Conference Coverage

Is medical aid in dying suicide?



– Medical aid in dying is not the same as suicide; it is a way to give people with terminal illness and facing imminent death a way to die better and avoid the terrible, drawn-out deaths from chronic disease that often now occur, Margaret P. Battin, PhD, said at the annual conference of the American Association of Suicidology.

Dr. Margaret P. Battin of the University of Utah Mitchel L. Zoler/MDedge News

Dr. Margaret P. Battin

Dr. Battin, professor of philosophy at the University of Utah in Salt Lake City, was lead author of a statement issued by the association in November 2017 asserting that medical aid in dying (MAiD) is distinct from suicide and hence the two should not be conflated, a position she expanded on during a session at the meeting. “We all know the stigma attached to the word ‘suicide,’ and it biases how we think about it,” she noted. That’s the major reason why the name changed from what originally was called “physician-assisted suicide” to something that dropped the word “suicide.”

The legal acceptability of MAiD has expanded gradually, and is allowed now by law in Colorado, Hawaii, Montana, Oregon, Vermont, Washington, the District of Columbia, and by court decision in California. It’s also a legal option in Belgium, Canada, Luxembourg, the Netherlands, Switzerland, and parts of Germany, she said. Dr. Battin attributed the spread of legalized MAiD to the frequent terrible and protracted deaths people in industrialized countries face from chronic diseases such as cancer, heart disease, organ failure, dementia, stroke, and other neurologic disorders, and the comforting option of choice that MAiD offers these terminally ill patients. All the laws that have legalized MAiD draw distinctions between it and suicide, she noted.

“Even it the patient doesn’t act on this, someone facing death can find comfort knowing that if things get too bad, there is a way to avoid it, that they can have some control over their death. People want to remain in control, and this gives people a sense of control” that is not pathologic; it’s reassuring. “It can also make bereavement easier for others,” she said. Medical aid in dying “ helps people with terminal illness reduce their confusion, despair, and sense of impotence. When we can’t prevent death, this can make it better.” Dr. Battin also cited the restrictions these laws make to rule out people with mental illness or psychiatric problems that influence their choice of MAiD. That plus cultural and societal attitudes toward self-directed death mean that very few people actually wind up taking MAiD to completion.

But Thomas Joiner, PhD, dissented that the MAiD process successfully winnows out people who are acting on a desire for suicide in the traditional sense.

Dr. Thomas Joiner of Florida State University Mitchel L. Zoler/MDedge News

Dr. Thomas Joiner

“If you look under the hood, the fundamental psychology at play is the same” between MAiD and suicide, said Dr. Joiner, professor of psychology and director of the psychology clinic at Florida State University in Tallahassee. Many people who complete MAiD have either a personal or family history of suicide or suicide attempts or a history of other mental disorder. “I’m not saying that people should not be able to choose [MAiD], but there is a lot of overlap between it and suicide,” he said, adding that he didn’t trust the ability of a psychiatric assessment to ferret out people with conventional suicidal motivations.

Another major problem with MAiD is that it focuses too much on self-determination and autonomy and downplays the importance of the social reverberations that this form of death has on others, he explained. “The social dimension is an afterthought [of MAiD], and that’s a problem.”

The American Association of Suicidality statement “has evolved, and Professor Battin had a lot to do with that, and I respect” the writing process. It shows better balance between autonomy and social connections, but I believe that [MAiD] is often an expression of [traditional] suicide,” Dr. Joiner said. MAiD has become more acceptable, “but that doesn’t make it right. It is trying to dodge the stigma of suicide.”

Dr. Battin and Dr. Joiner had no disclosures.

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