Opinion

Many people who want to end their lives because of intense mental suffering find themselves grateful for their lives once the suicidal moment or attempt has passed. As Ken Baldwin, who survived a suicide attempt by leaping off the Golden Gate Bridge, famously remarked, “I instantly realized that everything in my life that I’d thought was unfixable was totally fixable — except for having just jumped.”

One might expect that as someone who has repeatedly attempted suicide and yet is happy to be alive, I am opposed to euthanasia on psychiatric grounds. But it is because of my intimacy with suicide that I believe people must have this right.

It’s true that policymakers, psychiatrists and medical ethicists must treat requests for euthanasia on psychiatric grounds with particular care, because we don’t understand mental illness as well as we do physical illness. However, the difficulty of understanding extreme psychological suffering is in fact a reason to endorse a prudent policy of assisted suicide for at least some psychiatric cases. When people are desperate for relief from torment that we do not understand well enough to effectively treat, giving them the right and the expert medical assistance to end that misery is caring for them.

Canada’s MAID law recognizes that people suffering from extreme depression, for example, may find no other means to end their agony. Approximately one-third of people coping with major depressive disorder have symptoms that do not reliably respond to available treatments. If you know there is no medically sanctioned way out of your mental pain, you may be likely to take matters into your own hands. Major depression is one of the psychiatric diagnoses most common to suicidal people, and approximately two-thirds of people who die by suicide are depressed at the time of their death. Yet any of us can commit suicide — and currently it is an epidemic.

A panel of experts has recommended safeguards and protocols for requests for aid in dying made by people with mental illness. Should MAID’s extension to those suffering acute mental pain follow the Canadian model, patients will be able to make their case to two health care practitioners, who must agree that their illness is “grievous and irremediable.” This is far preferable to the messy, difficult, terrifying job of trying to do it yourself. The suicidal person’s involvement in a behavioral health setting that can give a variety of kinds of help might result in rethinking the desire to die. Suicidal ideation can consume the lives of those who live with it. By interrupting or complicating the habitual patterns of chronic suicidal ideation, the prospect of relief through MAID could, paradoxically, ease the need for ending one’s own life.