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Euthanasia for the Insane?

There is indeed a fundamental difference between physical and psychiatric disease.

by
Theodore Dalrymple

Bio

March 3, 2014 - 7:00 am
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Jack-Kevorkian-9364141-1-402

Dr. Jack Kevorkian

A moment’s reflection is all that should be necessary to convince anybody that our passions are not necessarily engaged by public controversies in proportion to the numerical or statistical importance of the question in hand. The debate over euthanasia and physician assisted suicide (PAS) is deeply impassioned everywhere; but not even the most enthusiastic advocate of euthanasia supposes – at least not yet supposes – that the question will ever affect other than a very tiny percentage of people.

The fact is that man is an animal that quarrels over symbols, and euthanasia is as much a matter of symbolic as of practical importance. How else are we to explain the fact, cited in an article in a recent edition of The Lancet about the new Belgian law extending the benefits of euthanasia to children, that there have been dozens of bills before the Belgian parliament desiring either to extend or to limit the scope of the current euthanasia legislation?

Reading the article and the articles to which it was linked, I came across two statements, one startling and the other importantly revealing. The starting fact was the following:

Recent studies have shown that the proportion of deaths that are the result of euthanasia or PAS in Oregon, USA as a whole, and The Netherlands, are 0.09%, 0.4%, and 3.4%, respectively.

Assuming this to be no misprint, why should the rate of physician-assisted suicide be more than four times higher in the United States as a whole than in Oregon, which is one of only four states (with a total of only 5 percent of the U.S. population between them) to permit it? Is it under-reported in Oregon? Is it carried out surreptitiously and illegally elsewhere? Are all the figures so inexact as to be virtually bogus? And if they are bogus, what does that tell us about the whole matter?

Another question is why there should be nearly forty times as many deaths by euthanasia and PAS as there are in Oregon. Is unbearable end-of-life suffering forty times more frequent in Amsterdam than in Portland? This is prima facie most unlikely. The pattern of disease in most western countries in very similar, and both in Oregon and the Netherlands cancer is by far the most common cause of requests for easeful death. Is there something sinister in the disparity?

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Top Rated Comments   
This is some serious stuff. I worked with the mentally retarded (and yes that is what they are, and NO, I have no problems saying that) for many years (from 1977-2000) and am well versed in eugenic theory and practice.

This is a horrible and Satanic (eyes wide open) thing to even contemplate.

It is horrifying that it even merits a post here.
32 weeks ago
32 weeks ago Link To Comment
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All Comments   (18)
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My fear is that, sooner rather than later, the emphasis will shift from "right to die" to "obligation to die". With millions of Baby Boomers reaching the age in which they will require vastly expensive medical treatment, how long before it becomes a positive good to have granny off herself? Then, wanting to get out in the lead, the Episcopal Church can declare it a sacrament to pump morphine into the veins of elderly parishioners.

And I only wish I was kidding.
32 weeks ago
32 weeks ago Link To Comment
The difference is not that someone with a myocardial infarction, or psychiatric disorder such as major depression are fundamentally different in the medical sense. Either one represents a major organ system failure with high risk of death. If fact patients with major depression are more than twice as likely to die from an MI as those without. This would impact on an end of life decision in terms of prognosis in some cases.

In every medical system I know of both are treated to the extent possible. In every medical system I know of death occurs on a regular basis.

I fail to see the "fundamental difference" here.

Perhaps what is intended is a discussion of autonomy. This is the most fundamental ethical principle we are talking about. The patient with major depression, schizophrenia, or other major psychiatric disorder, to what extent can the individual be considered to be making rational decisions given that the disease itself affects decision making?

Request consult psychiatry Dr House.





32 weeks ago
32 weeks ago Link To Comment
In the Netherlands, euthenasia is now considered by many hospitals and nursing homes a quick and cheap way to free up beds.
People are actively coerced into accepting or even asking for it who get diagnosed with life threatening or terminal conditions.
Also, a doctor who reports it is home free, won't get arrested and charged with manslaughter or murder. A doctor who doesn't report it gets every death under his care investigated as a potential manslaughter case, and can expect to get his medical license revoked and/or spend time in prison.

Hence the far higher incidence.

No doubt something similar is going on in the US, but with a twist.
In the Netherlands all such cases are listed. What if in Oregon, where it is legal, only cases that go to trial are listed, the vast majority that are done according to the rules never ending up in any statistic and just being "death by natural causes".
32 weeks ago
32 weeks ago Link To Comment
Who would run Congress?
32 weeks ago
32 weeks ago Link To Comment
"namely that there is a fundamental difference between physical and psychiatric disease"

This is already being eroded. Pain as the fifth vital sign? Why not anxiety? Why not depression? Just wait those are on the way. What it has done is cheapen the physical ailments. I get berated for this by the administrators since keeping pain under control is more important in reimbursement now than keeping people alive (or at least not destroying their kidneys with pressors).

These may be very real issues (i.e. sensed by the individual) but they are materially different from a BP or white count. When presented with a dilemma between objective and subjective data, are physicians capable of overriding the objective in treatment? We make determinations on futile care on objective only. Anything but turns us into monsters.
32 weeks ago
32 weeks ago Link To Comment
"Euthanasia for the insane"

I kinda like it, but then what would we do when there were no more liberals?
32 weeks ago
32 weeks ago Link To Comment
I couldn't follow the logic here either.
32 weeks ago
32 weeks ago Link To Comment
Ditto

Other than the Comparison of the stats of Netherlands, Oregon and the U.S., something about how tort law sees mental and physical disease I got not much out of it.

Dalrymple's articles are a must read for me. This one has me nonplussed. I think the author is confused also.
32 weeks ago
32 weeks ago Link To Comment
Wait, wait, wait... You have to be sane to commit suicide?
32 weeks ago
32 weeks ago Link To Comment
This article is quite inferior by Dalrymple's usual standards. The logic seems to be that, because not many people will be euthanised in any case, the wide concern the issue generates is simply a mark of human sentimentality. Yet if you could restrict people's thoughts only to those questions which have an obvious and immediate relevance to their material lives, you'd succeed in turning men into animals and put an end to all civilization. What Dalrymple derisively calls "quarreling over symbols" is precisely what makes man NOT an animal and what has made any progress possible. I can't believe a conservative would take such an anti-intellectual, anti-cultural view. Dalrymple's contempt for his fellow-man, his frequent impulse toward cheap "debunking," seems to have gotten the better of him here.
32 weeks ago
32 weeks ago Link To Comment
This is some serious stuff. I worked with the mentally retarded (and yes that is what they are, and NO, I have no problems saying that) for many years (from 1977-2000) and am well versed in eugenic theory and practice.

This is a horrible and Satanic (eyes wide open) thing to even contemplate.

It is horrifying that it even merits a post here.
32 weeks ago
32 weeks ago Link To Comment
If I read you right, I agree. It is horrifying that we live in a time (or maybe we've always lived in a time) where such a discussion's outcome could determine the possibility of destroying the mentally ill.

For my dough, this post is one of the more profound TD has written. Short, too.
32 weeks ago
32 weeks ago Link To Comment
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