Art Caplan on Switzerland's Decision that the Mentally Ill May Be Helped to Take Their Own Lives?

This is an incredibly momentous and controversial court decision by the highest court of Switzerland:

Switzerland already allows physician-assisted suicide for terminally ill patients under certain circumstances. The Federal Tribunal’s decision puts mental illnesses on the same level as physical ones.

“It must be recognized that an incurable, permanent, serious mental disorder can cause similar suffering as a physical (disorder), making life appear unbearable to the patient in the long term,” the ruling said.

Assisted suicide has always been linked to the challenge of allowing the terminally ill a choice in managing their inevitable death. That is the policy in the state of Oregon which has had legalized assisted suicide for the terminally ill for many years.

Linking the right to assistance in dying from physicians to the quality of someone's life or their suffering is an enormous and, in my view, very dangerous shift in thinking about assisted suicide.

IF this policy were to be put into place in Switzerland or elsewhere it would put physicians in the position of trying to distinguish 'competent' requests from persons with mental illness alleging emotional despair from 'incompetent' or 'temporarily desperate' persons with mental illness alleging emotional despair --something psychiatry and psychology are not always adept at doing.

Moreover, this policy opens the door to anyone who says they have unbearable psychological or emotional suffering to request help in dying--people with terrible burns, those who are severely disfigured, those who are emotionally bereft at the loss of a child, partner or loved one and even those suffering from career setbacks and failures.

I think the policy is both difficult to enforce and dangerous to apply since it is hard to see how it will not lead to a very slippery slope. Once assisted suicide is extended to those who claim or state that their quality of life is not worth living it puts medical professionals in the very difficult role of trying to figure out if such a claim is valid. It then puts them in the even more difficult role of trying to decide why it is their responsibility to alleviate the suffering, even the most miserable suffering, that people may face through the prescription of lethal doses of drugs.
-Art Caplan

Murder and Mental Illness: Yates' Conviction Overturned

A Texas appellate court overturned the conviction of Andrea Yates, who stood trial in 2002 for the murder of her five children. The conviction of Yates brought into the public spotlight the inadequacy of the law, particularly criminal law, in the way that it treats mentally ill individuals. The law doesn’t address the issue of whether an individual is “in control.” The question of innocence or guilt is phrased in such a way that defendants are “not guilty by reason of insanity” if at the time of the conduct they lacked the ability to know the wrongfulness of their action. Andrea Yates, who drowned her five children, was found guilty under this rule because even though the defense and prosecution agreed Yates was mentally ill, the court instructed the jurors that if they found that she knew right from wrong and knew that her conduct was wrong, she was guilty. Yet, most bystanders could clearly see that this was someone in emotional chaos and out of control. This case has been of particular interest in the field of neuroethics because the hope is that new techniques in brain imaging and other technologies might soon give us better diagnostic evaluation or therapeutic effectiveness, so that we can successfully treat individuals like Yates. It is important to note that better assessment is not about freeing individuals from responsibility for their actions, but it can, perhaps, help us determine whether an individual is capable of controlling his or her conduct and therefore help us achieve a more appropriate, humane, and fair outcome. The appellate overturned the conviction on the grounds that the false testimony an expert prosecution witness, Dr. Park Dietz, provided could have unfairly affected the judgment of the jury. The prosecution plans to appeal the decision to Texas Court of Criminal Appeals and have not ruled out a retrial if they lose the appeal. The appellate court's decision can be read at FindLaw. -- Linda Glenn