Catholic Medical Quarterly

The Journal of the Catholic Medical Association (UK)

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Catholic Medical Quarterly Volume 67(2) May 2017

Editorial:
Conscience: Pearls of Secular Wisdom

Dr Pravin Thevasathan

K Sonu Gaind is President of The Canadian Psychiatric Association. Last year, he wrote a highly perceptive piece on assisted suicide in relation to mental illness. [1] As we know, Canada legalized "medically assisted dying" in June, 2016 and while it is true that "medically assisted dying" is not currently available to relieve the suffering of mental illness, that was also true in the Netherlands not so long ago. Canada will come under increasing pressure to expand its current criteria. It has recently been suggested that euthanasia could save Canada's overburdened national health care system up to $139 million a year[2[. Perhaps Canada will not go down the way of the Netherlands, where a doctor was recently cleared of charges after she drugged a patient suffering from dementia, had her family hold her down, and then proceeded to kill her. [3]

Gaind writes: "Depression fuels negative self-thoughts, self-blame, hopelessness and struggle with one's place in the world....Teasing apart how illness-based cognitive distortions can influence decision making is a formidable challenge." In other words, it is difficult for experienced psychiatrists let alone other clinicians to decide whether or not the patient contemplating euthanasia is suffering from a mental illness which leads to a loss of capacity.

These cognitive distortions "can lead some to decline treatment and seek death."

In the Netherlands, about 3 per cent of deaths are the result of euthanasia and mental illness is an increasingly common justification. A young woman who suffered from post traumatic stress disorder as a result of sexual abuse was given euthanasia. Gaind writes: "In the Netherlands, most of the people receiving medically assisted death for psychiatric conditions cited depression and unresolved loneliness."

It could be argued that patients in the Netherlands are only offered euthanasia if they have irremediable mental illness. However, Gaind observes that "there is no established standard of care for defining when typical psychiatric conditions are irremediable." This lack of standards "leads to clinicians basing decisions on personal beliefs rather than sound medical science" when deciding on who should be offered euthanasia. Gaind writes: "Opening the door to assisted suicide for people with mental illness, involving inconsistent application of non-existent standards, would itself be discriminating against this vulnerable population...complex decisions without standards become value judgments or best guesses, and we should not be gambling with vulnerable lives."

It could easily be argued that those seeking euthanasia generally belong to a "vulnerable population" and can easily suffer discrimination. It is also argued that excluding mental illness in those with terminal illness is very challenging.

The Alberta bishops responded to the legalization of euthanasia by noting that euthanasia is gravely immoral. If penitents are determined to end their lives by euthanasia, priests "would need to delay absolution to a later time when the person may be properly disposed." [4] Similarly, Anointing of the sick might not be possible in such cases. The Bishops remind us that "Anointing does not in any way convey blessing upon or permission for the commission of any sin, in particular the sin of voluntary suicide..." [4] Unfortunately, further East the Atlantic bishops are citing Pope Francis and his exhortation Amoris Laetitia to support a decision allowing priests latitude to decide whether to give euthanasia seekers the sacraments before they are killed. Amoris Laetitia affirms Catholic teaching while recognizing "there are people who are not yet there" said one of the bishops [5]. If they are seeking euthanasia, it is rather unlikely that they will ever be there.

We now have the extraordinary situation where pastoral accompaniment means one thing for the bishops of Alberta and quite something else for the Atlantic bishops. Is this what is meant by a synodal Church? Two and two can never make five in theology because faith is founded upon reason and truth. The Alberta bishops and the Atlantic bishops cannot both be right. Such heterodoxy will be very confusing for patients, especially perhaps the depressed and mentally ill, as they struggle to cope with their illness and are encouraged to consider euthanasia. But that ecclesial heterodoxy will even harder for doctors and nurses who conscientiously object to euthanasia. Regulatory authorities and the law in Canada are already showing themselves to be hostile to conscientious objectors. The tolerance of the Atlantic bishops will only serve to make doctors and nurses who respect the lives of their patients even more vulnerable.

Clearly, as health care professionals, we must do what is both moral and right. The clarity of the Alberta bishops is hugely to be welcomed.