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It genuinely seems to me that the case you linked to is the system working as intended. I'm 100% serious:
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She has a point. If you're not familiar with the management of severe depression, then by the time you reach ECT, you've exhausted all the options. I don't know if she tried things along the lines of ketamine or psychedelics, but those don't work for everyone.
She's tried everything, it didn't work, and she's clearly suffering immensely.
This woman, the purported victim, seems entirely lucid and defending the medical establishment that's carrying out her wishes. What more can you possibly ask for? It is clearly not spur of the moment decision, she's engaged with the options that the medical field can offer her.
The only thing that I would (personally) say that strikes me as untrue is that there "there's no hope". I think I have strong reasons to hope got a cure for depression, but that isn't a certainty, and could take decades even for myself.
If someone doesn't have the same degree of confidence in future medicine or a technological singularity, then I think that's acceptable shorthand. Strictly speaking, there's always a possibility that someone might just develop a brain tumor that makes them not depressed (or at least makes them manic), but that's not particularly reliable.
Suicide is always an option, regardless of what the law has to say in that regard. It is also often a tragedy. The two aren't mutually incompatible statements!
In the UK, we have things called living wills or advanced care plans. In your case, since you're afraid that you might make the wrong call during a depressive spiral, in my described world, I would advocate that you draft something along those lines so that any doctor who isn't malevolent (in a manner that breaks the law at that point) would note that you don't you don't want to die, and stymie it then.
Yep that's because while editing my post I seem to have dropped the words that should have followed the linked text. My point was supposed to be that we had previously been assured that assisted suicide would never be used for anything except terminal illness and certainly never for depression, and yet here we are.
It feels like you are deliberately missing the point of my argument. When society is more permissive of something it happens more. Not just in medically approved settings, everywhere. And suicide is already considered less of a tragedy than it used to be. The valence is changing in front of us.
You live in a world where you see doctors all day every day so talking to one is nothing, hell you can do all that shit yourself if you like, but otherwise your buddy will bang it out for you as a favour after work. I live in a world where every fifteen minutes I spend with a doctor costs me $90, I can address one issue and if I bring up another it will cost me another $90 even if the last one only took two minutes to address. I do not go to the doctor unless I have no choice and I am incapacitated. And in my working class social circles I am considered a hypochondriac. I am regularly told that I trust doctors too much. That is the world I live in about half the time, and those people are not going to the doctor to ask him or her to promise not to kill them if they ask. I don't think you or @Throwaway05 understand how shot trust in medicine is amongst the working class. It's kind of terrifying.
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In case this is the point of confusion, I'm not concerned about that, I'm not concerned about me at all, I have the perspective of age now. I am worried about the young adults out there like me when I was a young adult, the undiagnosed schizophrenics (and the undiagnosed bipolars and major depressives) who would never give strangers power of deciding their fate, believe suicide is a personal decision and only hold back because of a sense of wrongness. Those people are going to die in your world before a doctor even knows there is something wrong.
Be careful with this kind of thinking, I see a wider swathe of the working class than you do (because everybody shows up in the hospital eventually). You do see some doctor skepticism and such but most people are quite happy to follow most types of recommendations unless something basic gets in the way (we tell everyone to exercise, not everybody listens).
A small fraction are upset and anti-doctor in a vocal way, but most people shut up in the room for a variety of reasons (including things like not listening to the doctor suddenly becomes very costly if you are having a significant medical event).
The people who actually cause us problems are the woke more often. I acknowledge that this is likely due to my location but keep in mind that a lot of bitching is just bitching and is essentially a luxury belief that fades on actual contact with illness.
The best explanation for the gap between things like online sentiment and what I actually see in clinical practice is probably just people talking a big game, but the issue of a loud minority or hyper geographic concentration are other possible explanations.
Good news and bad news here. Basically the people who are well and truly sick don't have a choice. Their friends, family, or the police drag them into interaction with healthcare if they really actually for real sick.
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As I've said above, I consider an intractable case of severe depression to be a terminal illness. I have no personal involvement in matters of euthanasia (beyond deciding if a patient is palliative and needs comfort care).
I presume that you're not in the Netherlands either, so when you say that "we were assured", who's the we?
I didn't provide that assurance, and regardless of whether, in the Netherlands, it was in fact a statement made some kind of authoritative figure, I consider this particular case an outcome I endorse!
And the case seems to be entering litigation, so it's not like the government ignored objections and killed the woman right away. I presume a court will rule on whether the actual law allows this.
If you point to an example of a clearly inappropriate decision for euthanasia, say someone who went to their doctors and said they're feeling sad, and that was the first suggestion made, then I would certainly say that's against my views.
I do see doctors every day. But I'm afraid that they're unable to help me in any way, in terms of medical problems that require a prescription and not just casual advice.
In the UK, the GMC strongly frowns on prescribing or treating colleagues, I have ADHD, there are several senior psychiatrists who could have written me a prescription for my meds. I even asked, but as expected, they declined, saying it was inappropriate.
I personally think this is bullshit, and I should personally have been allowed to write my own script if needed (though stimulants require a psychiatrist who has completed training). In India, it wouldn't have been an issue at all.
I had to wait three months to be seen by a psychiatrist for my depression. I took the opportunity to also get him to prescribe for my ADHD. But if it had been just my ADHD, then I would have had to wait 2 years to be seen!
Trust me, at least in the UK, getting a doctor to see you, even if you're a doctor yourself, isn't trivial at all. I won't deny that they take me more seriously as a fellow medical professional, if I were to tell a psychiatrist I'm clinically depressed and I calculated it to be moderate-severe, they'll take me at my word. But the typical doctor will not react to someone telling them they're suicidal and don't want to be in a dismissive manner.
Look, if I had ended up giving up on waiting for the NHS and gone private, I'd be paying anywhere from 400 to 700 pounds for an appointment that could be anywhere from 15 minutes to an hour. You can see how the rates compare.
And it might surprise you, but it's entirely possible that you make more money than I do! As a resident, I make about $50k a year. That would be well within the range of what a working class individual makes in the States. It's entirely possible for a skilled tradesperson in the States to out earn a senior doctor in the UK. If they start a small business and stick to it, they can leave us in the dirt.
And the cost of living in the UK is probably quite comparable to the US, while we pay more in tax to boot. I'm much closer to you than @Throwaway05 is in financial terms. I have technically free access to healthcare courtesy of taxes paid to the NHS, but even that isn't much good for anything but an ER visit straight away, or an appointment with a GP in weeks/months.
It is unavoidable that media coverage of suicide, or more permissive social norms, will likely increase the number of people opting to commit it both through (hypothetical) legal means as well as taking it on themselves.
I value free speech and personal autonomy strongly enough that I do not foresee the numbers rising to the point that I can't accept the cost, even if I wish it wasn't so.
I was not assigning blame, or talking about appropriate or inappropriate euthanasia at all then. Public attitude prior to about the 90s was suicide is wrong. Flat out wrong. Then euthanasia become a cause for terminal patients suffering from incurable cancers and the like, people in constant suffering. But it would never go past that the medical establishment insisted, and it would certainly never be trivialised by being offered to the depressed. 25 years later and the depressed can get assisted suicide. It is an example of the concept creep pusher_robot mentioned.
This pretty much sums it up for me. Yeah bud, I know it's unavoidable, that's been my point from the beginning. The fact that you would level it back at me as if that somehow excuses it is the core problem with the modern world. It's the death of a thousand cuts, responsibility is diffused so nobody has to own the psychological consequences of their actions and we say 'hey they have the freedom right? You aren't opposed to freedom are you? I didn't hand them a gun!' Sure you knew you were taking actions that would result in their deaths, but they could have just spent 700 pounds to ask a doctor to promise to never kill them during one of the infrequent periods when they could even see something resembling a future for themselves! How is that on you?
Well you're right, it's not. Congratulations on winning the argument.
I guess it's on me for expecting you to actually grapple with the issue because you claim to have suffered depression. I should have realised you wouldn't be able to empathise when you explained that you had never been suicidal.
Look, you're being too harsh on me.
When I say I had active suicidal ideation, I meant it. The barrier between suicidal ideation and an attempt is tenuous at best.
I wasn't very far at some points. I never actively planned things, but at certain points, if someone had come up and put a gun in my hand, I can't say for sure what would have happened.
Norms change over time, and we're talking 30 years. The people who might have made the original claims could easily be dead or retired.
Governments have changed multiple times since. Culture would have changed even without strong pushes. It's not the same set of people making promises and breaking them the moment backs are turned.
I strongly disagree that there's any "trivialization" involved in offering it to the incurably and severely depressed. They're living miserable lives, even if we can't clearly and legibly figure out what's gone wrong with them. That's just the state of psychiatry today.
I would strongly push back against it being offered to people who hadn't exhausted the treatment options for their depression. What else can I say?
I am a consequentialist. I seek to maximize my values, finding compromise where they conflict with each other.
I strongly value personal liberty and freedom, including control of one's life. I also value other people living on, preferably as happy and satisfied as they can be.
I'm not lying or denying that there are clear downsides and tradeoffs involved. I just think that they're worth it.
You offer me a bullet, and I'm biting it.
You might value things differently, and that's your prerogative.
I would be willing to perform the kinds of roles my envisioned system would require. It would be difficult and emotionally taxing work, but most doctors eventually understand, through bitter experience, that not all patients can be saved. Sometimes everything that can be done had been done, and you're keeping a corpse hooked up on life support. Sometimes it's not that clear cut, but they consistently report that their life is misery while being otherwise physically well. If I can't save them, then prolonging their life against their wishes is as bad as putting a confused elderly woman with dementia on the ventilator so she can spend another week in pain and terror before her inevitable death.
I never came into this with the desire to win an argument. If this passes as a victory, I want it even less than you do.
I'm doing my best to explain why I hold the views I do. That I am aware of your values and concerns, and the downsides of my own desires. I still think the price worth paying, and not because I'm not empathetic. I wouldn't be a psychiatrist if I didn't want to help people. I some rare circumstances, that help would be for them to no longer live on.
You're right, I flew off the handle, I'm sorry. I certainly didn't mean to imply I didn't believe you suffered depression, although I do think suicidal as a descriptor should require planning - if it's at the wanting to die level the whole of Denmark is suicidal.
But this subject is uniquely tilting me, I am trying to have empathy but it does feel like you are being deliberately obtuse. I believe you are not, and I appreciate you saying what you just did, and I have been trying to figure out another way to explain myself but I can't do it without tilting further.
I understand, and I won't press the point.
It can be frustrating to confront someone with the same set of observed facts, and find that they take away entirely different messages. Some of that is miscommunication, and common ground can be found if you hash things out long enough.
Sometimes, it can be genuine differences in what we value, and I wish I had a solution to that. I do not expect that there is, beyond letting the brute force of reality sort out a victor, though hopefully not with bloodshed or permanent acrimony. I've been there, when talking to someone who accepts what I find unacceptable, and I'd be lying if I said I'd never lost my temper in the process.
If you wish to continue the conversation, I'll be here. If not, then I did appreciate the opportunity to discuss our beliefs and ideas.
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