I have personal experience of seeking help with Medical Assistance in Dying (MAiD). I also have personal experience of considering taking my own life by suicide. These instances have been as a result of feeling physically and mentally distraught, and with a fear that there may be no realistic potential for improvement in my condition.
Presently, I am enjoying improved wellbeing, and would like to share some information in case it may be of use to other stakeholders in the consideration of MAiD.
Around fifteen years ago I first experienced what I would describe as a psychotic episode. My perception of reality altered dramatically, as did the ways in which I interacted with my environment and the ways in which I behaved.
Following a visit to a psychiatrist I was given an ‘antipsychotic’, and told that I would be on ‘medication’ for the rest of my life.
During fifteen years of experiencing intermittent psychotic episodes, among long periods of normality, I have noted the following:
There has been a tendency for psychiatrists to encourage, persuade, coerce and enforce use of ‘medications’, not only for acute episodes of psychosis, but for ‘prophylactic’ purposes. ie during periods in my life when I have been well and had capacity. They have gone to mental health tribunals on five occasions and been able to have use of ‘medication’ enforced during periods of wellness by claiming that I have ‘significantly impaired decision making ability (SIDMA)’.
Use of ‘medication’ has had significant adverse effects for me, including causing akathisia, tardive dyskinesia and inducing suicidal thoughts.
No psychiatrist that I’ve interacted with as a patient has informed me adequately of potential risks of adverse effects (side effects) of taking ‘medication’. It therefore took me a long time to make some conclusions about potential cause and effect relationships.
I have wanted to end my life several times. Shortly after experiencing my first episodes of psychosis I made inquiries to the ‘Dignitas’ organisation in Switzerland and received written information regarding the process of assisted suicide.
In retrospect, I associate the suicidal thoughts with times that I have either been on ‘medication’, or withdrawing from use. I consider the likelihood of there being a causal relationship to be high. During these periods psychiatrists have described my mental state as ‘stable’ and ‘well’.
Again, looking retrospectively, I have no experience of mental ill health, when not using ‘medication’, causing me to want to contemplate ending my life.
During these fifteen or so years, I have found that psychiatrists interacted with me in ways that neither recognised the severity of the distress that I was in, nor the potential for it to have an iatrogenic cause.
In addition, due to the trust that close family members, who care about me a lot, had in the medical profession, my descriptions of unbearable effects from the use of ‘medications’, and my preference to be dead rather than have to continue experiencing them, have not been taken as seriously as they otherwise would have been if reliable information had been presented by those responsible for my treatment. This is not an issue specific to me, nor people close to me: in general, patients and members of the public are not well informed about risks from use of ‘antipsychotics’.
To broaden the context, in my work with a mental health advocacy group, I have learned that not everyone who experiences psychosis does so in the ways that I do. Some find episodes to be very distressing, and welcome use of ‘antipsychotics’ as a means to alleviate the distress. Therefore, I am aware that not all mental health experiences relating to wanting to die necessarily align with my perception of only iatrogenic factors being involved.
I can imagine circumstances where someone’s mental or physical distress, regardless of causes, would not be able to be alleviated by any intervention presently available. In these instances I would be empathetic to the patient’s perspective on assisted dying.
However, I would like to think also, that consideration would be able to be given to possible iatrogenic causes of distress in any decision-making process about whether to proceed with MAiD.
In particular, I would hope that recognition would be given to a risk of providing assisted dying to a patient who, with a change of treatment plan, could have gone on to enjoy a good quality of life.
Taking account of my own experiences, I would be wary of poorly evidenced ‘expert psychiatric opinion’ in any ethical considerations.