For people with dementia, a fight for the right to die | MacLean's

Minister of Health Ginette Petitpas Taylor speaks outside the House of Commons, in Ottawa on Thursday, Nov. 30, 2017., about medical assistance in dying (Adrian Wyld/CP)

Minister of Health Ginette Petitpas Taylor speaks outside the House of Commons, in Ottawa on Thursday, Nov. 30, 2017., about medical assistance in dying (Adrian Wyld/CP)

Ron Posno was diagnosed with mild cognitive impairment—a precursor to dementia—in 2016, and soon after, the London, Ont., resident re-wrote his will. He already had a Do Not Resuscitate order in place, and to this he added instructions for the niece who was his substitute decision maker that at a specific point in the progress of his illness, she was to seek medical assistance in dying on his behalf.

The eight conditions that Posno identified as signalling the proper time for his death are like a photographic negative that also reveals what he considers a life worth living. When I am unable to recognize and respond to family and friends; when I frequently experience hallucinations, paranoia or acute depression; when I become routinely incontinent; when I am unable to eat, clean or dress myself without assistance: that is when I want it to be over.

But then Posno’s niece, a lawyer in Toronto, informed him that an advance request like this for medical assistance in dying (MAID) was against the law and she would have no ability to act on it once he could no longer consent.

Posno had assumed that this request was basically an extension of his DNR: a statement of his desires for medical treatment in a given set of circumstances. He found it incomprehensible that he could legally state that he did not want CPR and the instruction would be followed if he were unconscious with a DNR in place, but in the face of an illness that would eventually render him unable to provide informed consent, he couldn’t request MAID on behalf of a carefully delineated future version of himself.

https://www.macleans.ca/society/for-people-with-dementia-a-fight-for-the-right-to-die/

Ketamine Could Be the Key to Reversing America’s Rising Suicide Rate | Bloomberg Businessweek

[…] Wright decided to try again in 2016, this time using a cocktail of drugs he’d ground into a powder. As he tells the story now, he was preparing to mix the powder into water and drink it when his dog jumped onto his lap. Suddenly he had a moment of clarity that shocked him into action. He started doing research and came upon a Columbia University study of a pharmaceutical treatment for severe depression and suicidality. It involved an infusion of ketamine, a decades-old anesthetic that’s also an infamous party drug. He immediately volunteered.

His first—and only—ketamine infusion made him feel dreamlike, goofy, and euphoric. He almost immediately started feeling more hopeful about life. He was more receptive to therapy. Less than a year later, he married. Today he says his dark moods are remote and manageable. Suicidal thoughts are largely gone. “If they had told me how much it would affect me, I wouldn’t have believed it,” Wright says. “It is unconscionable that it is not already approved for suicidal patients.”

https://www.bloomberg.com/news/features/2019-02-05/ketamine-could-soon-be-used-to-treat-suicidal-ideation

Wanting to die at 'five to midnight' - before dementia takes over | Andrew Bomford

It's not unusual for Dutch patients with dementia to request euthanasia, but in the later stages of the disease they may be incapable of reconfirming their consent - one doctor is currently facing prosecution in such a case. But fear of being refused is pushing some to ask to die earlier than they would have liked.

Annie Zwijnenberg was never in any doubt.

"The neurologist said: 'I'm sorry, but there's no way we can mistake this - its Alzheimer's," says Anneke Soute-Zwijnenberg, describing the moment her mother was first diagnosed.

"And she said: 'OK, then I know what I want.'"

Anneke's brother Frank chips in: "Maybe she hesitated for five seconds, and said: 'Now I know what to do.'"

They both knew she was referring to euthanasia.

You could say Annie's story is a textbook case of how euthanasia is supposed to happen in the Netherlands - with very consistent and clear consent. But there are other cases where the patient's consent is less consistent, and at the final moment, less clear.

https://www.bbc.com/news/stories-47047579

Europe's top rights court to hear Belgian euthanasia case | AP

LONDON (AP) — Europe’s top human rights court has agreed to hear a case being brought against Belgium by a man whose mother was euthanized in 2012 for depression, the second case that implicates one of Belgium’s leading euthanasia doctors.

In a statement Tuesday, lawyers for Tom Mortier said they brought their case to the European Court of Human Rights in Strasbourg after Belgian authorities declined to pursue it.

Robert Clarke, one of Mortier’s lawyers, said there were some “deeply worrying” details about the case.

“This was a woman who was under the care of a psychiatrist and according to medical definition was a vulnerable person,” Clarke said. “The state had a duty of care to protect her and it failed.

https://apnews.com/8217108af4f841b3a2d551ca73eecb9c

Should patients with anorexia be force-fed to save their lives? - The Globe and Mail

Madam Justice Lise Bergeron of the Quebec Superior Court recently ruled that a 20-year-old woman who is suffering from severe anorexia should be force-fed to keep her alive.

The hospital where the young woman is being treated, Centre hospitalier universitaire du Québec, sought a court order when she began to suffer life-threatening pericardial effusion (build-up of fluid around the heart).

The patient, who is not identified for privacy concerns, has been under almost constant treatment since 2012. At one point she weighed a mere 32 kilograms, and was refusing to eat.

These cases are among the most ethically and legally challenging.

https://www.theglobeandmail.com/opinion/article-should-patients-with-anorexia-be-force-fed-to-save-their-lives/

That’s not Dad, that’s the Alzheimer’s that speaks, by Evelien van Veen (de Volkskrant 18 May 2018) – TrudoLemmens

It is March 9, 2018, and Luc Beemsterboer (52) enters the nursing home where his father has been living for three days. He walks through the long hallway and types in the access code for the glass sliding doors, behind which dad just happens to arrive. A little man, a little crooked by old age, neat jacket suit. When he sees his son, he momentarily pretends to run past him, a teasing twinkle in his eyes.

“How are you doing, Dad?”, asks Luc, when the tall and the short man stand head to head.

“Shitty”, is the answer – with a tone of: what did you expect?

Jacques Beemsterboer (80) is not in a nursing home because he really wanted it badly. He would by far have preferred to stay with his Toos, with whom he has been married for 55 years, in their new flat in the center of Papendrecht. But it did not work anymore. Jacques has Alzheimer’s, is confused, at home he ran around at night as a ghost, keeping Toos busy with him at the most impossible times. Sometimes, he realizes that he has dementia. “It enters your life insidiously,” he says when you ask him about it. “I can still participate quite well in conversations about nearly anything, but will I still know about it in fourteen days, that’s another question.

https://trudolemmens.wordpress.com/2018/07/14/thats-not-dad-thats-the-alzheimers-that-sounds-by-evelien-van-veen/

'It's nothing like a broken leg': why I'm done with the mental health conversation | The Guardian

Iam bleeding from the wrists in a toilet cubicle of the building I have therapy in, with my junior doctor psychiatrist peering over the top of the door, her lanyards clanking against the lock. Her shift finished half an hour earlier.

An hour later she calls the police, because I have refused to go to A&E or to let her look at me. Four policemen arrive. They are all ridiculously handsome. One of them is called Austin. Austin doesn’t have a Taser like all the others and when I question this, Austin says he hasn’t done his Taser training and all the others laugh. I feel bad for Austin.

I want to go home but I am not allowed. I am crying. The police ask me to tip out the contents of my jacket. Tampons fall out, with four sad coffee loyalty cards, each with a single stamp. Then I make a break for it because, seriously now, I just want to go home. The four officers surround me at the building entrance. One officer who has done his Taser training threatens to section me if I do not stop struggling.

As if you can just section me, I say. You can’t just say someone is sectioned and then they are sectioned. That is not how it works.

It turns out this is exactly how it works.

https://www.theguardian.com/society/2018/jun/30/nothing-like-broken-leg-mental-health-conversation

Psychedelics work by violating our models of self and the world | Aeon Essays

Psychedelic drugs are making a psychiatric comeback. After a lull of half a century, researchers are once again investigating the therapeutic benefits of psilocybin (‘magic mushrooms’) and LSD. It turns out that the hippies were on to something. There’s mounting evidence that psychedelic experiences can be genuinely transformative, especially for people suffering from intractable anxiety, depression and addiction. ‘It is simply unprecedented in psychiatry that a single dose of a medicine produces these kinds of dramatic and enduring results,’ Stephen Ross, the clinical director of the NYU Langone Center of Excellence on Addiction, told Scientific American in 2016.

https://aeon.co/essays/psychedelics-work-by-violating-our-models-of-self-and-the-world

'Zero Suicide': A Bold Mental-Health Initiative - The Atlantic

[...] Edward’s suicide was one of 6,188 recorded in the U.K. in 2015, an average of almost 17 a day, or two every three hours. In the U.K., suicide is the leading cause of death among women under 35 and men under 50. The World Health Organization estimates that 788,000 people died by suicide globally in 2015. Somewhere in the world, someone takes their life every 40 seconds. And despite advances in science and a growing political and popular focus on mental health, recorded suicides in the U.K. have declined only slightly over the past few decades, from 14.7 per 100,000 people 36 years ago to 10.9 in 2015.

A simple belief drives Mallen: that Edward should still be alive, that his death was preventable—at several stages during the rapid onset of his depression. Moreover, Mallen and a growing number of mental health experts believe that this applies to all deaths by suicide. They argue that with a well-funded, better-coordinated strategy that would reform attitudes and approaches in almost every function of society—from schools and hospitals to police stations and the family home—it might be possible to prevent every suicide, or at least to aspire to.

https://www.theatlantic.com/health/archive/2017/08/zero-suicide-strategy/535587

When Your Child Is a Psychopath - The Atlantic

[...] At 11, Samantha is just over 5 feet tall and has wavy black hair and a steady gaze. She flashes a smile when I ask about her favorite subject (history), and grimaces when I ask about her least favorite (math). She seems poised and cheerful, a normal preteen. But when we steer into uncomfortable territory—the events that led her to this juvenile-treatment facility nearly 2,000 miles from her family—Samantha hesitates and looks down at her hands. “I wanted the whole world to myself,” she says. “So I made a whole entire book about how to hurt people.”

Starting at age 6, Samantha began drawing pictures of murder weapons: a knife, a bow and arrow, chemicals for poisoning, a plastic bag for suffocating. She tells me that she pretended to kill her stuffed animals.

Adam Maier-Clayton’s death renews debate on assisted-dying access for those with mental illness

The suicide of Adam Maier-Clayton, a 27-year-old man who was an advocate for extending the right to a medically assisted death to those suffering from severe psychological distress, is likely to intensify one of the most difficult parts of the debate about assisted death in Canada. [...]

“What Adam did over the last year and a half is he asked a lot of medically difficult questions related to medical assistance in dying and people who have severe psychological and psychiatric illness,” said Shanaaz Gokool, the CEO of Dying with Dignity Canada. “He was young and articulate and incredibly bright, but had a lot of conviction around his condition and around this issue,” she said.

http://www.theglobeandmail.com/news/national/adam-maier-claytons-death-renews-debate-on-assisted-dying-access-for-those-with-mental-illness/article34718194/

Dark, Dark, Dark, Dark, Dark, Dark, Dark, Dark, by Corey Hirsch

It’s the summer of 1994, I am standing at the edge of a cliff in Kamloops, British Columbia, and I am checking out.

In February, as a 21-year-old starting goalie, I’d backstopped Canada to an Olympic silver medal. In June, as the third goalie for the New York Rangers, I’d drunk out of the Stanley Cup. I have a girlfriend at home. I have a turbo sports car parked behind me. I have the horizon in front of me — so much horizon — and as I look out past the end of it, I am completely calm.

I’m going to see how fast this sports car can go … and drive it right off this cliff.

And then, finally, I’ll be at peace. My thoughts will be gone.

http://www.theplayerstribune.com/corey-hirsch-dark-dark-dark/
 

Mental Illness and Access to Assisted Dying

One I wrote for Impactethics.ca

An independent review of medical assistance in dying is soon to begin under the auspices of the Council of Canadian Academies. A subject of further study and, one that remains fiercely debated, is whether medical assistance in dying should be permitted for persons whose sole underlying medical condition is mental illness. Let’s explore some of the objections to allowing medical assistance in dying for persons with mental illness.

https://impactethics.ca/2017/02/15/mental-illness-and-access-to-assisted-dying/

Magic Mushrooms Show Groundbreaking Psychological Relief in Cancer Patients

The Johns Hopkins group reported that psilocybin decreased clinician- and patient-rated depressed mood, anxiety and death anxiety, and increased quality of life, life meaning and optimism. Six months after the final session of treatment, about 80 percent of participants continued to show clinically significant decreases in depressed mood and anxiety, with about 60 percent showing symptom remission into the normal range. Eighty-three percent reported increases in well-being or life satisfaction. Some 67 percent of participants reported the experience as one of the top five meaningful experiences in their lives, and about 70 percent reported the experience as one of the top five spiritually significant lifetime events.

http://www.goodnewsnetwork.org/magic-mushrooms-show-groundbreaking-psychological-relief-cancer-patients/

Update:
Scientific American is covering this as well, featuring an interview with Roland Griffiths  - Psilocybin: A Journey Beyond the Fear of Death? 

If You're Thinking of Trying Antidepressants - Man Repeller

When I was 12 my grandmother died, and suddenly I saw death everywhere.

I’d been an anxious kid before that, with baby-sized panic attacks that had me hallucinating slow, booming voices and strange objects that ballooned into my frame of vision. Later, I’d sit up at night to guard against what felt inevitable: our house burning down, a murderer crawling in a window. Imperceptible rejections could propel week-long crying jags, gentle self-harmings (digging my nails into my palms, slamming my head into the side of a bathroom stall) felt better than living inside my brain. One thought became eight thoughts became an endless, tangled river of possibilities, inadequacies, shortcomings, failures. In bad times, I would go weeks without eating a real meal, feeding myself on the crumbs of my dramas and the odd croissant.

'The impact on society is enormous': In legal profession, depression, addiction hurt clients, too - Health - CBC News

At its worst, the depression crippled her at work, to the point where Hollins would walk into her office, say hello to her assistant and then "close the door and lay on the floor and cry for hours."

At her lowest point, she says she would "spend most of the day trying to figure out how to collect myself enough to get to my car and get home."

That raw vulnerability doesn't match the general impression society has of lawyers as tough and ambitious.

http://www.cbc.ca/news/health/lawyers-mental-health-addiction-problems-1.3865545