Assisted dying has become a hot topic.
For large parts of human history when people came toward an end, they might have been left in an outhouse by relatives or consigned themselves to a hut in the woods.
Children too. When born, Spartan children were taken outside and their hands placed on the eaves of the house – if they didn’t cling on, the bodies were discarded.
Marten de Vries and others showed some years back that it was probably once semi-normal for women to give healthy babies up at birth. When the woman already had more children than she could manage, perhaps because of straitened economic circumstances, it was not uncommon for her to give birth in a semi-public place and leave the child behind where it might or might not be picked up by another woman.
The bottom line according to Marten is that a woman doesn’t magically bond with a child. She makes a decision and its after the relationship starts that bonding happens.
Once medicine got involved in our lives in the twentieth century, it disturbed the informal ways we had of doing things.
Despite being obviously in the business of poisoning and mutilating people, doctors managed to hobble themselves with an idea that they were all about First do no Harm. Their professional bodies took it upon themselves to put a complete ban on any doctor being in any (detectable) way involved in helping people out.
Despite missing the many Shipmans in their midst, the public medical position was somewhere to the right of the Catholic Church who were comfortable enough with the idea of not too strenuously trying to keep people alive.
Now we have a crisis. Extraordinarily sad stories of people crippled with conditions like Motor Neurone Disease (MND) – something no-one in their right mind would want to live with or die from – confront us. Is it right to deprive people in this state of a dignified exit?
The exit narrative has taken a new twist lately. Patrick Hahn, an American science writer, interested in the latest fuss about Spravato and treatment resistant depression, has picked up on recent cases of several young women in Holland and Belgium who applied for assistance in dying on the basis of having Treatment Resistant Depression (TRD).
The troubled 29-year-old helped to die by Dutch doctors
In January Aurelia Brouwers drank poison supplied by a doctor and lay down to die. She was 29.
24 & ready to die | The Economist
Emily is 24 years old and physically healthy. But she wants her doctors to end her life.
The suffering from Treatment Resistant Depression (TRD) is as grim as anything from MND we are told – by out there bioethicists like Udo Schuklenk. There is no ethical or logical basis for not letting people end it in a setting with their friends and family around rather than attempting to do so in a painful and lonely way.
What about Post SSRI Sexual Dysfunction – PSSD? There are reliable accounts of several people with PSSD taking their own lives in the course of the last year or two. Its the same for PFS and PRSD – post finasteride and post-retinoid sexual dysfunctions. Probably very lonely suicides.
Motor Neurone Disease asks whether we have to be at the mercy of our biology. Should the twisted molecules in a cancer be let kill us in an undignified way?
When the psychotropic drugs came on stream in the 1950s, the new world opening up was caught in the phrase twisted thoughts and twisted molecules. For many the hope was the new drugs would untwist the molecules of people who were otherwise condemned to a living death in the grimmest of prisons.
But now we have TRD – which didn’t exist before the new drugs in the 1950s. Even people with the most severe of melancholias, people who had be drip fed in hospitals or else they would starve to death, recovered after 5 – 6 months or so – without drug treatment. The big deal with the new drugs was we could get these people well quickly – cutting down the risk they had of killing themselves during the earliest phase of their illness.
There simply weren’t people, living in the communities we used to have who, permanently miserable and mentally tortured from a depressive illness, opted to kill themselves rather than face an unendurably grim life.
Modern drugs have created TRD just as surely as they have created PSSD. With all drugs, there are a proportion of people who will have the opposite effects to those intended. The problem today is that many doctors no longer understand this and facing someone who appears to be getting worse, they increase the dose of the very thing that is causing the problem or add further drugs into the mix, leaving the original treatment in place. Ultimately the “victim” is left molecularly twisted like a pretzel. And twisted too by the wall of denial if not frank hostility they run into if they so much as hint their treatment might be part of the problem.
The drugs may be out of their body but the effects can endure for decades. Spravato (esketamine) marketed on the basis that TRD is an established disease entity, can only make this problem worse. See Ketamine – What’s God got to do with it.
Should someone with TRD then turn to an assisted dying program? Should people with PSSD , PRSD, and PFS, which likely have a very similar molecular basis, turn to assisted dying?
If death is the way out, what about a hunger strike outside a pharmaceutical company headquarters or a doctor’s office? Is there something about assisted dying legislation that means it has to take place somewhere private where you won’t disturb anyone?
A hunger strike appears to be a relatively pleasant way to die. It offers a chance for friends and family to gather round and do things to draw attention to the issues – raise money for research to solve the problem.
Withdrawing into a room – privatising your death – will suit the very people who have probably put you in the situation where death has become an option.
TRD is very different to cancer or MND. Or is it? Current estimates are that up to 80% of cancers are caused by environmental factors. MND – amyotrophic lateral sclerosis (ALS) in the US – is also sporadic for the most part. There is good evidence that statins can cause it and less solid but still substantial evidence that antidepressants can cause motor neurone problems that overlap with it.
Its a lot harder for someone with MND or terminal cancer to undertake a hunger strike but they could support someone with PSSD or whatever who could.