RE: Proposed Assisted Dying Bill: implications for mental healthcare and psychiatrists

Internal coercion and self-stigma

Professors Bhui and Malhi¹ ably describe some of the difficulties in constructing adequate protections around legalised assisted dying. Among those mentioned is the possibility of coercion from abusive (or simply exhausted) family and carers. These situations undoubtably exist, but a more common problem is a person within a loving family feeling pressure to pursue assisted suicide precisely because of the loving care they are being given and the impact of this on their family. In Oregon, 53% of people who requested assisted dying included ‘feeling a burden’ in their rationale.²

Our society generally looks down on those who are unable to work or who need care. People with severe enduring mental illnesses are particularly exposed to these negative beliefs, often shouted after them in the street. It takes a great deal of self-belief to avoid self-stigma, where the individual takes on society's stigmatising beliefs about their illness and devalues their own worth because of these.

Psychiatric review for capacity or treatment of depression will be essential to any legalisation. One problem is the impact of that association on the image new and potential patients hold of us. Those admitted with acute psychosis are often terrified that staff intend to kill them, while building up rapport with people affected by chronic persecutory delusions can be slow and difficult work. Neither of these will be helped by a genuine association between psychiatrists and killing (however voluntary and capacitous).

There is a large measure of agreement between both sides of the debate, No one on either side of this debate wants either for people to feel trapped in their bodies, fearful and lacking dignity, or for vulnerable people to feel pressure to opt for assisted suicide for the sake of others. Unfortunately, there is no way avoid both perils simultaneously. The argument for assisted dying is being championed by those who are educated and articulate, whereas the dangers affect those most marginalised and least eloquent. To protect those vulnerable and often voiceless people, we need to maintain the law as it stands.