Right to Die
Depends on the Situation…
To explain my position of the “Right to Die” issue, I will first state the situations in which I do not support the right and then move on to situations in which I do. First, to understand the “Right to Die”, you must first understand the basics of “rights.”
Basics of Rights…
As a health care worker, I go through everyday seeing the decisions people make about their health - both good decisions and bad decisions. People are given the RIGHT to make their own decisions when they are of legal age and of sound mind. To be denied the right to make your own decision and to have others make your decisions for you occurs in the cases of minors, when judged mentally incompetent (which usually takes a court order), and when in compliance to court-orders.
Major Depressive Disorder (MDD)…
Major Depression is a mood disorder (not a mental illness) which effects millions of people each year. It is one of the most commonly occurring mood disorders and tends to affect women more than men. Whether this is because women are more likely to seek medical help than men due to men in today's culture consider seeking help to be a sign of “weakness” is difficult to determine.
A depressed state with social and occupational decline in level of functioning must be present for at least two weeks from major depressive disorder to be diagnosed. The DSM-IV-TR is listed below.
Diagnostic Criteria for Diagnosis of Major Depressive Disorder:¹
A. Five or more of the following symptoms having been present during the same two week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (what they say about themselves) or observations made by others. (In adolescents and children it can present as an irritable mood instead of a depressed one.)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
- Significant weight loss when not dieting or weight gain (e.g. a change of more than 5% of body weight in a month) or an increase or decrease in appetite nearly every day
- Insomnia (inability to sleep) or hypersomnia (excessive sleeping) nearly every day.
- Psychomotor agitation or retardation nearly every day. (Observable by others, not merely subjective feelings of restlessness or being slowed down.)
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which many be delusional) nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death (not just the fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. There has never been a manic episode, a mixed episode, or hypomanic episode that was not substance or treatment induced or due to the direct physiological effects of a general medical condition.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not due to the direct effects of a physiological substance or a general medical condition.
E. The symptoms are not better accounted for by bereavement (loss), the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.
You're probably wondering by now why I included all that information. It's to back up a point I'm about to make. I DO NOT believe that people with major depression should be allowed to commit suicide. I feel that every effort should be made to keep them safe – even from themselves.
Major depression is a treatable disorder. Antidepressants are usually effective in treating the chemical imbalance that causes depression. As it is a treatable disorder with proper medical attention, the right to die should be denied. As the DSM-IV-TR shows, depression causes delusional thinking. Someone could think themselves worthless and that life is not worth living when under normal circumstances and in a “normal” mood, they would not.
This delusion thinking is the very thing which takes away their RIGHT to make the decision to die. Remember to have the right to make a decision you must be of legal age and of sound mind.
Dying with Dignity
Those who are in chronic un-relievable pain or suffering from a terminal illness should have the right to end their lives after discussing their options with a trained medical doctor and a licensed psychiatrist.
Why? Let’s go back to the DSM-IV-TR for major depression. Statement D states that major depression can not be explained by a general medical condition. Chronic pain is classified as a general medical condition. Statement E. states the major depression can not be better explained by bereavement or loss. A terminal illness brings with it a sense of bereavement. You have lost your life. You have lost watching your children grow up. You have lost time with the ones you love. That is a sense of loss and a cause of bereavement.
In both cases – un-relieved chronic pain and terminal illness – you lose your sense of control. You worry about becoming a burden on your loved ones and fear ending up not being able to care for yourself. These are not treatable disorders. This is not simply an escape from temporary problems that get blown out of proportion. These people are not suffering from a delusional illness. They are in their right frame of mind.
If cleared by a medical physician as not being able to have further successful treatment and cleared by a psychiatrist as not having a mental illness precipitating the feeling of wanting to die, I see no reason why, in those circumstances, their decision can not be respected. Let them have the peace they want with a painless end.
“Mercy” Killings
If a dog is in un-relieved pain or can’t be treated for a terminal illness, we put them down so they don't suffer. That can’t be done with humans because we have the moral and legal right to make our own decisions. Let them go if they want to ease their pain, but it is by no means ethical to take away their right to make that decision.
I don't believe it is murder to assist someone who wishes to die and who has been cleared medically for that purpose. IT IS MURDER to kill someone because you feel sorry for them. People have no right to take away the rights of another who is capable of making their own decisions.
Mercy killings are without a doubt murder and those who practice them should be tried for murder.
In conclusion:
Major Depressive Disorder and Chronic Illness are in two different medical categories. Wanting to die because you just feel bad or suffer from a mood disorder is not a valid reason to authorize assisted suicide. Every attempt should be made to protect suicidal persons.
Those with chronic illness should be given the right to make their own decision for assisted suicide if no medical treatment is possible or if their illness is terminal.
Last Updated: September 26, 2008
References:
¹ Townsend, M. (2008) Essentials of psychiatric mental health nursing: Concepts of care in evidence-based practice. (4th ed.). F.A. David Company. Philadelphia, PA.