Power to Prevent Suicides - Case Study Example

Suicide Psychiatrists have a duty to do everything in their power to prevent suicides. Some patients do not exhibit signs, or hide their intentions. If this occurs, then a psychiatrist did everything in their power to save the patient. However, if there is any indication that a patient might hurt themselves or others, the psychiatrist must have them committed. Assistance to suicide by a psychiatrist or psychiatric euthanasia should never be an option. I would advise a clinician seeking my opinion of these facts. The first issue is psychiatrist have a duty to do everything in their power to prevent suicides. Not every suicidal patient survives, even when a psychiatrist does everything in their power. If a patient wants to die, they will find a way. When a person commits suicide, the word means more than just one killing oneself. When suicide: as self-killing was viewed as an act, language only had verbs and verbal nouns with which to name it. Absent the word suicide, people viewed the self-killer as a moral agent, responsible for his deed. By contrast, we now think of suicide as a happening or result, attribute it to mental illness, and view the agents as a victim (patient).1 Patients that commit suicide are self-killers. They are responsible for their actions. If a psychiatrist acts responsibly, then they are guiltless concerning their patients death. On the other hand, if a psychiatrist helps a patient commit suicide, they are breaking the spirit of their profession. Psychiatrists are supposed to help suicidal patients. It is true not all patients can be helped, but a doctor, even psychiatrists, are supposed to do no harm. Assisted suicide does more harm than good. The psychiatrist in effect gives up on the patient. Most patients that commit suicide do not want to die, they want the mental pain to stop. One author explains: Stripped down to its bones, my argument goes like this: in almost every case, suicide is caused by pain, a certain kind of pain---psychological pain, which I call psychache....[Suicide] is a lonely act, a desperate, and almost always, unneccessary one.2 Psychological pain cannot be determined with an hundred percent accuracy by anyone other than the patient. It is a psychiatrist job to work with mentally ill people, but they can only see the symptoms, not the actual problem. This is why a psychiatrist should never assist in suicide. Now assisted suicide in terminallyill cases are different. The guidelines for assisted suicide vary, but the following is a general guideline: The condition under which doctors, and only doctors, may practice euthanasia: the decision to die must be the voluntary and considered decision of an informed patient; there must be physical or mental suffering which the suffer finds unbearable; there is no other reasonable (i.e. acceptable to the patient) solution to improve the situation; the doctor must consult another senior professional.3 In terminally ill patients, a doctor can judge a patients pain and disease. For example, an inoperable cancer spread through out the body can be judged through tests. Doctors can predict how long a patient has to live by studying the proof of the bodys failing, like tumors and other tissue samples. The brain can still be a mystery at times. CAT scans can determine if mental illness is caused by a tumor or growth on the brain. However, many causes of depression are unknown. Patients can have chemical imbalances, childhood issues, or true mental illnesses, such as bi-polar or schizophrenia. One report explains: There is still a limited understanding of the underlying causes of common mental illnesses, including depression and schizophrenia. In the case of an individual patient, it remains extremely difficult to predict whether therapy will produce an early response, a delayed response or no response.4 This is why in the Netherlands guidelines for assisted suicide were examined. The following guidline was determined: The criteria address the decision of the patient to be assisted with suicide, which must be voluntary and well considered, and the patients desire to die, which must endure over time. The patients suffering must be unacceptable, and the disorder incurable. The authors conclude that important aspects of psychiatric practice are not addressed in the guidelines, which were originally developed for use in somatic medicine.5 The problem is that suicidal patients all have an enduring desire to die, if the symptoms are not treated. A suicidal patients suffering is unacceptable, and most mental illnessess can be treated, but not cured. Another problem with mental illnessess are the symptoms. For example, schizophrenics will take medicine, until they start to feel better, then quit. Bi-polars take many different combinations of medicines, but sometimes can only cope, lacking highs or lows. Mental illnessess are also being redefined all the time. Bi-polar is an example. Many bi-polar people were informed they did not fit the criteria ten years ago, but today a new type II bi-polar has started to be diagnosed. When a psychiatrist treats mental illnessess, unlike traditional medice, most mental illnessess can only be maintained. Thus if psychiatric assisted suicides became routine, some psychiatrists might help patients that just need maintaince to kill themselves. Psychiatrists are human. Some patients might irrate a psychiatrist, or grate on their abilities. If psychiatric suicide became the norm, then biased decisions could be made. In reality: The assessment of treatment prognosis in psychiatry is not accurate enough to allow a final decision about incurability. Boundaries of the psychiatric therapeutic relationship are violated in physician-assisted suicide. The therapists inability to objectively assess the patients wish to die is overlooked.6 Psychiatrists are intricately involved with a patient. Some patients can be seen monthly, bi-monthly, weekly, or even more by a psychiatrist. This causes a deep bond to develop. This would make the psychiatrist too involved to make an unbiased decision on assisted suicide. For example: The various roles of the psychiatrist in this situation, however, may not rest easily with each other. Notably, the concept of assisting — rather than preventing — suicide counters the core aims of psychiatric practice. The shift of therapeutic role from alleviating psychic despair to facilitating suicide would be anathema to many psychiatrists. The psychiatrist may be drawn into the position of mediator between patient, family and medical staff.7 It goes against what a psychiatrists job describtion is to assist in suicides. Psychiatrist must try to prevent suicides, not assist in suicides, and avoid turning a blind eye to the signs of suicide. A persons life, no matter how little they value it, is important. If a person commits suicide, then that is their decision. However, if a psychiatrist turns a blind eye to obvious symptoms, like threats of suicide, self mutilation, or previous suicide attempts, they are responsible for letting their patient die. It would be the same, if a doctor observed a patient flatline and did not respond. Psychiatrists are to treat a patients mental illness, not ignore the signs of suicide. Another issue is the lack of experience most psychiatrists have with assisted suicide. One report states: While psychiatrists specialising in old age or liaison psychiatry may have regular experience in the management of patients in the end stages of dementia or other terminal conditions, most general psychiatrists have little experience of euthanasia-related issues.8 Psychiatrists normally attempt to prevent suicide. They do not have any training in euthanasia-related issues directly. If this was to become a part of a psychiatrists duties, more education and training would be necessary. It has also been considered for patients without mental illnessess who want to die, a psychological test or exam must be completed. In many cultures, no matter the reason, suicidal people are considered mentally ill. For example in Orgeon, The Netherlands, and Australia: Psychiatric assessment is mandatory for patients who request PAS in some jurisdictions, but not in others. Between 1995 and 1997, each patient in Australias Northern Territory requesting PAS underwent mandatory psychiatric assessment (Kissane et al, 1998). In Oregon, a physician refers the patient to a psychiatrist or psychologist only if the physician believes a psychiatric disorder may be present. A similar situation applies in The Netherlands, where psychiatric assessment is requested for only 3% of patients who request PAS (Groenewoud et al, 1997), raising the possibility that psychiatric disorder may be underdiagnosed in this population.9 A patient can be terminally ill and mentally ill. This must be examined by the jurisdiction where the patient lives. Psychiatrists also are starting to become more involved in terminally ill patients requests for assisted suicide. One source reports: In assessing patients requesting PAS, the primary role of the psychiatrist is to identify and treat psychiatric illness. The psychiatrist may also be expected to provide an assessment of the patients decision-making ability and to support staff in their own decision-making process (Bannink et al, 2000). These are all important issues in light of the prevalence of depression in this patient group (Chochinov et al, 1995) and also the potential for distress and division among staff members.10 Terminally ill patients are going to be depressed. However, especially if the patient is not in pain, psychiatrists should not approve assisted suicide requests. If a patient is in great pain that is different. However, if a patient is terminally ill, but not in pain, just dealing with the reality of death, assisted suicide would be akin to murder. There is never a justification for psychiatric euthanasia. Because of the reasons listed above, like psychiatrists bond with the patient, a psychiatristss job describtion, and the unknowns of mental illness, psychiatric euthanasia could never be justified. It goes against what a psychiatrist should be. If psychiatrists start giving up on patients, then patients will feel no one cares. This attitude could raise the suicide rate. As a student of philosophy, I would advise a clinician seeking my opinion on the above questions strongly. Firstly, I do not belive in assisted suicide regardless. If a person wants to die, then they should kill themselves. Many times patients, especially terminally ill, want their cake and to eat it also. They want to live as long as possible, but die when they are too weak to commit suicide. This fact shows they really cannot kill themselves. The self protection instinct is very strong. It also absolves them from any religious guilt. Most religions have a taboo about harming oneself. However, all of these considerations are part of life. If assisted suicide becomes routine, then patients will slip through the crack. Secondly, another reason I do not believe in assisted suicide or euthanasia is the possibility of abuse. At first it would be the terminally ill that want to die, then it would be patients who do not have a quality of life, and then it could become useful for patients that cannot afford medical services. Doctors and psychiatrists would start determining who should live and who should die. This should not be up to doctors, but only the individual themselves. Thirdly, many mental illnessess cannot be accurately predicted. Moods can change. Therapy can help depressed patients to face their problems and move on. Psychiatry is not a concrete science. An example: It is impossible to predict which patients will undergo spontaneous remission and when this will happen. These uncertainties are far more pronounced in psychiatric practice than in medical practice, to the extent that it is essentially impossible to describe any psychiatric illness as incurable, with the exception of advanced brain damage as occurs in progressive neurodegenerative disorders such as Alzheimers disease and Huntingtons disease.11 This unknown flow of mental illness can give no justification for assisted suicide. Another issue when accessing mental illness is the question on how much a psychiatrist can really determine. For example: Socrates suggested that ‘the unexamined life is not worth living’; several papers in this issue of the Journal examine aspects of contemporary psychiatric life. For example, how does a psychiatrist assess a patient suffering from mental illness who is requesting euthanasia?12 There is no scientific method to determine how bad a mentally ill patient feels. A psychiatrist can only track symptoms. Finally, ethics should be considered. Doctors and psychiatrists are supposed to do no harm. These professionals are supposed to help patients, not help them kill themselves. Ethically doctors should not assist suicide because of their oath and training. It is unethical to experiment on patients, but today assisted suicide has become just that; an experiment. The only drawback is these experiments have no conclusive results. Psychiatrists should do everything in their power to prevent a patients suicide. Under no circumstances should psychiatric suicide be allowed ethically or morally. There is no justification for a psychiatrist to participate in this type of behaviour. I would advise against psychiatrists assisting in suicide. References Hume, David. (1986). “Of Suicide” in Peter Singer (ed.) Applied Ethics, OUP, pp.19-27. Kelly, B.D. and D.M. McLoughlin. (2002). The British Journal of Psychiatry 181: 278- 279. Schoevers, R. A., Asmus, F. P. & van Tilburg, W. (1998) Physician-assisted suicide in psychiatry in The Netherlands. Psychiatric Services, 49, 1475-1480. Shergill, S.S. The British Journal of Psychiatry (2006) 188: 401-a17. Szasz, T. (1999). Fatal Freedom. USA: Greenwood Publishing. Read More