All pets go to heaven.

— She helps them do it at home.

Eden Gaines, left, talks with veterinarian Karen Meyers about the decision to euthanize Xochitl, a boxer-Great Dane mix who has cancer.

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Veterinarian Karen Meyers pulls her black minivan into the driveway of a townhouse in Maryland’s National Harbor. The home, in a gated community, is perched on a windy bluff not far from restaurants, bars, a casino — places of revelry.

The vet carries her brown doctor’s bag inside. There, she meets her patient: Xochitl, known as Xochi, an 11-year-old boxer-Great Dane mix weighing around 80 pounds.

Xochi, recently diagnosed with cancer, is struggling. A film covers her right eye. She had been bleeding from her mouth, refusing to eat. Now she stands in the townhouse’s living room, mournfully greeting family members who have come to say goodbye.

Xochi climbs onto the living room’s leather couch and lies down. Owner Eden Gaines and her family gather around her. Meyers opens her bag.

Meyers explains the procedure. First, Xochi will be injected with a sedative to make her fall asleep. Five to 10 minutes later, Meyers will administer sodium pentobarbital, which will euthanize her. But Xochi would feel no pain, Meyers assures the family.

She asks whether anyone has any questions.

No one does.

“Here we go,” she says.

Meyers says she has euthanized 1,500 animals in four years.

Pet adoption spiked during the pandemic, with nearly 1 in 5 American households taking animals in and spending far more on them than pet owners did decades ago. With more beasts in our lives — as companions, as emotional support animals, as the beneficiaries of pet trusts — it only makes sense that their owners want their final moments in their lives to be as peaceful and painless as possible.

That’s where Meyers comes in. Working with Lap of Love, a company that provides veterinarian referrals for at-home pet euthanasia, she travels from house to house in the D.C. region offering grieving families’ animals what the word euthanasia means: “good death.” In four years, she has euthanized 1,500 animals: cats, dogs, rabbits, rats. Some had been with their owners since childhood. Some had traveled the world with them. Some were their owner’s sole companion.

Meyers has observed death rituals that include praying, burning incense, wrapping a deceased pet’s body in a white sheet, and opening a window for a pet’s spirit to exit. She has listened to owners read poems or letters to their pets and cried along with them.

“When people hear what I do for living, it sounds sad,” Meyers says. “But it’s strangely rewarding. … You give pets a peaceful experience. It’s a final gift.”< Meyers has been surrounded by a menagerie all her life. Growing up, she usually had a dog and one or two cats; at various times, she’s also had two hamsters, two turtles, a guinea pig, a bird and four chickens. Right now, she has Wren, a 6-year-old Cavalier King Charles spaniel; Travis, a 3-year-old pug; Brinkley, a 13-year-old rat terrier Chihuahua; and Pablo, a red-belly parrot. Right before the pandemic, Meyers decided to shift to doing euthanasia full time. She had been a veterinarian for more than two decades, and pet euthanasia turned out to be less stressful than working in an office while raising two children. In-home euthanasia can be easier on animals and their owners than office appointments with other sick animals and their distressed owners crowded around.

The first injection makes Xochi fall asleep.
Rameses Gaines holds a piece of Xochi’s fur.

Meyers administers the first shot in Xochi’s back. The dog, already lying down with her head on Gaines’s lap, turns to glance at Meyers as if mildly annoyed.

Then, the dog relaxes.

Minutes pass.

Using a hair clipper, Meyers shaves an inch-long strip of one of Xochi’s legs and inserts a small IV line. After confirming that the family wants to continue, Meyers administers the second shot, the one with the fatal dose.

Gaines looks at the spot on Xochi’s leg where the IV had been inserted.

“It’s amazing how gray she became,” Gaines says.

Meyers holds a stethoscope to Xochi’s chest. “Xochi has her wings,” she says.

The family cries.

So does Meyers.

She and Gaines embrace.

Meyers maneuvers Xochi onto a stretcher and covers her with a blanket. With the help of Gaines’s sons, she loads the dog into her car. Eventually Xochi will be cremated and her ashes returned to the Gaines family.

Death is a part of life, Meyers says.

“Many times, people will comment how a human family member passed, and it was so painful at the end, and this is peaceful by contrast,” she says.

They tell her, she says, that they wish they could go the same way.

Rameses Gaines touches a mold of Xochi’s paw print.

Complete Article HERE!

Irish committee to recommend laws for assisted dying

— Proposed legislation would allow people help with ending their lives under certain medical conditions

The legislation would require two doctors to sign off on a person’s incurable and life-threatening condition.

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An all-party parliamentary committee in Ireland is to recommend that legislation be introduced to allow for assisted dying if a person has a terminal illness or has only a short time to live.

A majority on the Oireachtas committee on assisted dying supported the proposal that the law be changed to allow someone to get assistance to end their life if they have between six and 12 months to live.

The legislation would apply to people who have been diagnosed with an illness or a medical condition that is “incurable, irreversible, progressive” and at an advanced stage that will cause death within six months.

It is expected that the time limit for those with a neurodegenerative condition would be extended to 12 months.

The committee’s report is to be published on 20 March but has now been agreed by a majority of representatives from all sides of the Irish parliament. After its publication it will go to government for further consideration.

It is unclear whether the three-party coalition government led by Leo Varadkar is prepared to introduce legislation to enact the recommendation before a general election expected this autumn.

If it does, Ireland will join other countries including Switzerland, Belgium, Canada and the Netherlands in allowing assisted dying under certain circumstances.

It is understood that the proposed Irish legislation would require two doctors to sign off on a person’s incurable and life-threatening condition.

At hearings representatives of the Christian churches and a Muslim cleric voiced their opposition to the legislation, saying it was morally wrong to kill someone and was against God’s will.

Some psychiatrists also argued it could lead to “a slippery slope” with increasing numbers seeking to end their lives.

But the committee’s recommendation has been welcomed by the chair of the advocacy group End of Life Ireland.

Janie Lazar said: “We’ve been working hard to get people talking about assisted dying and about the choices that should be available to those who have no time to wait or waste.”

Constitutional law experts say they are confident that the committee’s recommendation would not require a referendum but a simple law change.

Nathan Stilwell, assisted dying campaigner for Humanists UK, welcomed the “bold move”, comparing it favourably with the debate in Britain where a report by MPs last month did not recommend a vote on the issue.

“Well done to the Irish special Oireachtas committee on assisted dying for taking an evidence-based and compassionate approach. It’s brilliant to see such a bold move after just a week ago a Westminster committee did not vote for any change in the law,” said Stilwell.

Complete Article HERE!

A cancer patient had decided how to die.

— Here’s what I learned from her.

For those with a terminal diagnosis, it’s getting easier to control death, but the process remains complex

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I first learned about “medical aid in dying” last spring when my sister, Julie, who suffered from advanced ovarian cancer, chose to end her life — in accordance with New Jersey law — after all realistic treatments had been exhausted and the pain medicines prescribed could no longer alleviate her suffering. At that time I didn’t know anyone else who had taken this step. While Julie’s hospice social worker provided answers to our questions, there was much I didn’t know about medical aid in dying at the time she died at age 61, much that I wish I’d understood better.

After Julie’s death, Lynda Shannon Bluestein, 76, became one of my teachers. The married mother of two also suffered from late-stage ovarian — and fallopian — cancer.

In a series of conversations last fall Bluestein told me she had wanted to plan for medical aid in dying when her condition worsened, but medical aid in dying, or MAID, is not legal in her home state of Connecticut. However, it was legal in nearby Vermont, but barred to nonresidents. Last year Bluestein sued the state to eliminate the residency requirement, which put her on front pages throughout New England.

Last March, when her chemotherapy regimen become too much to bear, she stopped treatment and began hospice care. By May she’d won her court case and the right to utilize Vermont’s medical aid in dying procedures

Like others who want to use life-ending medications, Bluestein had to follow a carefully prescribed process, which begins with a terminal diagnosis. Following Vermont’s MAID law, known as Act 39, Bluestein made two verbal requests to her attending doctor, at least 15 days apart, then made a written request signed by two witnesses who were 18 or older.

As she told me, “My two witnesses had no interest in my estate and no influence on my life [and] they weren’t related to me in any way.” (This ended up later sparking a journalism controversy when it turned out one of the witnesses was a columnist from the Boston Globe, who had been writing about Bluestein.) As a final step, a second physician reconfirmed that she met all the qualifying criteria.

By October, when we first spoke, Bluestein had met all the requirements. And so Diana Barnard, a Vermont family medicine doctor who is board certified in hospice and palliative care, called in the prescription for the mix of sedatives and barbiturates to the one pharmacy in the state that dispenses them. They would be held there until Bluestein needed them and would cost her $700 out of pocket, since Medicare, her insurance provider, does not provide coverage.

I spoke with Barnard about what happens during the procedure. “It’s harder to hasten a death than you might imagine,” she said. Five powerful medications are currently used, including diazepam, digoxin, morphine sulfate, amitriptyline, and phenobarbital. Death usually comes within 90 to 120 minutes but can take longer, she explained.

Bluestein completely understood what would happen after she swallowed the lethal mix of medicines. When we last spoke by phone, she told me she worried that if she waited too long, she’d be unable to ingest the drugs or would throw them up. When it became clear over the year end holidays that her health was deteriorating rapidly, she chose her date.

On Jan. 3, she and husband, Paul, drove to a private hospice facility that provides “a safe and caring space” for patients to end their lives.

Barnard explained that when a patient is ready to take the meds, they, a relative or friend would mix the drugs with water or apple juice. It’s crucial to imbibe the entire potion within two minutes for the greatest efficacy, said Barnard. Within a couple of minutes, patients lose consciousness, she said, and “appear to be unaware and not experiencing external stimuli,” with just the heart and lungs still working. Then comes the waiting for the end.

The 2022 Oregon Death With Dignity annual summary reported rare complications such as difficulty swallowing and regurgitation, but Barnard said there are precautions that can prevent most of them. (Oregon is one of 10 states plus the District of Columbia that now allow MAID.)

For instance, Barnard makes sure her patients can swallow effectively and can drink the whole mixture at once (some people practice with a placebo or view a video enactment of how to take these drugs at bedside).

On the morning of Jan. 4, now in Vermont, Bluestein and her husband Paul got up early, he said, and after the rest of the family arrived, he gave her the premedication (which makes the patient calm and drowsy, though not too drowsy to take the next step). After 30 minutes, the hospice owner came in to mix up the life-ending cocktail. He asked her if she was ready, and according to Paul she replied, “I’m so happy I don’t have to suffer anymore.” She drank it all — quickly.

Bluestein was unconscious within five minutes, her husband said. “She looked like she had fallen asleep peacefully. … A lot of the pain that was in her face went away, and I was grateful.” She was pronounced dead by a hospice nurse after just 25 minutes.

A few weeks after Bluestein’s death, I asked Paul Bluestein about the pain she had endured. He replied in a text: “There are some things in life no one should have to see and one of them is watching someone you love in pain.” It was “intolerable” and “undescribable.”

During my last phone call with Bluestein, she made a point to say that making her plan “was extraordinarily difficult. You really have to want to do this a lot, have a fair amount of money, a lot of flexibility, and be very well connected to accomplish this.”

I understood exactly what she meant, as the same had been true for my sister, who, while suffering, had to arrange this last medical procedure.

For critics who fear that MAID could make it too easy for someone to take their own life, or to pressure someone else to take theirs, I offer Bluestein’s words, along with my sister’s experience.

It’s not an easy process, and requires deliberation and intent, and the sign-off from others. But it offers an end to much pain and suffering, and that is a gift to those like my sister and Lynda Bluestein.

Complete Article HERE!

Woman found father dead after he took assisted dying drugs meant for someone else, Queensland inquest hears

— Man aged in his 80s kept the substance in his home after it was no longer required for another person, coroner told

A man who took a voluntary assisted dying substance intended for someone else was found dead at home by his adult daughter, an inquest has heard.

“I thought he was asleep in the chair. I put my arms around him. He was cold,” the woman said.

The coroner’s court in Brisbane on Tuesday opened the inquest into the May 2023 death of a man aged in his 80s referred to by the pseudonym ABC.

ABC’s name and those of his family members along with many other details surrounding his death cannot be published for legal reasons.

The substance involved in ABC’s death was obtained legally after Queensland allowed voluntary assisted dying (VAD) in January 2023.

Under that law, a person can self-administer a VAD substance in a private location but they must nominate a person who will be legally required to return any unused or leftover portion within 14 days.

Coroner David O’Connell heard ABC kept the VAD substance in his home after it was no longer required for another person.

ABC’s daughter said she held his hand and shook him after returning from running errands to find the house locked up with the blinds drawn.

Becoming tearful and with her voice breaking with emotion at times, the woman said her husband told her there was an open box on the kitchen table.

“I knew immediately it was the VAD,” she said.

O’Connell asked the woman if anyone had thought to have a medical professional collect the VAD substance as ABC was temporarily unable to leave his home.

“In hindsight, I didn’t even think to ask,” the woman said.

Queensland Health’s VAD staff were aware that the substance was due to be returned and ABC had said he would do so when he picked up his other medication.

A registered nurse involved in VAD told the inquest that there had been one patient where the substance was not kept in their home.

“It was share accommodation … the man chose not to have it in the house as it was unsafe. It was taken to the local hospital,” the nurse said.

The nurse said she would also not allow the substance to be stored in a home if she herself felt it to be unsafe.

O’Connell said he was concerned that regulations around self-administering VAD could allow other people without a terminal illness to be physically harmed or suffer mental distress.

“We’ve got medication safety and patient autonomy; we’ve got to find where the pendulum swings to get the balance right,” he said.

The nurse said VAD substances in a hospital were kept in a locked cabinet that required two keys to access but were not monitored after a patient took possession.

Barrister for Queensland Health, April Freeman, asked the nurse if some cancer patients were given pain medication in potentially fatal amounts.

The nurse said it was not uncommon and she was not aware of health authorities having control over those drugs once they were handed to patients.

Complete Article HERE!

‘Duo euthanasia’

— In the Netherlands, a famous couple chooses to die together

Former Dutch prime minister Dries van Agt and his wife, Eugenie, in Den Bosch, the Netherlands, in June 1983.

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The vow is “til death do us part.” But for former Dutch prime minister Dries van Agt and his wife, Eugenie, the aim was to leave this life the same way they had spent the past seven decades — together.

The couple, both 93, died “hand in hand” earlier this month, according to a statement from the Rights Forum, a pro-Palestinian organization that Dries van Agt created. They chose to die by what is known as “duo euthanasia” — a growing trend in the Netherlands, where a small number of couples have been granted their wish to die in unison in recent years, usually by a lethal dose of a drug.

A longtime politician who had conservative roots but campaigned for numerous liberal causes, van Agt served as prime minister of the Netherlands from 1977 to 1982. He later became the European Union’s ambassador to Japan and the United States

Photos of the couple from their decades-long careers as public figures often show them walking in step: waving to crowds through a car window, voting together at an election site and giving each other a smooch at a public event.

The van Agts’ health had declined in recent years, Dutch public broadcaster NOS reported. The former prime minister never fully recovered after suffering a brain hemorrhage in 2019, which happened while he was delivering a speech at a commemoration event for Palestinians. Eugenie’s health issues were largely kept private.

“I feel like it’s kind of beautiful, honestly, that you’ve lived your life together, you both happen to be gravely ill without a chance of getting better, you’re ready to go, and you would like to go together,” said Maria Carpiac, director of the gerontology program at California State University at Long Beach.

When it comes to the right to choose one’s own death, the Netherlands is “kind of the model” for any U.S. legislation on the topic, she said.

At least 29 couples — or 58 people — died together via duo euthanasia in 2022, the most recent year of data from the country’s Regional Euthanasia Review Committees. That’s more than double the 13 couples who did so in 2020, when the committee first started looking at partners specifically, but it still represents only a small fraction of the 8,720 people who legally died by euthanasia or assisted suicide in the Netherlands that year.

“It is likely that this will happen more and more often,” said Rob Edens, press officer for NVVE, a Dutch organization focused on research, lobbying and education about assisted suicide and euthanasia in the Netherlands. “We still see a reluctance among doctors to provide euthanasia based on an accumulation of age-related conditions. But it is permitted” in the country’s legal guidelines, he said in an email.

Assisted suicide is when a person self-administers a lethal dose while a physician is present, while euthanasia is when a medical professional administers the dose. Both are legal in the Netherlands when specific criteria are met. (Some groups prefer the term “medical aid in dying,” or MAID, due to religious and social stigma around suicide.)

Euthanasia is illegal in the United States, but assisted suicide is allowed in D.C. and at least 10 states: Oregon, Washington, Montana, Vermont, California, Colorado, Hawaii, New Jersey, Maine and New Mexico. Eligibility requirements tend to be strict across the country, Carpiac said, but there are differences between jurisdictions.

The Netherlands, a country of almost 18 million people, has allowed assisted suicide and euthanasia since 2002. It requires that individuals willingly request the termination of their life in a manner that is “well-considered,” with a sign-off from a doctor that they are experiencing “unbearable suffering with no prospect of improvement.”

Another physician then has to agree that the person qualifies, and doctors can choose whether they are involved in the procedure. After every death, doctors are required to notify a regional review committee, which examines whether each case was handled lawfully. Couples who seek duo euthanasia are required to apply and undergo the review process individually, with separate doctors.

“An accumulation of age-related complaints can lead to unbearable and hopeless suffering,” Edens said, explaining the Dutch guidelines. “The expectation is that if doctors are increasingly willing to provide euthanasia when there is an accumulation of old-age complaints, the number of duo euthanasia [cases] will increase.”

Research suggests that older Americans are at a higher risk of dying after losing a spouse, particularly in the first few months after their death. While the cause of this phenomenon is unclear, studies have found that grieving partners have higher rates of inflammation and are at increased risk of heart attack and stroke, often due to stress-induced changes in blood pressure, heart rate and blood clotting.

“The first thing that came to my mind was the widowhood effect,” Carpiac said, referring to the van Agts’ choice to die by duo euthanasia. “I have a grandmother who is 96, and she’s like, ‘I’m not going anywhere!’ But if I had a partner and they were my person, and we were both kind of at the end of our lives, would it be worth it if he were to go without me? Would I die of what I considered to be a broken heart? I would want to have a choice.”

Complete Article HERE!

My dad’s assisted death was a parting gift.

— I wish I’d said so in his obituary

Kelley Korbin wished she’d included the fact that her father had a medically assisted death in his obituary.

In writing about death, we use euphemisms that sometimes obscure how we actually feel

By Kelley Korbin

My father’s death was something I’d worried about for decades — probably since I learned that smoking kills. But years of pre-emptive angst didn’t prepare me for the crushing heartache that landed like a rock on my chest when he finally died from lung cancer at 82 last year.

I couldn’t have known how the deliberate way he chose to die would become part of his legacy. Or that Mom’s reticence would prevent me from sharing with the world that he had medical assistance in dying. I had hoped to honour my father with an obituary that inspired readers to live harder and love bigger. And, I wanted to package his life with all its complexities and idiosyncrasies into an honest tribute that — if you read between 20 column inches — revealed his authentic nature.

For example, I wrote he regaled us with tales that we never tired of hearing, that he was never one for small talk and that he was his most relaxed self when he travelled. I’ll decipher: Dad always prefaced his (albeit entertaining) stories with, “Stop me if you’ve heard this,” and then launched right in with nary a nanosecond pause for interjections; he did not suffer fools and, without a margarita in hand on a tropical beach, he could be pretty set in his ways.

The one thing I didn’t want to couch was how he died.

I’m reticent to use a hackneyed term like transformational but it’s the only one I have to describe what we experienced. Medical assistance in dying spared Dad many indignities and, for the family he left behind, knowing in advance the exact day and time of his death provided us with a chance to say everything we needed to say and send him off steeped in the love he deserved.

As I watched Dad take his last peaceful breath (not a euphemism, it really was), I was flooded with gratitude for living in a country where my father had the option to forgo a long, slow death. I wanted to share it with the world.

The federal government wants another pause in allowing medical assistance in dying (MAID) requests from those suffering solely from mental illnesses. CBC’s Christine Birak breaks down the division among doctors and what it means for patients who have waited years for a decision.

So, I asked Mom.

“Can I write that Dad had MAID in the obituary?”

“I’d rather you didn’t.”

I’m not usually one to demur. But this was my mother — just a day after her husband of 60 years had died. Plus, obituaries cost a bundle, and she was paying.

“OK, no problem,” I said and went on the hunt for a breadcrumb to drop in the obit. Dad’s death was neither “sudden” nor “unexpected” or “tragic,” leaving me unsure of what coded language to use for assisted dying.

In the end, I settled for the truth: Dad died surrounded by his family as the sun set.

Two women and a man pose for a selfie on a rooftop with palm trees in the distance. They’re all smiling.
Korbin’s parents, David and Judi, were married for 60 years.

For the next year, I regretted what felt like a lie of omission. Then, on the first anniversary of his death, Mom said to me, “It’s taken me a while, but now I see that your dad traded a few months of his life to give us a beautiful death.

She was right.

Dad had always been generous with material things, but his deliberate death was perhaps his greatest gift. Watching him make his difficult decision with grace and equanimity was the bravest thing I’ve experienced. We have always been a close family, but I don’t think any of us, even Dad, could have predicted the way sharing this rite of passage would bring us closer. Even a year after our patriarch’s death, I can feel a deeper intimacy between those of us he left behind.

Beautiful indeed.

I took my mom’s opening to probe further.

“Why didn’t you want me to put MAID in the obituary? Were you worried about the stigma?”

“Me? Stigma? Not at all,” she said, “I just didn’t think it was relevant.”

And then she added, “But I do now. So you go and tell the world about your father’s big, beautiful, assisted death.”

Complete Article HERE!

Should treatment for severe mental illness include medical assistance in dying?

By Anand Kumar and Sally Weinstein

Canada is on the threshold of enacting a law that would make medical assistance in dying (MAiD) accessible to people whose only medical condition is mental illness. If this were to pass, Canada would be one of only a handful of countries to extend that process for patients with serious mental illness.

It will apply to conditions that are primarily within the domain of psychiatry like depression and personality disorders. Political leaders have accused the Trudeau government of promoting a “culture of death;” others see this as a sign of gross underfunding of high demand mental health services.

In the United States, Oregon was the first state to enact the Death With Dignity Act, in 1997. The measure allowed terminally ill adults to end their lives by voluntarily self-administering lethal doses of medication prescribed by a physician for that purpose, with key caveats that included a physician’s diagnosis of terminal illness leading to death within six months. Since then, the District of Columbia and nine additional states have enacted laws that facilitate medication assisted death along the lines of the Oregon model.

Societal expectations regarding MAiD evolved over time. Several European countries have broadened the scope beyond terminal illness and imminent death to include suffering, functional decline and unbearable circumstances with no prospect of improving with treatment, thereby incorporating quality of life metrics into the process.

In a potentially dangerous expansion, countries including Switzerland, the Netherlands, Belgium and Luxembourg currently permit medical assistance in dying for patients characterized as having severe and persistent mental illness (SPMI) — defined as conditions resistant to evidence-based treatments — provided they meet additional criteria that include intolerable suffering with preserved decision-making capacity. By expanding into the realm of mental illness, we change the fundamental nature of the discussion.

Serious mental disorders are in essence brain disorders that are influenced by psychosocial factors. Unlike neurologic diseases, mental disorders cannot be localized to specific regions of the brain. Neuroimaging studies of patients diagnosed with SPMI, including bipolar disorder, the schizophrenia spectrum, anorexia, and post-traumatic disorder, for example, demonstrate that multiple brain regions are involved in the development of these illnesses. These disorders are mediated by impaired brain circuits — interconnected brain regions — rather than any specific part of the brain. The region most consistently involved in these circuits is the prefrontal cortex, which mediates executive functions.

Executive functions include judgment, abstract thinking, planning, integrating information from all brain regions and insight. These domains are therefore compromised in patients with SPMI, with important downstream behavioral consequences that include impaired insight into the nature of their illness and loss of the ability to objectively consider the pros and cons of intervention.

This is not to suggest that all patients with SPMI have minimal insight or are incapable of making rational decisions about their health care. Far from it. But it must be acknowledged that not all diseases, not even all brain disorders, are the same, and some of them do adversely impact cognitive domains germane to consequential decision-making.

There are effective treatments, both pharmacological and psychotherapeutic, that can reduce the burden of disease and improve the quality of life for patients with mental illness. Some of them require long treatment trials using traditional approaches or with newer neuromodulation techniques, such as transcranial magnetic stimulation.

A major compounding factor for patients with SPMI is the lack of adequate access to psychiatric care. Insurance companies frequently use a ‘business model’ approach that maximizes profit; for those with insurance, especially publicly funded insurance that is increasingly privatized, payment is often denied or limited. Denial of care exacerbates the challenges patients face as they navigate our health care system and potentiates the desire for an “exit plan.” Like the current debate in Canada, adequate mental health services and access to care will serve as mitigating factors favoring life in a subgroup of patients.

The notion that there is a right dose and combination of medications for all patients that will eventually result in symptom remission is more folklore than science. We must be intellectually honest and acknowledge that not all forms of SPMI are curable with appropriate therapy and that some patients remain refractory to treatment even after repeated attempts. Patients may also be overwhelmed by long medication trials and experience hopelessness about clinical remission, which is difficult to disentangle from the very symptoms of these illnesses. Perseverance is often a long game in clinical medicine.

An option for this group would be palliative psychiatry. Palliative medicine — that is, the absence of active medical interventions while providing basic sustenance and support — is more widely appreciated in cases of cancer and other near terminal illnesses where the patient makes an informed decision that quality of life, brief as it may be, is more important than measures to extend life, especially when they cause undue discomfort. Palliative approaches in psychiatry are conceptually comparable and include accepting that severe mental illness can be incurable, avoiding direct treatments with challenging side effects and questionable impact, and offering a support system that helps patients live impactful lives until death.

The American Medical Association’s Code of Ethics maintains that assisting in death violates a fundamental code for medical practitioners. The American Psychiatric Association adopted the same position as the AMA in 2016, stating “a psychiatrist should not prescribe or administer any intervention to a non-terminally ill person for the purpose of causing deaths. Suicide prevention is the bedrock of mental health care throughout the country.”

The debate is clearly a difficult one, fraught with emotions; it needs to incorporate not only new scientific information but also the cultural values and principles of the society in which we live. The relationship between patients with mental illness and the practice of medical assistance in dying is a slippery slope that is likely to get even more slippery over time. We will require great caution and a thoughtful national debate as we move forward.

Complete Article HERE!