank you Michael, that was extremely erudite and exactly what I would say if I had the same intelligence and writing ability as you!

  88. Joshua

    Why don’t we ban rejection then? Social rejection and isolation are the leading cause of depression and anxiety. This isn’t fair. I remember when I tried to kill myself and my landlord evicted me right after. I am sure she’d be all against suicide too but she didn’t give two shits about me because she didn’t care about me. Thats the bottom point too. Doesn’t the sound hypocritical? Also, we are fundamentally insane as a species. Think about it: just because you get emotional that someone you love is dead think about all the other heartbreaking situations we allow in life. Rejection, loneliness and someone who you loved turns around and says they don’t want to be with you are ALL apart of live. So why should death be too.

    • Vinita Garnier, MSW

      It’s not your landladys job o care for you. It sounds like you are seeking approval and sjppot from he wrong people. Try cultivating friendships or volunteer somewhere. Those are the relationships in which you can develop caring relationships. Mostpeople are not altfuistic. Caring relationships develop over time and need cultivation. When we assume a person doesnt care about us and take it personally we can feel sad. Depression is more of a chemical imbalance that is often corrected by taking medication. Be well.

  89. Jody

    I’m a long term sufferer from mental health problems and for 14 years i have been suicidal, it hasn’t got better if anything i am getting worse with age, I’m 28 and i am voting yes i do think assisted dying should also apply to the mentally ill too, unless you have felt what being mentally ill feels like you will never understand how much pain and suffering we go through on a daily basis. We should stop treating mental and physical illnesses differently

  90. Keith

    Doctor assisted suicide will be the answer to the BC Liberals economic plan by making conditions so bad for people who are disabled and seniors who are not only forced into sub poverty and who are subjected to these political parasites decisions while she and her government gorge at the trough of the taxpayers and stuff their own pockets. They will tell u they will do it out of compassion and empathy when the BC liberals are the cause of much of the suffering of these disenfranchised groups of people.

  91. Douglas

    When treatment has repeatedly failed over the course of many years, then yes. Depression does not equal mental-incompetence.

  92. alfredo a. atwater

    If the mentally ill person’s issue is not solved with meds why should a mentally ill be less qualified than a non mental sufferer ?

    Anti-depresants do not prevent a suicide if the person has a plan.

  93. Jade

    It is Unethical and going against the Natural Laws of the Universe to not allow a human being to die when suffering becomes intolerable.

    I suffer from both incredible physical and mental pain. I should be allowed to die. However, the country that I live in (United States) will not allow this to happen as to them, my condition is “not serious enough” which is bull crap!

    Human beings, with extreme mental and physical pain and suffering, should be allowed to die!

    Animals are allowed to die.
    Human beings should too!

  94. cecilia brown

    I have lost all hope in any future free of emotional pain. This is because of my severe mental illness, combined with the difficulties of aging in this society. I have worked as hard as I can for the past several years in therapy but can see no improvement. In fact, things seem to be getting worse. Medications have caused severe and permanent side-effects and no apparent benefit. Perhaps if I could get more and/or better mental health treatment I could see some point in continuing to survive. But that is not possible for me.

  95. Vinita Garnier, MSW

    Thought provoking article. I have been living with bipolar disorder since I was a child. I have had many debates w/my thrapist. I have suffered for many years with a number of good feelins but they don’t last. I just want to be at peace and fo rme that’s assisted suicide. I hesitate to do it myself…I do not want to become a vegetable or wake u tothe same nightmare.

  96. camilla j forer

    They should have the right suffering for 6 decades with mental illness is unfai!! Over the age of 55 we should have the right to end perment suffering!!!

  97. nobody special

    As a person with lifelong low self esteem, anxiety, and depression I would very much like to die with some dignity rather than hanging myself, out whatever method I end up using. Because there is no question that I will end my life in the next few years or so, living with this pain is just torture. With no realistic prospect of my condition improving, I should be allowed to end my life. Living in near complete social isolation, no family, no friends, decades of loneliness, is really just torture at this point.

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