Friday, January 3, 2014

Suicide prevention plans at odds with right to die

This Canadian article is consistent with the Oregon experience in which legalization of physician-assisted suicide was followed by a significant increase in other suicides.  See footnote 1.

By Susan Martinuk, Calgary Herald January 3, 2014 

Retired politician Bob Rae used the occasion of a friend's apparent suicide to call on Canada to establish a national suicide prevention plan.
Susan Martinuk

Chris Peloso was Rae's friend and well known in Ontario's political circles as the husband to George Smitherman, a former high-profile cabinet minister and politician. Media reports haven't utilized the term suicide, but the phrase "lost his battle with depression" seems to indicate that was the case.

Calls for such a strategy are made every time there is a high-profile suicide in this country (such as Amanda Todd and Rehtaeh Parsons, two girls who suffered unbearable bullying in school and on the Internet). Parliament passed a suicide prevention strategy one year ago, but few seem to be aware of its existence or its implementation, and society continues to call for somebody to do something to prevent such tragedies from occurring.

Prevention is usually a good policy. But I have questions about whether any suicide prevention policy can be successful with Canada's health-care system and be consistent with other societal messages.

The first question is how can we effectively prevent suicides by those who are depressed when our health-care system offers limited (at best) access to psychiatric care and treatment?

A depressed person can call a suicide hotline or speak with a counsellor, and a crisis may be prevented. Or maybe not. But, at some point, the only way to prevent suicide is to access medical treatment.

The Fraser Institute's 2013 report, Waiting Your Turn: Wait Times for Health Care in Canada, reveals that the national average wait time from referral by a general practitioner to the time of beginning non-urgent psychiatric treatment was 20.3 weeks. If you live in New Brunswick, that wait is 73.5 weeks. That's about 1.5 years to access treatment and includes a 46-week wait from the time of GP referral to seeing a psychiatric specialist.

If you live in Saskatchewan, the wait for treatment is one year. Even if the case is urgent, patients still face a five-week wait to get an appointment with a psychiatrist. Anyone familiar with depression or other mental illnesses knows that a lot can change in five weeks, let alone one year.

Rae thinks it's important to have public conversations about mental illness. But awareness has absolutely nothing to do with treatment and, based on the above statistics, it's difficult to imagine that any province could maintain an effective suicide prevention strategy.

My second question raises an issue that Canadians may not be familiar with, but will undoubtedly face in the coming months as Quebec (and eventually the rest of Canada) debates the legalization of euthanasia.

That is, how can we credibly promote suicide prevention strategies at the same time as a large portion of society is publicly claiming they have a right to die? After all, euthanasia is supposedly about the right to self-determination when individuals are forced to live in circumstances that are unbearable.

At least that's how the conversation goes. The reality of legalization is very different, as we've seen in Belgium, the Netherlands, Switzerland and Oregon. Each of these has relaxed their laws to the point that depressed people can easily access euthanasia. As one bioethicist claims, euthanasia in these districts expands the options for the mentally ill and "empowers" them when they make the choice.

A 2005 study in the Journal of Clinical Oncology showed that almost one half (44 per cent) of requests for euthanasia were made by patients with depression. These authors started with the premise that terminally ill people who requested euthanasia were more accepting of death and that depression would therefore not be a factor. In contrast, they found that depressed patients were four times more likely to request death.

A report in Current Oncology in 2011 summarized euthanasia in the Netherlands by saying that in 30 years, it "has moved from euthanasia of people who are terminally ill, to euthanasia of those who are chronically ill; from euthanasia for physical illness, to euthanasia for mental illness; from euthanasia for mental illness, to euthanasia for psychological distress of mental suffering," and now to euthanasia of those over 70 who are simply "tired of living."

How do we talk about such facts while promoting a national suicide prevention policy? A society that knows the slippery slope of euthanasia and still accepts its legalization has no credibility in talking about suicide prevention for those with mental illness.

Susan Martinuk is a columnist based in Western Canada. Her column appears every Friday.

* * *
[1]   This quote is from  page 17 of Vote No on SB 220:
Oregon’s suicide rate, which excludes suicide under Oregon’s physician-assisted suicide act, is 35% higher than the national average.  This rate has been "increasing significantly since 2000." Just three years prior, Oregon legalized physician-assisted suicide.  This increased suicide rate is consistent with a suicide contagion (legalizing one type of suicide encourag[ing] other suicides).  There is, regardless, a statistical correlation between these two events.