Discussion The argument and topic of 'treatment resistant depression' and other similar mental conditions

[TAW122]

Disclaimer: I am not a doctor nor do I have a medical degree and nor am I giving medical advice. This is a topic that I have seen countless times around our community, in certain online communities, and even in academia (in narrow subjects). I am only giving my two cents and my position on this and what I believe may be a solution (or at least something leading towards the right path towards a solution.).

This topic is indeed a gray area, and there is no clear-cut answer which is best or not as it depends on many factors, including said individual's background. There will likely be no absolute solution given the ethics and moral dilemmas faced by many sides and what not... However, I (personally) would still ultimately like to see an 'out' as a VALID option for those suffering indefinitely, even if they are considered irrational (which at that point guardianship and power of attorney, and/or those in charge of making decisions SHOULD STILL ULTIMATELY DO NO HARM (OR MINIMAL IF UNAVOIDABLE AND/OR INEVITABLE) to said person.

One key point: Voluntary euthanasia, assisted suicide, death with dignity (and similar processes) ALWAYS remain an option, even for such a case. Contrary to what pro-lifers and anti-choicers say, having the option is the most ethical, moral, and dignified approach to take because this at least gives some endpoint, or limit to suffering other than indefinitely suffering until natural causes or other causes that result in death.

I could see that there is a lot of gray area because people have the argument of but they aren't of sound mind if they are depressed or lacking capacity, which has already been debunked and addressed in other threads as well as some news articles (TRTNLE Podcast #4 the lack of clarity of thought argument, MAID in Canada, the thread about expanding the coverage and legal power of the advance directive, and news article about the Belgian woman who choose voluntary euthanasia (a, and b)). Also, this is why advance directives and living wills as well as similar legal documents seek to address; for one to have the power to determine in advance what kind of treatment or lack thereof for one's own health and dignity.

As a side note: regarding the case about the Belgian woman who chose assisted suicide, it doesn't surprise me over how there are people (especially in the comments) arguing against her mental state and her decision. It was her decision and her's alone, and nobody should dictate how she lives her life or not. Additionally, the news article is coming from an news organization that is more aligned with pro-life values and the audience are generally 'pro-life', so that may explain the pushback and what not. There are some people who defend her actions and I do applaud their stance.

So in conclusion, there is no easy answer to this and there will always be some pushback and/or grey area (as it is a grey subject with multiple arguments advocating for different policies based on different perspectives), but I believe we could find a common ground, even if there is a compromise. The compromise would AT LEAST INCLUDE THE OPTION TO OPT out at some point so that way it is not a never-ending cycle of suffering and has an exit for someone who chooses to go. It is not a perfect solution given the circumstances, but it is at the least much better than to always deny said option to those with treatment resistant mental illnesses. Additionally, I will say that the criteria is that if one is of sound mind (knows as well as understands the decision, and has capacity to consent) and persistently wants it (not just an impulsive choice), then one should be granted the option.

What are your thoughts on this?

 

[situationalsui]

Countering prolife hysteria around MAiD

I am from Canada and was devastated when the gov announced in Dec. they were postponing the March '23 date when folks with mental disorders were supposed to become eligible for MAiD (medical assistance in dying). We have already waited two years longer than everyone with somatic nonterminal...

sanctioned-suicide.net

Thanks for your post. Here is a post I wrote recently on the topic. I personally think we need to create a MAID for mental disorders website to promote the cause and counter the pro-life, disability activist hysteria that now even psychiatrists are buying into.

 

[charon]

requiring doctors to "do no harm" is asking very little of them. they already do immense harm when treating people against their will -why not hold them to the higher standard of helping clients fulfill their wishes. obviously there would need to be a huge cultural shift in most regions for doctors to assist people in escape of this world.

we see it as mostly black and white with only a little grey. people are bound to be hurt with the loss of other humans in their life. it is not as if ctb has no impact on others, but ones autonomy must by its very definition override this; there is no choice we make that will not impact others. we are always stepping on the tulips in a trek toward our own destinies.

most of the grey we see lies in the places where minors or people under the control of others are locked in an awful situation. running away worked for us, but we got lucky. from an outsiders perspective, those are situations that are remedied by the removal of the victim from that environment, but as plenty of us know - that environment sticks with you. transplants carry painful scars

there is immense comfort in having the viable option of escape where there often otherwise isnt one in life. expecting people to edure thru situations brought on by the chronic mistreatment of others in order to meet some arbitrary standards to make all those left living in the world feel better is a tall order. we owe nothing to others in death - it is a private and personal choice. perhaps we would be open to sharing and getting that gold star of approval in another world where there wasnt the constant threat of imprisionment hanging over ones head, but we are not in that world.

that being said, if the option existed for us as long as we persistantly want it and be of sound mind, we would have gotten in line long ago. -if only so that others in our life could come to terms while we are still around. can only hope that arbitrary metric would have showed us persistant enough.

i dont think there will be a comfortable comprimise for either side. we demand autonomy, and pro-lifers are often so personally terrified to the extent that they cannot fathom the idea of rationally taking ones life. at least in our experience x.x

we also tend to disagree with definitions of mental illness -hence treatment-resistant being fairly meaningless- but thats a topic for another day.

 

[Forever Sleep]

I ABSOLUTELY agree with you. It's perhaps too much to expect them to allow someone who has had no treatment access to assisted suicide- ie. no medical history and no treatment.

While I hate the thought of treatment being forced on someone- I think realistically and initially in any case- the acceptance of mental illness as a justifiable reason for assisted suicide will likely still need documentation- as physical illness presumably does.

I ABSOLUTELY agree with you that this ought to be a finite process though- not a case of- the last 13 drugs didn't work- perhaps the 14th will... Let's put you through every type of therapy and hang on until new ones are created... There really OUGHT to be the equivalent to physical illness- if the person is suffering massively and nothing seems to be helping over a period of time- they ought to be given the same choice that a person suffering physically is.

I guess it would have to depend on psychiatrists and therapists to come up with reasonable time scales though according to the particular illness. I guess that's where it could get complicated.

I'm massively naive when it comes to illness- both physical and mental. Still- I get the impression physical illness seems to yield more definite diagnoses. I don't think you hear of anyone with terminal mental illness... perhaps chronic mental illness though. Ok- maybe you can't die of a mental illness. (Can you? I expect you can if it manifests physically- stress is a killer after all...) Still- when is someone considered treatment resistant? At what point? That's surely the same as saying they are incurable and stuck in something that yields no quality of life. At that point- they REALLY ought to be given the same choice as someone who's physical illness gives them no quality of life.

 

[TAW122]

Countering prolife hysteria around MAiD

I am from Canada and was devastated when the gov announced in Dec. they were postponing the March '23 date when folks with mental disorders were supposed to become eligible for MAiD (medical assistance in dying). We have already waited two years longer than everyone with somatic nonterminal...

sanctioned-suicide.net

Thanks for your post. Here is a post I wrote recently on the topic. I personally think we need to create a MAID for mental disorders website to promote the cause and counter the pro-life, disability activist hysteria that now even psychiatrists are buying into.

I've read your thread and replied to it. It is a good thread and if I were a Canadian citizen, I would go do activism for MAID. As for creating a website, I don't have the resources or time currently at this stage in my life (when I have many other matters to attend to as well as my own fate in the future), but someone else who does either here or elsewhere could take up the offer. I do like your idea though nevertheless.

I ABSOLUTELY agree with you. It's perhaps too much to expect them to allow someone who has had no treatment access to assisted suicide- ie. no medical history and no treatment.

While I hate the thought of treatment being forced on someone- I think realistically and initially in any case- the acceptance of mental illness as a justifiable reason for assisted suicide will likely still need documentation- as physical illness presumably does.

I ABSOLUTELY agree with you that this ought to be a finite process though- not a case of- the last 13 drugs didn't work- perhaps the 14th will... Let's put you through every type of therapy and hang on until new ones are created... There really OUGHT to be the equivalent to physical illness- if the person is suffering massively and nothing seems to be helping over a period of time- they ought to be given the same choice that a person suffering physically is.

I guess it would have to depend on psychiatrists and therapists to come up with reasonable time scales though according to the particular illness. I guess that's where it could get complicated.

I'm massively naive when it comes to illness- both physical and mental. Still- I get the impression physical illness seems to yield more definite diagnoses. I don't think you hear of anyone with terminal mental illness... perhaps chronic mental illness though. Ok- maybe you can't die of a mental illness. (Can you? I expect you can if it manifests physically- stress is a killer after all...) Still- when is someone considered treatment resistant? At what point? That's surely the same as saying they are incurable and stuck in something that yields no quality of life. At that point- they REALLY ought to be given the same choice as someone who's physical illness gives them no quality of life.

Yes, I believe there should be documentation (as thorough as possible and making sure that there is no doubt about the patient/person's suffering. Just like any other physical ailment that a person may be suffering through. I agree with having a finite process because at some point, it should be very clear that it is not (likely) to get better and that further prolongation of suffering is not only unethical, cruel, but immoral and selfish. We don't do that for those who are chronically physically ill (severe chronic pain with little prognosis of adequate recovery or reasonable (to said person) quality of life, quadriplegic, ALS, MS, neuro-degenerative disease, etc.), so we shouldn't do for those whose sole underlying condition is that of a mental illness.

Mental suffering is indeed suffering and if reasonable efforts and avenues have already been tried, tested, and exhausted, then the most compassionate choice would be to let them go, peacefully. This would save them from resorting to violent, brutal methods/means that not only aren't always reliable, but may end up with worse consequences if failed (oftenly as a vegetable or coma, yet still clinically alive). Additionally, this would prevent collateral damage to unwilling participants who would otherwise have to witness the aftermath of a dead body (or be put at risk during an attempt, e.g. landing on someone, physical injuries, and/or other causes).

As for coming up with a criteria that would be reasonable, it would require a consensus on all (or as many people who are suffering) to reach a common ground to what is reasonable in terms of treatment, waiting periods, and other criteria. As for a time frame for example, it could be somewhere around 6 months as a start (similar to most state's death with dignity laws, where a terminally ill patient would have to be within 6 months or less of life (based on prognosis of the ailment that said patient is suffering from). It would of course, not be perfect as every case and situation will be different, but it is at least a start and better than nothing at all. Throughout time, adjustments can be made to loosen criteria (if deemed to unreasonable or too stringent) so that accessibility will be less of an issue.

For your last point, yes I suppose that it will be harder to quantify and distinguish mental suffering as compared to physical suffering (as it is not physically observable nor does it have a biomarker attached to said ailment). It (mental suffering and mental illness) oftenly manifests through behaviors and actions of a person so trying to predict the exact cause is more difficult to do and predicting prognosis is more challenging than a physical ailment. However, yes, I believe that all patients who are suffering from treatment resistant depression and/or other similar mental conditions, should absolutely be allowed the right to a peaceful, dignified exit after having exhausted all (reasonable) avenues of recovery, treatment, and really want out. Furthermore, the benchmark for this would be the 'of sound mind' criteria, which should not be conflated with the ailment itself (in other words, if a patient knows that he/she is wanting to exit life, understands what he/she is choosing (permanent end to life), and willing chooses it, then he/she shall be granted that right.).