Euthanasia: Should it be legalised for mental health? (UK)

Picture by: Morbidgrungy (2017). Professor Ramos Blog.

Mental illness can become so debilitating to many, that ‘treatment’ often feels impossible to reach. When all people feel is an overwhelming darkness and hopeless, life does not feel worth living and they take their own life. This unfortunately happens frequently in modern-day society and often at a young age. However, what would happen in the UK is assisted suicide was made legal? Euthanasia in the UK is currently illegal, but what would happen if it were legalised

**Disclaimer – This article may be viewed as subjective and controversial. Be aware that there is sensitive content included, so please read with caution. I am not qualified in any medical profession, but research has been properly analysed beforehand**

**Warning – Very long article.**

Introduction:

Mental Health is a huge problem, not only in the UK, but worldwide. One in four of us will experience mental health problems within our lifetime and it is one of the leading causes of disability. Even though this is the case, mental health services have for several decades been poor compared to acute hospital services for physical conditions. However, these are very gradually improving with the little resources available to the NHS. 

It is not globally recognised that mental illness results from a chemical imbalance in the brain, and these imbalances once identified, can usually be managed or controlled with the cooperation of the individual. Depressive illness distorts a persons thinking so that they cannot think clearly or rationally.

According to Deputy Chair at NHS Kingston, Dr Moore (2018), people living with SMI (severe mental illness) have a reduced life expectancy of 15-20 years.

Many people who suffer from mental health know that it can be extremely debilitating and performing the simplest of tasks, feels impossible. From waking up to even taking a shower, it can be very difficult. Unfortunately, (depending on the situation) some people even take their life, which is also known as ‘suicide.’ No matter what someone does to end their life, it would be a scary experience but, what if it did not have to be scary? What if assisted suicide (also known as euthanasia) for mental health was legalised? Would it be better / less stressful to die with someone you trust or to die feeling alone? 

Difference Definitions:

Definition differences need to be explained before we go any further with this article. These may be controversial to public opinion, however, it was what was found through research.

Suicide, Euthanasia and Terminal:

(1) Suicide – This is often impulsive and undertaken whilst in a state of agitation or intoxication etc. Their pain is not usually caused by a physical ailment but psychological desperation, meaning it is very subjective. A minor setback for some, can be a devastating crisis for others. It is of course possible for someone to rationally and deliberately, after long periods of reflection decide to commit suicide. Self-reflection is something that many people conduct before ending their life. Suicides also tend to be a lot messier because methods are devised by upset or disturbed individuals who have varying tools to help assist them in ending their life, such as sharp pieces of equipment etc.

(2) Voluntary Euthanasia – This is also known as ‘assisted suicide.’ It is when a medical professional helps someone who is sick and suffering, to take their own life. It tends to reflect the thinking of the involved person(s), and the judgments of society as in both laws and common norms, and it is usually a process which undergoes considerable scrutiny over a period of time. It is deliberated, argued, and considered by a range of different people, including medical professional, friends and relatives of the person requesting euthanasia and sometimes, even legal courts.

(3) Terminal – When someone is terminal, they reach a point where they themselves, their medical team, carers or loved ones, understand that their illness is likely to lead to their death. Depending on their condition and treatment, people who are terminal may only live for a certain amount of time including, days, weeks, months or years.

Suicide tends to be the private recourse of an individual, often effected against the judgments of society and opinions of loved ones, whereas euthanasia is a medical, procedural form of suicide which demands ‘acceptable’ justifications and offers safer, more comfortable, more reliable mechanisms of death. Terminal tends to be a certain period of time before someones death. Health care is given, but it is not enough to save their life.

Unlawful and Illegal:

(1) Unlawful –  Not conforming to, not permitted or not recognised by national law.

(2) Illegal – Contrary to or forbidden by law.

They are both similar in meaning to one another, except in a small detail. The small variation is that ‘unlawful’ is prohibited and not permitted by law (either civil or criminal law), while ‘illegal’ is not approved by law full stop.

Palliative Care, Hospice and Intensive Care Units:

(1) Palliative Care – According to Palliative Care Coordinator, Charlie Antoni, palliative care is a whole-person care that relieves symptoms of a disease or disorder, whether or not it can be cured. Palliative care can be provided at any stage of a serious illness, whether that illness is curable, chronic or life-threatening.

(2) Hospice – Hospice is a specific type of palliative care for individuals who have six months (estimate) or less to live. In other words. hospice is always palliative, but not all palliative care is hospice care.

(3) Intensive Care Units – These units provide special medical treatment and rehabilitation for patients who are dangerously ill. They are kept under observation, typically in a dedicated department of a hospital. Those suffering from mental health are kept in rehabilitation in accordance with the ‘Mental Health Act 2007’ (originally the Mental Health Act 1983).

Assisted Suicide In Other Countries and The UK:

Within the UK, there is a continuous ongoing debate on the issue of legalising assisted suicide, though less attention is devoted to euthanasia. The current legal framework with respect to assisted suicide is often described as pragmatic. In England, Wales and Northern Ireland, individuals who assist in the death of another could face prosecution via imprisonment for up to 14 years under the ‘Suicide Act 1961.’

In a study by (Danyliv and O’Neill, 2015, pp.52-pp.55), assisted suicide has been legalised in five states of the United States of America including, Washington, Oregon, Vermont, New Mexico and Montana. Luxembourg, the Netherlands, Germany and Switzerland have also legalised it. Euthanasia has been legalised in Belgium (not mentioned explicitly in legislation), the Netherlands and Luxembourg. Despite its legalisation in multiple jurisdictions, fastening death remains the subject of intense debate, worldwide.  

It was concluded in this study that the most significant observable determinant of opposition to legislation of euthanasia was from religious beliefs. They found that trends in public support are immutable and that a change in law would not improve the approach in England and Wales, which bans euthanasia and seeks to strike a balance between compassion and safeguards against abuse in respect of assisted suicide (Danyliv and O’Neill, 2015, pp.55).

NHS Mental Health Improvements Over the Years:

Fortunately, there is now reliable evidence that tackling some major health problems early reduces subsequent problems, improves people’s life chances, an also saves money for the wider economy. Over the year, mental health has improved within the NHS (National Health Service) and it still is to this day. See examples as below:

From 2012 to 2018:

  • There has been a decisive investment upturn, with mental health funding over £1.4 billion, compared to three years ago.

  • 120,000 more people receive specialist mental health treatment compared to three years ago, including over 20,000 more young people and children.

  • The use of police detainment as a place of safety for people with mental health has seen more than a 3-fold decrease over the past three years.

  • The NHS introduced national waiting time standards for mental health services, 25 years after targets were set for surgical operations.

  • NHS England’s mental health taskforce agreed to a detailed improvement blueprint by 2020, in partnership with patient groups, clinicians and NHS organisations (Mental Health Task-force Report).

NHS Mental Health Improvements for 2018:

  • An increase in verbal psychological therapies.

  • Better mental health care for new and expectant mothers.

  • Improved care for children and young people.

  • Care closer to home.

  • Specialist mental health care in A&E (accident and emergency).

  • Improved physical health for people with mental illness.

The National Health Service has improved over the years in the United Kingdom and is doing the best it can to work with the little resources they have been provided. 

Suicide:

Suicide is the act of taking one’s own life, and is often a desperate step taken by individuals who consider their problems to be so severe, that hopelessness becomes a reoccurring theme. Individuals suffering from depression usually undergo severe emotional and physical strain that impacts their everyday life. This physical and emotion exhaustion impairs basic cognition, creates self-blame, and generally lowers self-esteem, all of which lead to distorted judgements. 

These problems also contribute to a heightened sense of hopelessness, which is the primary trigger of suicidal behaviour. Studies have shown that during the period of people’s obsession with the idea of suicide, individuals tend to think in a very rigid, dichotomous way, seeing everything in ‘all or nothing’ terms; they are unable to see any genuine alternatives because they are fixated on ending their life. Many are locked into automatic thoughts and responses, rather than accurately trying to understand and respond to their environment. Those who attempt suicide also tend to maximise their problems, minimise their achievements, and generally do this to ignore the larger content in situations.

Those who suffer from mental health sometimes have inordinately unrealistic expectations of themselves and during the period of their disorders / conditions, these individuals see life much more traumatically than it actually is, and view minor temporary setbacks as major permanent ones.

Understanding Euthanasia and Assisted Suicide:

Even though it would be their own life, a mentally-ill person cannot give consent to euthanasia due to lacking the mental capacity to make clear and informed decisions. One of the main worries in regards to euthanasia and individuals suffering with mental health is that people are concerned the person suffering do not fully understand the extremity of their request, as it would be a final decision with a permanent end. If consent was given, it would have to be by a close relative or equivalent. 

Asking a mentally ill person for consent to euthanasia would be like asking a drunk person to answer a complex academic question. They would be incapable to do so, due to their state of mind and overall condition. However, if someone does have the ability to make informed decisions but still requests euthanasia due to the severity of their mental health…are they still classed as being mentally ill?

Types of Euthanasia:

There are different types of euthanasia available in many countries, and they each mean different things. While some of them may be similar in small aspects, many of them do have morally unsatisfactory distinctions. See as below:

(1) Active – For this an individual directly and deliberately causes a patients death. Active euthanasia is when death is brought about by a certain act. Example – when an individual is given pills to overdose on.

(2) Passive – For this, individuals do not directly take a patients life, they just allow them to die. Passive euthanasia is when death is brought on by omission. Example -Withdrawing vital treatment to let a person die.

(3) Voluntary – This is when a person requests to die.

(4) Non-voluntary – This is when an individual is unable to make a meaningful choice between living and dying, therefore, an appropriate person must make the decision on their behalf. 

(5) Involuntary – This is when an individual who dies chooses life, but is killed anyway. This is commonly known as ‘murder,’ which results in legal prosecution.

(6) Indirect – This means providing a treatment to reduce pain, that has a side effect of fastening the individuals death. As the primary intention is not to kill, this is seen as morally acceptable (also known as the doctrine double effect).

(7) Assisted Suicide – This typically refers to cases where a person who is going to die needs help to kill themselves and requests it. 

The Suicide Act 1961:

Euthanasia is illegal in England and Wales because of this act. 

In section 2, subsection 1a and 1b:

It becomes an offence when a person:

(a) Encourages or assists the suicide or attempted suicide of another person.

(b) An act was intended to encourage or assist suicide or an attempt at suicide.

The Alternative; A New Legislative Act?

If euthanasia was to become legal in the UK, the ‘Suicide Act 1961’ would have to be completely eradicated and a new one would need to take its place to prevent a huge loss of life. Suicide rates are already high in both the UK and worldwide, so how would this act reduce those rates? Strict protocols and regulations would have to be adhered to in order for the procedure to take place, and only qualified medical professionals with the correct training would be able to make the final action. 

Many doctors supporting legalisation in 2009, expressed reservations and advocated safeguards, whereas doctors opposing legalisation believed and accepted that treatment and non-treatment decisions may shorten and devalue human life (Seale, 2009, pp.205).

If a new act was to be implemented, legalising euthanasia for mentally ill individuals and others, what would the process involve and how would medically trained staff prepare for such a procedure? Would it be free of cost or would the procedure have to be privatised? What would need to be recorded? Who would be able to provide consent on behalf of the person requesting the procedure? Would there be criteria to accept people and follow, if so, what would it entail? What alternatives would there be if someone was denied assisted suicide? Would group therapy sessions talking about how someone would end their life be put into place?

Different Perspectives:

There are a wide range of differing perspectives in regards to euthanasia and assisted suicide. See these views as below:

(1) A Political Perspective – Political views suggest that euthanasia will have an effect on society regardless of what is decided by the government and general public. As modern-day society heavily relies on following the footsteps of others, deciding to request death will cause others to follow these methods too. Many politicians believe that euthanasia violates codes of medical ethics, which prohibits medical professionals from helping their patients to die. In multiple countries including the UK, euthanasia is a social and ethical dilemma, although many feel it is an unethical practice, one of the biggest arguments is the process of how it will be approached in the future. If euthanasia is permitted without strict regulations, then it will be abused.

(2) A Researchers Perspective – Death is the end of a humans life and it is inevitable, so why fasten that process? Many researchers believe that euthanasia is not legal or ethical in any form. It is strange in modern-day society to find supporters who will not exploit the scientific, medical and technological advances in finding new medical methods, but instead supporting euthanasia (Lemiengre et al., 2008, pp.293).

(3) The World Health Organisations Perspective – This organisation recommends that governments around the world devote their attention to pain relief before considering laws to allow euthanasia. Most patients who request it change their minds once satisfactory pain control is established (Inghelbrecht, et al., 2009, pp.1212).

(4) The Humanitarian Perspective – From a humanitarian perspective, the right to die with respect, dignity and peace belongs to every individual, and this cannot be ignored no matter how many arguments are put forth against the practice (Seale, 2009, pp.210).

(5) Religious Perspectives:

(a) Catholic Roman Church Views – They consider euthanasia to be a crime against life and god. Evangelical churches and the Roman Catholics have similar attitudes towards euthanasia and believe life is sacred (Voultsos, et al., 2010, pp.136).

(b) Hindu Views – There are two points of view for this. One considers euthanasia as a good action; the other considers it as disturbing the cycle of death and rebirth (Voultsos, et al., 2010, pp.135).

(c) The Greek Orthodox Church Views – Euthanasia is not accepted in any type, and there is no legal legislation or any action that helps patients to be allowed to commit any form of euthanasia (Voultsos, et al., 2010, pp.132).

(d) The Buddhists View – Buddhists have many opinions on this, but overall, they justify it as ending the sufferings of a human. However, there is no justification whatsoever to end the life of a human under any circumstances (Keown, 2005, pp.944).

(e) Islamic View – Islam forbids all forms of self-killing, whatever the reason, as life and death is in the hands of Allah and nobody has the right to end their life bestowed by Allah, which is otherwise considered to be suicide, therefore, Islam is completely against euthanasia whether active or passive. They believe if killing is committed by a different person and suicide is planned by the same person, both of them should be punished and set to hell in another life. They believe only Allah has the right to give and take away life. In addition to this, the Islamic Code of Medical Ethics (1986) mentions that the concept of life not worthy of living does not exist in Islam, therefore, justification of taking one’s life to escape suffering is not acceptable (Fatwah Bank, 1996, pp.21).

(f) The Christian View – Christians believe all life to be a divine gift, therefore, regard suicide as a sin.

The Moral and Ethical Implications of Euthanasia:

There are many ethical and moral implications to euthanasia, which are stated as below:

Does an individual who has no hope of recovery have the right to decide how and when to end their life, no matter whether it is mental or physical? The ongoing debate comes down to one question: is euthanasia ethical? The issue rests on one main fundamental moral principle: mercy. There are professionals in the medical field who believe that euthanasia and assisted suicide are far more ethical to those who have suffered terribly in terminal and mental health illnesses.

Ethical Problems:

There are two sides to analysing ethical problems with euthanasia; those in favour and those in opposition. See as below:

(1) In Favour – Those in favour of euthanasia often argue that a civilised society should allow people to die in dignity and without pain – a death of their choosing. They believe that others should be allowed to help individuals if they cannot manage or carry out the deed alone. Many people believe that as our bodies are our own, we should be able to do what we want with it, therefore, it is wrong to make anyone live longer than they want. Forcing people to live when they do not want to violates personal freedom and human rights, which many consider to be an immoral act, as people are forced to continue living whilst suffering and in pain. As suicide is not a crime, euthanasia should not be either.

(2) In Opposition – Most people who oppose to euthanasia are religious. They believe that life is given by God and that only God should decide when to end it. Others fear that if euthanasia was made legal in the UK, the laws regulating it would be abused and people who did not really want to die would be killed.

An Ethical Dilemma:

A study by (Badr Naga and Mrrayan, 2013, pp.32), says how in spite of technological and scientific advances in modern-day society is related to human health, there is still controversy over the concept of a ‘peaceful death.’ This ethical dilemma imposes health care providers to legal and ethical risks, which are widely debated, worldwide. There are many differing opinions on the principles of personal morality and religious beliefs too. Scientists are still looking to reach a general consensus on this ethical dilemma as to how everyone can benefit from it.

The Doctrine Double Effect:

The doctrine double effect says that if doing something morally positive has a morally negative side effect, it is ethically okay to carry it out, providing the negative side effect was not originally intended. Many doctors believe this to be true even if they did not know the negative side effect was going to occur.

Prior Death Interventions:

According to (Cox et al., 2017, pp.37), chronic and long-term conditions (physical and mental) will require some form of palliative care interventions prior to death. In order to plan appropriate services, it is vital to understand what might influence public attitudes towards death and dying as well differing perspectives on the ethical and moral challenges facing those affected by end-of-life care issues. These views are very important in determining what kind of services people will request and will need at that point in their lives, as well as highlighting challenges associated with an increasing ability to extend or prolong life. Bearing knowledge of such views may be further values as a means of targeting education and policy campaigns to prepare for the substantial public health consequences of population profiles.

The Human Rights Act 1998:

Human rights provide everyone with the right to take the best medical practices to face different health problems, as well as the symptoms that affect all quality of life domains; therefore, from the British medical professions perspective, the majority do not support legalising assisted suicide, neither in the form of euthanasia or physician-assisted dying (Seale, 2009, pp.211).

No-one in modern-day society within the UK would condone assisted suicides. An important distinction in UK law exists between active and passive euthanasia. Since the Bland ruling of 1993, assisted suicides, which involve omissions that are principally the removal of life-saving care, are not illegal. However, actively taking action to end another’s life is illegal, even if consent has been granted. The law of the Suicide Act has been reviewed since 1961, but has not been amended in anyway, despite attempts made by members of parliament. Since the Human Rights Act 1998, campaigners have claimed that the denial of a right to release an individual from unbearable pain amounts to inhuman and degrading treatment (Article 3 of the European Convention on Human Rights), is a violation of privacy and family life (Article 8), amounts of discrimination given the legality of suicide itself, and that an individuals inherent dignity and ‘right to die’ is violated by current UK legislation.

Questions to Consider:

(A) Why would people with poor mental health need euthanasia when they could already end their life without medical assistance?

(B) What would assisted suicide be for people with poor mental health? Who decides when it is life-threatening and how would the process work?

(C) How would euthanasia change the face of Great Britain and how would it benefit the economy? Would it be or would it makes matters worse?

(D) How would euthanasia be implemented into the UK and recorded? Would only medically professionals be able to undertake this or everyone?

(E) What finances would be included? 

(F) What training would medical staff have to train for to undergo this issue?

(G) How would the Suicide Act 1961 be amended to legalise assisted suicide? Would it be eradicated altogether? Would a new act replace it?

(H) If assisted suicide was legal in terms of mental health, would the rates of suicide not soar compared to beforehand, and where is the line drawn for the acceptance of euthanasia? Would there be a criteria for it?

(I) If someone is turned down for euthanasia, what could be an alternative?

(J) If euthanasia was legalised and mental health patients who were mentally capable of answering questions and giving consent were denied of their request, would that not be a breach of human rights – the freedom of choice, and would it class them as being mentally ill?

(K) If we do not have the right to end our own lives on our own terms, then do we have the right to live? Are our lives our own if we cannot make the choices that we believe will benefit us?

Conclusion:

Euthanasia, assisted suicide and suicide are all three very complex debates that still occur to present day, especially as the UK has not legalised any form of assisted killing. There are a wide range of conflicting views from religion to general moral ethics as to why euthanasia etc., have not been brought into the UK, especially in regards to mental health.

Thank you for reading.

What are your thoughts?

References:

I am a freelance writer and aspiring author. My passion lies within UK adult education, stigmatised topics and mental health, however, I aim to keep an open mind.


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