If you think the idea of assisted suicide is controversial, welcome to the farthest frontier in the debate.
Announcing his visit to Tucson for two Nov. 23 presentations, Derek Humphry, a pioneer in the movement for legal assisted suicide, broached this shocking notion: assisted suicide for those suffering from mental illness and unable to get better.
The idea, he said, came from his long experience in the movement. As right-to-die advocates have become more visible in their fight to establish physician-assisted-suicide laws, people with mental illness have been increasingly approaching Humphry and others seeking what he called “positive help” — in other words, assistance in killing themselves.
“From their point of view, the suffering is as great as a person dying of a physical illness,” he wrote in the announcement of his Tucson presentations. “And it probably is! They argue a terminal patient knows soon death will bring about the end of pain, whilst they are condemned to a lifetime of suffering. They report they have endured long hours of therapy and used mountains of prescribed medications. Still they would prefer death, they say.”
Tucson is an important place for Humphry, who rose to prominence with his 1975 book, “Jean’s Way,” about his first wife’s death by suicide in the face of terminal breast cancer. He founded the Hemlock Society in 1980, and Tucson was the first place in America with a local chapter.
When I spoke to Humphry Friday, he wasn’t willing to advocate directly for the idea and said it won’t be the thrust of his presentations here, but instead explored how and if it would work.
“If ever people wanted to pass laws for the mentally ill,” he said, “it would be done most carefully. There would have to be long record of treatment of illness for the individual” before suicide assistance would be permitted.
The arguments for and against assisted suicide, which is legal in three states and three European countries, are by now well worn. Advocates say those who are terminally or degeneratively ill should be allowed to get help ending their lives, sparing themselves further suffering and indignities. Opponents say that legally sanctioning assistance in death puts society on a slippery slope toward selecting who can live and die, that doctors should not help in hastening death and, among some religious-based opponents, that only God should end life.
Under Arizona law, helping another person to commit suicide is a felony, manslaughter. Even where assisted suicide is legal, it is mostly permitted only for people with terminal illnesses.
The arguments related to mental illness and assisted suicide are not so practiced, perhaps because the idea has such fundamental flaws that no one dares float it.
Scott Whitley, a Tucson man with bipolar disorder who leads support groups here, expressed one of them in a written response to Humphry he sent me: “I have been suicidal and now have the right treatment and I thank the people who stepped in and got me in the hospital. If at these times I had a gun (a whole other subject) or a choice of assisted suicide would have been available, I would be dead now.”
In other words, it’s dangerous for the rest of us to judge when a mentally ill person is clear-headed enough to choose, and get help with, suicide. When I asked Dr. Ronald Pies, a psychiatrist at Tufts University who has written on assisted suicide, about Humphry’s writings, he too found them troubling. He explained via email Friday:
A mental illness diagnosis by itself does not nullify ‘rationality’ or ‘competence’ in decision-making, whether about end-of-life care, choosing a medication, having elective surgery, or, for that matter, voting for a political candidate. So, in theory, a person with a diagnosis of, say, schizophrenia, could make a rational decision re: ending his or her life; but this is exceedingly unlikely when the person is acutely psychotic. Similarly, a diagnosis of ‘major depressive disorder’ does not automatically nullify decisional competence, but in the midst of a severe major depressive episode, the person is very unlikely to make rational, evidence-based decisions.”
The issue is not just hypothetical. An American advocate of assisted suicide, George Exoo, claimed in a British documentary to have assisted more than 100 people in killing themselves, including a severely depressed Irish woman and others with mental illness. Irish authorities issued an arrest warrant, and he was arrested by FBI agents, but his extradition was denied.
In April 2007, members of the Final Exit Network — inspired by Humphry’s 1991 suicide self-help book, “Final Exit” — assisted Phoenix resident Jana Van Voorhis in killing herself. Van Voorhis, 59, had long suffered from mental illness, her sister, Viki Thomas, told me Friday. They helped her kill herself anyway.
In 2009, then-Maricopa County Attorney Andrew Thomas brought charges of conspiracy to commit murder against the group. One man, Final Exit’s then-medical director, was acquitted at trial, but the other three pleaded guilty to lesser charges.
Humphry, who chairs the Final Exit Network’s advisory board, told me Friday the group acknowledged “that was a blunder on their part.”
“She said she was terminally ill and described her terminal illnesses,” Humphry said. “The Final Exit Network accepted that. If they had investigated, they would have found she was mentally ill, not terminally ill.”
Indeed, Viki Thomas told me her sister had first threatened suicide at age 10, 49 years before she died.
“Most times, she called three or four times a day because of some kind of crisis,” Thomas told me. “We were in touch a lot, and I tried to set rules. Call me once a day, so we can do this talking in one time.”
While Thomas objected to Final Exit’s helping her sister kill herself, she said something surprising Friday that made me stop and wonder: “She’s in a better place, I know that.”
That, in a nutshell, is what makes Humphry’s flawed suggestion worth talking about at all — the suffering of people with serious mental illness is real and torturous enough that sometimes death seems better than life, even to loved ones. It might be a discussion worth having if we were doing the more basic work of ensuring that seriously mental ill people get the treatment they need.