Interim specialIn the debate on legalizing physician-assisted suicide, the pro-life movement may have found an ally in psychiatrists.

That psychiatrists almost universally oppose physician-assisted suicide is amply discussed in an article published last fall in an American psychiatric journal. Authors Thomas Zaubler and Mark Sullivan, both doctors, note that psychiatrists oppose physician-assisted suicide because of their view that suicide is an outcome of mental illness.

“The belief that suicidal ideation is a sign of psychotherapy stems from the high correlation between suicide and mental illness,” Zaubler and Sullivan write.

Indeed, even in a study of terminally ill patients at two Canadian hospitals, only 17 patients out of 99 desired death. Of those 17, more than half were suffering from depression.

In non-terminally ill, the correlation between mental illness and suicide is even higher. The authors cite a statistic that 90 per cent of suicides are committed by individuals who suffered from a psychiatric disorder at the time of suicide.

Some psychiatrists argue that the legalization of physician-assisted suicide may lead to doctors assisting in the deaths of chronically ill patients who are not terminally ill or mentally ill patients without medical illness. Such cases have occurred in The Netherlands.

“Dutch studies indicate that medical decisions that hasten death occur in 38 per cent of all deaths with 2.1 per cent of these including either assisted suicide or voluntary active euthanasia and 0.8 per cent including euthanasia without the patient’s consent,” Zaubler and Sullivan write.

Chock full of statistics, the article shows the pivotal role psychiatrists can play in the debate on legalizing assisted suicide. Psychiatric evaluations of those requesting assisted suicide have become commonplace in jurisdictions allowing physician-assisted suicide, such as The Netherlands.

However, diagnosing depression in a terminally ill patient has its own difficulties.

“In the absence of an impartial and precise method, psychiatrists’ judgments are likely to reflect their own personal views about assisted suicide,” the authors write, adding, “Something similar happened in the late 1960s when, in most states, abortion was illegal and psychiatrists were frequently consulted to demonstrate that a woman was at risk for developing a mental illness unless the pregnancy was terminated, despite the fact that there was no conclusive research on the psychiatric consequences of denied abortions.”

There is some suggestion that a terminally ill patient’s desire for suicide may subside with psychotherapeutic intervention.

Perhaps this is where psychiatrists ought to focus their energies in the debate, instead of becoming gatekeepers in the gruesome choice of death.

The article concludes on a morally weak note that the desire for death should at times “be respected as a decision.”

(Nipa Mukerji is a lawyer and journalist in Toronto).